12th May 2017, Volume 130 Number 1455

Louise Signal, Kelly Semper, Jeannine Stairmand, Cheryl Davies, Elinor Millar, Tony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati

Multimorbidity, the coexistence of two or more health conditions,1 is a common and growing problem worldwide.2 While the risk of multimorbidity is higher in those aged 65 years and older,…

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Summary

Living with multimorbidity (two or more long-term health conditions) is becoming more common in both young and older New Zealanders. It disrupts people’s 'normal' lives, posing challenges for many, yet people learn to cope by making changes to much of what they do (eg, eating, activity and employment). Dealing with the health care system for those with multimorbidity can be challenging and people value simple things like good communication and receiving care that is effective and respectful even when they are from a different cultural background to that of their health care provider. Health care system support is needed to help people with multimorbidity manage the challenge of dealing with multiple medications using simple aids such as blister packs. Improvements to the health care system are needed to better serve those people living with multimorbidity, their support people and health care providers, eg, longer consultation times with GP/primary care providers to discuss multiple health issues and medications.

Abstract

Aim

Multimorbidity is common, yet there are major gaps in research, particularly among younger and indigenous populations. This research aimed to understand patients’ perspectives of living with multimorbidity.

Method

A qualitative study of 61 people living with multimorbidity, 27 of whom were Māori and a third aged under 65, from urban and rural regions in New Zealand. Six focus groups and 14 interviews were conducted, recorded, transcribed and analysed.

Results

For many participants, living with multimorbidity disrupted their ‘normal’ lives, posing challenges in everyday activities such as eating and toileting, working and managing medications. Dealing with the health system posed challenges such as accessing appointments and having enough time in consultations. Cultural competency, good communication and continuity of care from healthcare providers were all valued. Participants had many recommendations to improve management, including a professional single point of contact to coordinate all specialist care.

Conclusion

Living with multimorbidity is often challenging requiring people to manage their conditions while continuing to live their lives. This research suggests changes are needed in the health system in New Zealand and elsewhere to better manage multimorbidity thus improving patient’s lives and reducing costs to the health sector and wider society.

Author Information

Louise Signal, Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington; Kelly Semper,Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington; Jeannine Stairmand, Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington; Cheryl Davies, Tu Kotahi Asthma Trust, Lower Hutt; Elinor Millar, Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington; Tony Dowell, Department of Primary Healthcare and General Practice, University of Otago, Wellington; Ross Lawrenson, Waikato Clinical School, University of Auckland, Hamilton; Dee Mangin, Department of General Practice, University of Otago, Christchurch; Diana Sarfati, Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington.

Acknowledgements

The authors would like to acknowledge the participants and thank them for their generosity in sharing their stories to assist others. We would also like to thank our clinical and community advisors. This research was funded by the Health Research Council of New Zealand, Grant No. 14/173.

Correspondence

Associate Professor Louise Signal, Cancer Control and Screening Unit, Department of Public Health, University of Otago, Mein St, Newtown, Wellington 6021.

Correspondence Email

louise.signal@otago.ac.nz

Competing Interests

Dr Lawrenson is an employee of the University of Waikato and Waikato District Health Board; Dr Sarfati reports grants from the Health Research Council during the conduct of the study.

