REPORT OF THE RESEARCH ON: MANAGEMENT OF PATIENTS WITH MULTIPLE

CHRONIC CONDITIONS AT SOUTH COAST HOSPITAL IN AUSTRAILIA

Table of Contents

Abstract......................................................................................................................................2

Research hypothesis...................................................................................................................2

Research questions.................................................................................................................2

Significance of the study........................................................................................................3

Literature review........................................................................................................................3

Foster health-care by integrating management of patient with MCC....................................3

Expected outcome......................................................................................................................4

Current trend in South Coast Hospital.......................................................................................4

Credible sources used to collect data.........................................................................................4

Method and approaches used to collect data..............................................................................5

Relevance of the information.....................................................................................................5

For further research....................................................................................................................5

Feasibility, benefit and risk associated with information source...............................................5

Conclusion..................................................................................................................................6
Abstract

The problem of multiple (≥2) chronic conditions (MCC) among Americans has rapidly
escalated to become a major public health and medical challenge Schneider et al 2009. More
than one in four Americans have multiple, concurrent chronic conditions Anderson,.2010.
Chronic diseases are the leading cause of illness, disability and death in Australia, accounting
for 90% of all deaths in 2011 (AIHW 2011b).Chronic illnesses—defined as “conditions that
last a year or more and require ongoing medical attention and/or limit activities of daily
living Warshaw et al 2006. The worldwide chronic disease ‘pandemic’ was the subject of a
high-level United Nations meeting in 2011, which called for a 25% reduction by 2025 in
mortality from chronic diseases among people aged between 30 and 70, adopting the slogan
’25 by 25’ (Beaglehole et al. 2011; Hunter & Reddy 2013).

Individuals with MCCs were found to require more medical attention, including a higher
number of visits to primary and specialist care. They also had more prescriptions and
incurred greater healthcare expenditures compared to those with one or no chronic conditions
Hajat,.2018. Nevertheless, current traditional health systems and basic disease programs, as
well as some of the most widely used health repositories (such as the World Health
Organization and Global Burden of Disease databases) often adopt a single disease
framework and rarely deal with co-occurring chronic diseases as a whole. Thus, the need for
multidisciplinary approaches in the management of multiple chronic medical problems, rather
than focusing on individual diseases, should be borne in mind by global healthcare
professionals, public health professionals, healthcare providers, health policymakers and
pharmaceutical industries [Sultan et al 2019].

Research hypothesis

There is no improvement in management of individual patients with multiple chronic

conditions in the hospital

Research questions

I. How to foster health-care by integrating management of patient with MCC?

Significance of the study

Deficiencies in care coordination represent a particularly vexing problem, as underscored by

the Institute of Medicine (IOM) in its 2001 report, Crossing the Quality Chasm: A New
Health System for the 21st Century. The report noted that patients actively receiving care
for one chronic condition may not necessarily receive care for another, unrelated condition.
The IOM warned against designing care around specific conditions to avoid defining patients
solely by a single disease or condition. Redelmeier,.2015. Moreover, disease-specific
instruction also may be less important than problem-solving skills, as many of the challenges
inherent in living with a chronic condition are common across many chronic diseases and
involve day-to-day problem solving. Such challenges include management of emotions (e.g.,
discouragement, fear, and depression); medication use and side effects; adherence to diet and
physical activity regimes; and communication with health-care providers [Bodenheimer et al
2018]. The study addressed the challenges faced by these individual clients in the hospital
due to disintegrated health services. This will lead to improved health outcome for the clients.

Literature review

One in three adults globally suffers from multiple chronic conditions (MCC). This figure is
closer to three out of four in older adults living in developed countries (Marengoni et al
2011). It is estimated that 20% of Australians (4.9 million people) had 2 or more of the 10
selected chronic conditions in 2017–18, a state of health known as multimorbidity (ABS
2019). Chronic condition may not necessarily receive care for another, unrelated condition.
The IOM warned against designing care around specific conditions to avoid defining patients
solely by a single disease or condition. Redelmeier,.2015. Individuals with MCCs were found
to require more medical attention, including a higher number of visits to primary and
specialist care Hajat,.2018

Foster health-care by integrating management of patient with MCC

Integrating chronic disease prevention and management (CDPM) programs into primary care
provides an opportunity to enhance the care of patients with chronic diseases directly in the
setting where they receive their comprehensive care, while ensuring continuity Hajat,.2018.
CDPM programs by interdisciplinary teams are usually designed to improve outcomes for
patients with chronic diseases (CD) such as self-management, adherence to medications,
disease specific outcomes, quality of life or use of health care services Johnson.,2014. There
was great need to deviate from specific chronic health specialist to general physician that will
manage the patient holistically (Hamar et al 2012).

Expected outcome

Health improvement for individual with MCC due to integrated health services, collaborative
management of the patient with general physician or different specialists through
communication and reporting of the patient condition. Interdisciplinary patient centered care
decision making on the patient management hindering defragmentation in the management.

Current trend in South Coast Hospital

Patients with MCC were managed with different specialists for the specific condition, this
fragmented management of patient lead to waste of resources, delayed holistic management
of the patient, long hospital stay and poor health outcome.
For example
Patient X is 50 years known diabetic, hypertensive patient in HIV was admitted in the mental
hospital with depression. Patient X had four different specialists each managing a single
condition. This made the outcome of patient X to be unfavorable. We discuss as a team to
change and review each specialist notes and to holistically manage the patient, all the
specialist the caregivers attending to the patient collectively met and discuss. It was resolved
that each will be communicating and reporting to the general physician on patient
management. Two weeks later patient was improving and plan for discharge was made.

Credible sources used to collect data

Data was collected from the hospital records, book, scientific journals and online articles
publications. The information organized in order of priority and significance. Dates were
checked to have the current information. Refer to the in-text citation and the references
below.

Method and approaches used to collect data

Data was collected through observation of the hospital practice on management of MCC
patient. This was the main method that was used. Check list was made on the parameters’ of
concern. Only the hospital authority and the research committee knew about the research.
They also supported the research and used the result to spearhead better management of the
patient.
In addition, patients were interviewed using well-structured open questionnaires where 32
patients were interviewed. Criterion for inclusion was any voluntary consented patient with
MCC who came to the hospital during the research period. Among the 32, only 30 completed
the questionnaire while 2 opt out of the study. They said they were no-longer interested in the
interview.

Relevance of the information

The information was organized in-terms of their priority and the following questions were
used to decide on the information. Does it answer the problem, how current is the
information, and is it relevant. All the information gathered were checked if they came from
authentic sources. The purpose of the information gathered in this research was used to
inform change in the health care system and improve patient outcome.

For further research

The information collected shows the high prevalence of MCC and Poor management of
such. Using this research it should inform training of generalized physicians to holistically
manage the patient with MCC without fragmenting the care.

Feasibility, benefit and risk associated with information source

The information from this research show how it’s of importance to integrate health services.
To deal with increasing numbers of MCC there should be funding and training of specialist to
mitigate the same. The risk associated with this is the complex nature of this MCC to be
handled by same professional. There may be drug to drug interaction leading to poor patient
outcome.

Conclusion

MCC has become public health concern; this is due to increasing prevalence and incidences
of MCC. With the available gap of specialist to holistically manage the conditions rather a
single condition. This research have illustrated importance of having generalized physician
to holistically manage the patient instead of fragmented management. This has redirected the
health system of integrated services and betterment of health system procedures and
processes.
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