Health Care System Must Address Unique Challenges Faced by People with Multiple Chronic Medical Conditions

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Angela Sharma
Annals of Family Medicine
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LEAWOOD, Kan. - The growing population of patients with multiple chronic diseases (co-morbidities) may experience a wide range of barriers to self-care that are specifically related to managing the simultaneous demands of more than one disease, according to a new study published in the May/June 2003 edition of Annals of Family Medicine.
 
Currently 60 million people in the United States suffer from multiple chronic medical conditions.  This figure is expected to increase to 81 million by the year 2020 as the population ages. While numerous studies have investigated the barriers to self-care experienced by patients with one disease, until now, no studies have attempted to identify barriers to self-care specific to patients with more than one chronic disease.

"Self-management interventions geared toward single diseases may fail to address the unique priorities of people with multiple conditions," said the study's lead author, Elizabeth A. Bayliss, M.D., M.S.P.H., from the Kaiser Permanente Clinical Research Unit in Denver, Co. "If our findings are confirmed by larger studies, it would suggest a need for clinicians to create a reorganized model for self-care that emphasizes collaborative management of physical and emotional well being.  Recognizing barriers to self-care could help physicians better equip patients with multiple medical conditions with the tools necessary to address specific management issues."

Bayliss and colleagues conducted a qualitative study in a practice-based research network to investigate the perceived barriers to care specific to people managing multiple medical conditions.  The research team conducted semi-structured personal interviews with adults from four urban practices who reported two or more common chronic diseases (osteoarthritis, coronary artery disease, chronic obstructive pulmonary disease, asthma, diabetes, hypertension and congestive heart failure).  Subjects were asked to list everything they could think of that affects their self-care.

"Participants' responses revealed multiple potential barriers to self-care, including physical limitations; lack of knowledge; financial constraints; logistics of obtaining care; a need for social and emotional support; aggravation of one condition by symptoms of, or treatment for, another; multiple problems with medications; and overwhelming effects of dominant individual conditions."  The researchers point out, "Many of these were directly related to having co-morbidities."

Of particular interest, 14 of the 16 respondents reported that "symptoms from, or lifestyle changes for, one of their conditions interfered with self-care for another condition," nine patients mentioned the "compound effects of medications as interfering with care" and eight subjects cited "a single dominant condition as an impediment to the care of other conditions."

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Editor's Note: This project was funded by a National Research Service Award training grant from the Health Resources Administration and completed while Dr. Bayliss was a primary care research fellow at the University of Colorado Health Sciences Center.

Annals of Family Medicine is a peer-reviewed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care discipline.  Launched in May 2003, the journal is sponsored by six family medical organizations, including the American Academy of Family Physicians (AAFP), the American Board of Family Practice (ABFP), the Society of Teachers of Family Medicine (STFM), the Association of Departments of Family Medicine (ADFM), the Association of Family Practice Residency Directors (AFPRD) and the North American Primary Care Research Group (NAPCRG).  The journal is published six times per year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials.  A board of directors with representatives from each of the sponsoring organizations oversees the Annals. Complete editorial content and interactive discussion groups can be accessed free of charge on the journal's Web site, www.annfammed.org.