Patient prioritization of comorbid chronic conditions in the Veteran population: Implications for patient-centered care

Abstract

Objective:Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions.Methods:We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center.Findings:The diverse factors influencing condition prioritization reflected three overarching themes: (1) the perceived role of a condition in the body, (2) self-management tasks, and (3) pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions.Conclusion:Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient–provider communication regarding the importance placed on different conditions.

Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a scoping review

“…Mean age and age ranges of older adults with MCC are presented in Table 1 . The percentage of female older adults with MCC ranged from 6% [ 49 ] to 100% [ 51 ]. Of the 36 studies included in the review, 22 studies included at least 50% females as their study participants [ 26 , 28 – 30 , 32 , 33 , 36 , 37 , 39 , 43 , 45 , 48 , 50 – 53 , 56 – 61 ].…”

“…The mean number of chronic conditions ranged from 2 to 4 in six studies [ 26 , 34 , 51 , 52 , 59 , 61 ], from 5 to 7 in ten studies [ 30 , 33 , 37 , 38 , 41 , 43 , 46 , 49 , 55 , 56 ], and 8 or more in one study [ 36 ]. Three studies reported range of number of chronic conditions [ 27 , 29 , 48 ].…”

“…Twenty-two studies reported the ethnicity of the study participants [ 26 , 27 , 29 – 33 , 35 , 37 , 41 – 43 , 47 – 49 , 52 , 53 , 55 , 57 – 60 ]. Most study participants were Caucasian or white, followed by ‘non-Hispanic’, Hispanic, black and South Asian populations.…”

Conversion of Tuberculosis Screening Tests During Biologic Therapy Among Veteran Patient Population With Rheumatic Disease

“…This is the first study among the veteran patient population, a high‐risk group with multiple comorbidities. Studies have shown that veterans tend to have higher rates of hypertension, diabetes, osteoarthritis, chronic pain, and lung disease . Our study reflects data from routine clinical practice and has a relatively longer follow‐up duration compared with other studies from the United States.…”

Health-related preferences of older patients with multimorbidity: an evidence map

“…The only intervention study in the evidence map (113) used a cluster-randomised design to evaluate whether structured priority-setting consultations led to a sustainable reconciliation of diverging physician–patient views on the importance of health problems. Overall, content analysis of this evidence cluster revealed five key themes: (1) patients’ prioritisation of their multiple health problems (20/34),30 45 47 54 83–98 as an example of which patients were asked how they prioritised their osteoarthritis over their other conditions,97 (2) patients’ preferences regarding self-management of their medications (8/34)42 43 47 54 99–102 and, for instance, its association with treatment adherence,42 (3) patients’ self-care behaviours (3/34)44 55 103 aimed at accomplishing their life goals,44 (4) characteristics of eHealth support tools (2/34)30 104 to help patients self-manage their multiple health conditions104 and (5) changes in patients’ choices resulting from changing circumstances (2/34) 29 30…”