Many Diseases, One Model of Care?

Abstract

Patients with multiple chronic conditions (multimorbidity) have complex and extensive health and social care needs that are not well served by current silo-based models of care. A lack of integration between care providers often leads to fragmented, incomplete, and ineffective care, leaving many patients overwhelmed and unable to navigate their way towards better health outcomes. In planning for the future, healthcare policies and models of care are required that cater for the complex needs of patients with multimorbidity and that deliver coordinated care that is patient-centred and focused on disease prevention, multidisciplinary teamwork and shared decision-making, and on empowering patients to self-manage. Salient lessons can be learnt from the work undertaken at a European and national level to develop care models in cancer and diabetes – two complex and often co-occurring conditions requiring coordinated long-term care. Innovative work is also underway in many European countries aimed at improving the integration of care for people with multimorbidity, resulting in more efficient and cost-effective health outcomes. This article reviews some of the most innovative programmes that have been initiated across and within Europe with the aim of improving the way care is delivered to people with complex and multiple long-term conditions. This work provides a foundation upon which to build better, more effective models of care for people with multimorbidity.

Self-Management Support Needs of Patients with Chronic Diseases in a South African Township: A Qualitative Study

“…Albreht, Dyakova, Schellevis, and Van den Broucke (2016) argued that, worldwide, the advances in healthcare systems have transformed previously life-threatening diseases like the human immunodeficiency virus (HIV) into chronic conditions requiring ongoing care. Because of this transformation, developing countries now face an unique double burden of communicable and noncommunicable diseases.…”

An atlas of evidence-based phenotypic associations across the mouse phenome

“…Relationships among phenotypes in each ppAp. In considering the collection of phenotypic abnormalities within each PPAP as the symptoms of a human disease, presentation of 'the order (flow), according to the relative level of abnormal case numbers in each phenotype' among phenotypes in the collection could facilitate understanding of principles underlying gene pleiotropy 34 , secondary phenotypes [9][10][11] , and comorbidity 7,8 . Therefore, we ranked PPAP-constituting phenotypes linearly, based on rule polarity values for each rule within each PPAP (logarithmic P value of the test for differences in the number of abnormal cases between the two phenotypes in each rule; the degree of deviation of the difference) ( Fig.…”

“…Data analyses that model relationships among omics hierarchies, including genomes, epigenomes, transcriptomes, proteomes, metabolomes, and phenomes, are imperative for holistic understanding of life 1,2 . Elucidation of principles underlying the complex relationships among mouse phenotypes [3][4][5] would provide a useful data resource for multi-omics studies in mammalian species and assist in elucidating biological mechanisms underlying pleiotropic gene expression 6 and multimorbidity 7,8 (which are understood as secondary phenotype expression [9][10][11], as well as human disease etiology. In human, relationships between phenotypes have generally been based on correlations between gene variants and phenotypes, derived from the analyses of genome-wide association studies (GWAS) 12,13 and phenome-wide association studies (PheWAS) [14][15][16][17] .…”

Putting a Population Health Lens to Multimorbidity in Ontario

“…Patients who have multiple and often complex conditions require a more holistic and integrated healthcare process, especially given that they are more likely to receive care from different types of healthcare providers (Kastner et al 2018;Tricco et al 2014). There have been several calls to address the silos in medical care delivery to provide more comprehensive care to patients (Albreht et al 2016). Those calls need to be addressed to improve patient experience and efficiency of healthcare delivery (Leijten et al 2018).…”