One too many...when you have more than one diagnosis

Healthcare in the 21 Century has woken up to a new challenge — multimorbidity. The presence of two or more chronic medical conditions in an individual is referred to as multimorbidity. Examples include dementia and stroke, diabetes and ischemic heart disease, hypertension and chronic kidney disease. 

Who does it affect?

Multimorbidity mostly affects the middle aged and the elderly. Over a third of all elders in India suffer from one or more chronic medical conditions. As chronic medical conditions co-occur, they lead to a cumulative burden of medical disability. Multimorbidity is most prevalent in these individuals.

What is the impact?

Multimorbidity has significant impact on the person, family and society.

• Increased healthcare costs
• Higher risk of hospital admissions
• Earlier death
• Poorer quality of life
• Increased burden on the care-takers

Where should we intervene?

Experts feel that interventions for multimorbidity must be primary care and community based and not confined to the specialist setting. Yet most patients with more than one chronic medical disease consult multiple specialist settings. In India where the family physician has gone out of vogue, people turn to various specialists. There is a need for integration of care, and this must begin with the family medical practitioner.

When should we intervene?

Interventions for patients with multimorbidity are needed urgently and without delay. Those interventions can be situated in primary medical care, and extend to specialist care settings. Healthcare professionals across settings, the family and society, should also be involved. 

How should we intervene?

Patient-centred: Education, support, self-management.

Financial: Targeting healthcare providers to reach specific targets.

Regulatory: National regulations designed to alter healthcare delivery and alter specific outcomes.

Organisational: Case management and coordination, allocation of tasks to specific members, addition of members to the team.

Best practice model in India

Neurokrish & Trimed have developed an innovative model of assessment and care for multimorbidity and chronic medical disability, for neuropsychiatric conditions, and subsequently expanded it to include all medical conditions.

Presented as a best practice model in the ‘World Health Report of the WHO, 2012" on dementia it envisages both assessment and care being accomplished by an interdisciplinary team

While assessment follows the best medical traditions of in-depth analysis and quantification, care is restorative, rehabilitative and palliative and integrates both modern and traditional medical systems, with focus on activities of daily living and quality of life.

Importantly, in India and other developing nations care has to be centred in the family and community.

Importance:

A series of editorials on multimorbidity in the British Medical Journal, have in recent times highlighted the need for a comprehensive approach and innovations.

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