References

  1. Smith S, Wallace E, O’Dowd T, et al. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. The Cochrane database of systematic reviews 2016; 3:CD006560-CD60.
  2. Vogeli C, Shields A, Lee T, et al. Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs. Journal of General Internal Medicine 2007; 22(3):391–95. doi: 10.1007/s11606-007-0322-1
  3. Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for healthcare, research, and medical education: a cross-sectional study. The Lancet 2012; 380(9836):37–43.
  4. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. The Lancet; 374(9683):65–75. doi: 10.1016/S0140-6736(09)60914-4
  5. Tinetti ME, Fried TR, Boyd CM. Designing healthcare for the most common chronic condition—multimorbidity. JAMA 2012; 307(23):2493–94. doi: 10.1001/jama.2012.5265
  6. Mangin D, Heath I, Jamoulle M. Beyond diagnosis: rising to the multimorbidity challenge. BMJ 2012; 344.
  7. Smith SM, Soubhi H, Fortin M, et al. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ 2012; 345.
  8. Guthrie B, Payne K, Alderson P, et al. Adapting clinical guidelines to take account of multimorbidity 2012.
  9. Haggerty JL. Ordering the chaos for patients with multimorbidity. BMJ 2012; 345:e5915. doi: http://dx.doi.org/10.1136/bmj.e5915
  10. Forum NQ. Multiple Chronic Conditions Measurement Framework, 2012.
  11. Institute of Medicine. Living well with chronic illness: A call for public health action. The National Acadamies Press, 2012.
  12. Löffler C, Kaduszkiewicz H, Stolzenbach C-O, et al. Coping with multimorbidity in old age–a qualitative study. BMC Family Practice 2012; 13(1):45.
  13. Noël P, Parchman M, Williams J, et al. The Challenges of Multimorbidity from the Patient Perspective. Journal of General Internal Medicine 2007; 22(3):419–24. doi: 10.1007/s11606-007-0308-z
  14. Drennan V, Walters K, Lenihan P, et al. Priorities in identifying unmet need in older people attending general practice: a nominal group technique study. Family Practice 2007; 24(5):454–60.
  15. Zulman D, Kerr E, Hofer T, et al. Patient-Provider Concordance in the Prioritization of Health Conditions Among Hypertensive Diabetes Patients. Journal of General Internal Medicine 2010; 25(5):408–14. doi: 10.1007/s11606-009-1232-1
  16. Eaton S, Roberts S, Turner B. Delivering person centred care in long term conditions. BMJ 2015;350:h181.
  17. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health affairs 2013; 32(2):207–14.
  18. US Department of Health and Human Services. Multiple Chronic Conditions - A strategic framework: Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Washington DC, 2010.
  19. US Department of Health and Human Services. Multiple Chronic Conditions: A Framework for Education and Training. Washington DC, 2015.
  20. New Zealand Immigration. New Zealand Now: Healthcare Services [cited 2017 18 January]. Available from: http://www.newzealandnow.govt.nz/living-in-nz/healthcare/healthcare-services
  21. Denzin N, Lincoln Y, editors. The Sage Handbook of Qualitative Research. Third ed. Thousand Oaks, London, New Delhi: SAGE Publications, 2005.
  22. Noël PH, Chris Frueh B, Larme AC, et al. Collaborative care needs and preferences of primary care patients with multimorbidity. Health Expectations 2005; 8(1):54–63.
  23. Krippendorff K. Content analysis: An introduction to its methodology: Sage 2012.
  24. Salisbury C, Johnson L, Purdy S, et al. Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 2011; 61(582):e12-21. doi: http://dx.doi.org/10.3399/bjgp11X548929
  25. Ridgeway JL, Egginton JS, Tiedje K, et al. Factors that lessen the burden of treatment in complex patients with chronic conditions: a qualitative study. Patient preference and adherence 2014;8:339-51. doi: 10.2147/PPA.S58014
  26. Roberto KA, Gigliotti CM, Husser EK. Older Women’s Experiences with Multiple Health Conditions: Daily Challenges and Care Practices. Healthcare for Women International 2005; 26(8):672–92. doi: 10.1080/07399330500177147
  27. Bayliss EA, Bonds DE, Boyd CM, et al. Understanding the Context of Health for Persons With Multiple Chronic Conditions: Moving From What Is the Matter to What Matters. The Annals of Family Medicine 2014; 12(3):260–69. doi: 10.1370/afm.1643
  28. Duguay C, Gallagher F, Fortin M. The unique experience of adults with multimorbidity: a qualitative study. Journal of Comorbidity 2014; 4(1):11–21.
  29. Roland M, Paddison C. Better management of patients with multimorbidity. BMJ 2013; 346:f2510.
  30. Brundisini F, Giacomini M, DeJean D, et al. Chronic disease patients’ experiences with accessing healthcare in rural and remote areas: a systematic review and qualitative meta-synthesis. Ont Health Technol Assess Ser 2013; 13(15):1–33.
  31. Freeman GK, Horder JP, Howie JG, et al. Evolving general practice consultation in Britain: issues of length and context. BMJ 2002; 324(7342):880–82.
  32. Ministry of Health. Care Plus Wellington: Ministry of Health; 2016 [Available from: http://www.health.govt.nz/our-work/primary-health-care/primary-health-care-subsidies-and-services/care-plus accessed 18 August 2016.
  33. University of Otago. Māori medical student graduates create history 2016 [cited 2017 18 January]. Available from: http://www.otago.ac.nz/news/news/otago628801.html
  34. Connor J, Rafter N, Rodgers A. Do fixed-dose combination pills or unit-of-use packaging improve adherence? A systematic review. Bulletin of the World Health Organization 2004; 82(12):935–39.
  35. Whyte L. Medication cards for elderly people: a study. Nursing standard (Royal College of Nursing (Great Britain): 1987) 1993; 8(48):25–28.
  36. Martin D, Kripalani S, DuPapau Jr V. Improving medication management among at-risk older adults. Journal of gerontological nursing 2012; 38(6):24.
  37. Grain H, Schaper L. Evaluation of a medicines list iPhone app. Selected Papers from the 21st Australian National Health Informatics Conference (HIC 2013) 2013; 188:142.
  38. Doessing A, Burau V. Care coordination of multimorbidity: a scoping study. Journal of Comorbidity 2015; 5(1):15–28.
  39. Jacobs J, Fisher P. Polypharmacy, multimorbidity and the value of integrative medicine in public health. European Journal of Integrative Medicine 2013; 5(1):4–7.
  40. Durie M. Whaiora Maori Health Development. 2nd ed. Auckland: Oxford University Press 1998.
  41. Crampton P, Dowell A, Parkin C, et al. Combating effects of racism through a cultural immersion medical education program. Academic Medicine 2003; 78(6):595–98.
  42. Dowell A, Crampton P, Parkin C. The first sunrise: an experience of cultural immersion and community health needs assessment by undergraduate medical students in New Zealand. Medical Education 2001; 35(3):242–49.
  43. Cram F, Smith L, Johnstone W. Mapping the themes of Maori talk about health. 2003.
  44. Shiner A, Ford J, Steel N, et al. Managing multimorbidity in primary care. InnovAiT: Education and inspiration for general practice 2014:1755738014549756.
  45. Salisbury C. Multimorbidity: time for action rather than words. Br J Gen Pract 2013; 63(607):64–65.
  46. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Healthcare 2007; 19(6):349–57.

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