Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review

Abstract

Background: Multiple Long Term conditions (MLTC) are a major health care challenge associated with high service utilisation and expenditure. Once established, the trajectory to an increased number and severity of conditions, hospital admission, increased social care need and mortality is multifactorial. The role of wider environmental determinants in the MLTC sequelae is unclear. Aim: the aim of this review was to summarise and collate existing evidence on environmental determinants on established MLTC. Methods: comprehensive search of Medline, Embase, Cochrane, CINAHL and Bielefeld Academic Search Engine (BASE), from inception to 4th June 2022 in addition to grey literature. Two authors independently screened and extracted papers. Disagreements were resolved with a third author. Results: searches yielded 9079 articles, 12 of which met the review’s inclusion criteria. Evidence of correlations between some environmental determinants and increased or decreased risks of MLTC were found, including the quality of internal housing/living environments, exposure to airborne environmental hazards and a beneficial association with socially cohesive, accessible and greener neighbourhood environments. Conclusions: The majority of the 12 included papers focused on the built and social environments. The review uncovered very limited evidence, indicating a need for further research to understand the role of environmental determinants in MLTC.

Eliciting and prioritising determinants of improved care in Multiple Long Term Health Conditions (MLTC): A modified online Delphi study

“…An important learning point for policy-makers from our study is that these are likely to continue to feature as critical determinants influencing care in MLTC until further significant progress is made towards redesigning care services and delivery around the needs of the individual rather than service providers [26,25]. In relation to care practice, our findings suggest that clinicians and care practitioners need to take further steps to ensure wider non-medical determinants and care needs are fully assessed and taken into consideration in care plans and subsequent delivery of care to those with MLTC [2, 10].…”

“…However, the care needs of those living with MLTC are often broader, encompassing biopsychosocial needs (e.g. mental health and emotional wellbeing) [2, 25] and social circumstances including the impact on health and wellbeing of the wider environment in which an individual is situated [10]. Our study supports the growing body of evidence that further progress towards a holistic and person-centred care model [2, 25, 32] is urgently required, which empowers people to be full and equal participants in their care decision-making to ensure that care delivery can be further optimised to address the diverse range of individual care needs often associated with MLTC [2, 25, 33].…”

“…MLTC is also a challenge for professionals providing care for this cohort, as health and social care systems (including clinical training and clinical practice guidelines) [7], are primarily based on a single disease paradigm [8,9]. This is problematic, as the existing focus on single disease approaches based on a highly specialised care and treatment regime [8] may not comprehensively address the complex range of care needs which are a feature of MLTC [10]. A recent scoping review [10] found evidence that experiences of living with and seeking care for MLTC are not only shaped by medical factors and the quality of clinical care, but also by wider non-medical determinants (also referred to as social determinants) of health [11] such as housing conditions, income and employment, and the quality of the local environments (access to green space, air quality, and neighbourhood crime levels and social cohesion).…”

“…This is problematic, as the existing focus on single disease approaches based on a highly specialised care and treatment regime [8] may not comprehensively address the complex range of care needs which are a feature of MLTC [10]. A recent scoping review [10] found evidence that experiences of living with and seeking care for MLTC are not only shaped by medical factors and the quality of clinical care, but also by wider non-medical determinants (also referred to as social determinants) of health [11] such as housing conditions, income and employment, and the quality of the local environments (access to green space, air quality, and neighbourhood crime levels and social cohesion). These non-medical determinants interact with each other and also with medical factors to determine an individual's probability of developing MLTC and their subsequent deterioration in health [6,[9][10][11].…”

“…A recent scoping review [10] found evidence that experiences of living with and seeking care for MLTC are not only shaped by medical factors and the quality of clinical care, but also by wider non-medical determinants (also referred to as social determinants) of health [11] such as housing conditions, income and employment, and the quality of the local environments (access to green space, air quality, and neighbourhood crime levels and social cohesion). These non-medical determinants interact with each other and also with medical factors to determine an individual's probability of developing MLTC and their subsequent deterioration in health [6,[9][10][11]. Whilst there are potentially a limitless number of medical and non-medical determinants that could be examined across all dimensions of care, it is unclear which of these determinants should be prioritised to deliver effective interventions for MLTC [10].…”