Effect of multimorbidity on health service utilisation and health care experiences

Abstract

INTRODUCTION: Multimorbidity, the co-existence of two or more long-term conditions, is associated with poor quality of life, high health care costs and contributes to ethnic health inequality in New Zealand (NZ). Health care delivery remains largely focused on management of single diseases, creating major challenges for patients and clinicians. AIM:To understand the experiences of people with multimorbidity in the NZ health care system. METHODS:A questionnaire was sent to 758 people with multimorbidity from two primary health care organisations (PHOs). Outcomes were compared to general population estimates from the NZ Health Survey.RESULTS: Participants (n = 234, 31% response rate) reported that their general practitioners (GPs) respected their opinions, involved them in decision-making and knew their medical history well. The main barriers to effective care were short GP appointments, availability and affordability of primary and secondary health care, and poor communication between clinicians. Access issues were higher than for the general population. DISCUSSION: Participants generally had very positive opinions of primary care and their GP, but encountered structural issues with the health system that created barriers to effective care. These results support the value of ongoing changes to primary care models, with a focus on patient-centred care to address access and care coordination.

Complexity in disease management: A linked data analysis of multimorbidity in Aboriginal and non-Aboriginal patients hospitalised with atherothrombotic disease in Western Australia

“…Current treatment guidelines overwhelmingly focus on a single disease and the health system is fragmented and sub-specialised [ 64 ]. Poor patient-provider communication, limited standard consultation time, lack of care coordination and shared decision-making are important challenges for managing multimorbidity [ 65 , 66 ]. These challenges are even more marked for Aboriginal people who often fail to receive safe and culturally appropriate health services, and may be exposed to institutional racism, poor communication with health providers and economic hardship [ 67 ].…”

<p>Patterns of Multimorbidity and Differences in Healthcare Utilization and Complexity Among Acutely Hospitalized Medical Patients (≥65 Years) – A Latent Class Approach</p>

“…Consequently, patients with multimorbidity face increasingly complicated medical lifestyle with fragmented appointments, investigations, polypharmacy, and medical regimes. 6 Also, patients with multimorbidity are experiencing difficulties with access to information, 7,8 lack of coherence or coordination in treatments 8,9 and managing and adhering to treatment recommendation. 8,10 Acute medical illness in older adults is associated with several adverse outcomes [11][12][13][14][15] and the majority of the acutely hospitalized older medical patients are multimorbid.…”

Pill for this and a pill for that: A cross‐sectional survey of use and understanding of medication among adults with multimorbidity

“…Haverhals et al [17] found that patients with multimorbidity often felt their primary care physician was too busy to answer their medication questions. This is likely to be similar in New Zealand, where patients with multimorbidity frequently report having too much to discuss in one primary care appointment [27]. Pharmacists could potentially provide key information and answer medication questions; however, in other studies, many patients report never or rarely receiving advice from their pharmacist [28] and in a New Zealand study only a small proportion of patients reported using their pharmacist as a primary source of medication information [29].…”