Multiple chronic disorders - health care system’s modern challenge in the Maccabi Health Care System

Abstract

BackgroundOne of the major challenges health care systems face in modern time is treating chronic disorders. In recent years, the increasing occurrence of multiple chronic disorders (MCC) in single individuals has compounded the complexity of health care. In 2008, it was estimated that worldwide as many as one quarter of the population between the ages of sixty five to sixty nine suffered from two or more chronic conditions and this prevalence rose with age. Clinical guidelines provide guidance for management of single disorders, but not for MCC. The aim of the present study was the study of the prevalence, distribution and impact of MCC in a large Israeli health system.MethodsWe performed a cross-sectional study of MCC in the Maccabi Healthcare System (MHS), Israel’s second largest healthcare service, providing care for approximately two million people. Data regarding chronic conditions was collected through electronic medical records and organizational records, as was demographic and socioeconomic data. Age and sex specific data were compared with previously published data from Scotland.ResultsTwo thirds of the population had two or more chronic disorders. This is significantly higher than previously published rates. A correlation between patient age and number of chronic disorders was found, as was a correlation between number of chronic disorders and low socioeconomic status, with the exception of children due to a high prevalence of learning disabilities, asthma, and visual disturbances.DiscussionMCC is very prevalent in the MHS population, increases with age, and except for children is more prevalent in lower socioeconomic classes, possibly due to the a combination of the structure of the Israeli universal insurance and requirements of the ministry of education for exemptions and benefits. A higher than previously reported prevalence of MCC may be due to the longtime use of use of integrated electronic medical records.ConclusionsTo effectively deal with MCC health care systems must devise strategies, including but not limited to, information technologies that enable shared teamwork based on clinical guidelines which address the problem of multiple, as opposed to single chronic disorders in patients.

A Chinese version of the Patient Continuity of Care Questionnaire: reliability and validity assessment

“…It was also found that older people face greater health burdens caused by multiple chronic diseases (Arbelle et al . ). As older patients suffer from the discomforts brought about by symptoms, dysfunction related to physical activities and impaired cognitive and emotional functions in the acute phase; when they return to their communities, they are faced with the problem of long‐term control of their diseases (Nolte & McKee , Ryan et al .…”

“…When the prevalence of chronic diseases increases, the hospitalisation rate of the older adults becomes 3Á6 times that of other age groups, and their hospitalisation cost is as much as one-third of the overall hospital costs, showing the important needs for continuity of care (CoC) in care for the older adults (Ministry of Health and Welfare, Taiwan 2014). It was also found that older people face greater health burdens caused by multiple chronic diseases (Arbelle et al 2014). As older patients suffer from the discomforts brought about by symptoms, dysfunction related to physical activities and impaired cognitive and emotional functions in the acute phase; when they return to their communities, they are faced with the problem of long-term control of their diseases (Nolte & McKee 2008, Ryan et al 2013.…”

Prevalence and Losses in Quality-Adjusted Life Years of Child Health Conditions: A Burden of Disease Analysis

“…The issues of perspective and reporting by parents were discussed above, although these are not necessarily negatives. Second, children may have multiple health conditions (38–40) and children with a health condition often have multiple functional limitations. (41, 42) For example, chronic physical conditions have been shown to be a significant risk factor for behavior problems,(43) and ADHD is often associated with anxiety/depression and problems with usual activities.…”

High performance team-based care for persons with chronic conditions

“…Screening, an important first step, helps identify persons who can benefit from targeted preventive and therapeutic services; and analysis of screening and process data across populations helps in developing targeted programs. Diabetes, for instance, is more prevalent among Arab Israelis [ 2 ]; and as shown in an article in this journal from Maccabi Healthcare Services, multiple chronic diseases are more prevalent among older and poorer Israelis [ 3 ]. Programs at the community and practice level are, and in the future should be targeted to, and tailored for, high risk groups.…”

“…In the 21 st century, there is a high and increasing prevalence of single and multiple chronic conditions in the populations of developed countries, including Israel [ 3 ]. It has been known for many years that patients with multiple chronic conditions account for a very large percentage of total health care costs [ 4 ], estimated to be as high as 75 percent of total costs in the United States (U.S.).…”