Quality of care for people with multimorbidity – a case series

Abstract

BackgroundMultimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark.MethodsTo investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups. Before each focus group, clinicians were asked to review patients’ medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients. Further, two clinical pharmacologists reviewed the appropriateness of medications listed in patient records.ResultsThe review of the patients’ records conducted by three groups of clinicians revealed that around half of the patients received adequate care for the single condition which prompted the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review of the medication lists revealed that the majority of the medication lists contained inappropriate medications and that there were incongruity in medication listed in the primary and secondary care sector. Several barriers for providing high quality care were identified. These included relative short consultation times in general practice and outpatient clinics, lack of care coordinators, and lack of shared IT-system proving an overview of the treatment.ConclusionsOur findings reveal quality of care deficiencies for people with multimorbidity. Suggestions for care improvement for people with multimorbidity includes formally assigned responsibility for care coordination, a change in the financial incentive structure towards a system rewarding high quality care and care focusing on prevention of disease exacerbation, as well as implementing shared medical record systems.

Polypharmacy and medication deprescribing: A survey among multimorbid older adults in Denmark

“…Most of the participants believed that their medications were necessary, and only few of the participants felt that they took unnecessary medication, which contrasts with the literature stating a high degree of inappropriate prescriptions in populations with excessive polypharmacy . A previous study from the DHS focusing on the quality of care for patients with multiple chronic conditions, found that patients with a high number of prescribed medications often have inappropriate medications on their list of prescribed medications . Thus, it seems that patients with a high number of prescribed medications can be comfortable with the medicine they take even though some of the medicine may be inappropriate.…”

“…Elderly persons and those with multiple chronic medical conditions such as chronic obstructive lung disease and diabetes are often treated with numerous drugs prescribed by several physicians. 1 Concurrent treatment with several drugs, known as polypharmacy, is costly for society and comprises a risk for medication interactions, adverse effects, hospitalizations, and increased mortality. 2 Excessive or severe polypharmacy (ie ≥10 medicine) is strongly associated with inappropriate medication use 3,4 and might represents a large pill burden to patients.…”

Diabetes and Palliative Care: A Framework to Help Clinicians Proactively Plan for Personalized care

“…Many older people with diabetes have at least three coexisting comorbidities, but these are often managed as single entities that may not address the many diffuse symptoms [12][13][14] or the need to change the focus of care from achieving normoglycaemia to prevent complications to focus on comfort by managing existing complications and preventing hypoglycaemia and hyperglycaemia.…”

“…Diabetes and the associated comorbidities affect the quality of life, compromise function and self-care and increase the need for hospital admissions and readmissions and eventually lead to death [11,13,17]. Over 50% of people aged 65-80 experience moderate to severe disability and increased dependency.…”

General Practitioners’ Barriers Toward Medication Reviews in Polymedicated Multimorbid Patients

“…Due to increasing longevity and widening diagnostic boundaries, the prevalence of people with more than one chronic disease (ie, multimorbidity) is increasing. 1 , 2 As the array of pharmacologic treatments is also expanding, most multimorbid patients are treated with polypharmacy, which can be defined as the concomitant use of more than 2 drugs—often arbitrarily set at a cutoff value of 5 or more. 1 , 3 Polypharmacy is frequent among elderly patients and is often associated with negative health outcomes, greater economic burden, increased risk of hospital admissions, and mortality.…”