The Challenges of Multimorbidity from the Patient Perspective

VERDICT/South Texas Veterans Healthcare System, 7400 Merton Minter Blvd, San Antonio, TX, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 01/2008; 22 Suppl 3(S3):419-24. DOI: 10.1007/s11606-007-0308-z
Source: PubMed


Although multiple co-occurring chronic illnesses within the same individual are increasingly common, few studies have examined the challenges of multimorbidity from the patient perspective.
The aim of this study is to examine the self-management learning needs and willingness to see non-physician providers of patients with multimorbidity compared to patients with single chronic illnesses.
This research is designed as a cross-sectional survey.
Based upon ICD-9 codes, patients from a single VHA healthcare system were stratified into multimorbidity clusters or groups with a single chronic illness from the corresponding cluster. Nonproportional sampling was used to randomly select 720 patients.
Demographic characteristics, functional status, number of contacts with healthcare providers, components of primary care, self-management learning needs, and willingness to see nonphysician providers.
Four hundred twenty-two patients returned surveys. A higher percentage of multimorbidity patients compared to single morbidity patients were "definitely" willing to learn all 22 self-management skills, of these only 2 were not significant. Compared to patients with single morbidity, a significantly higher percentage of patients with multimorbidity also reported that they were "definitely" willing to see 6 of 11 non-physician healthcare providers.
Self-management learning needs of multimorbidity patients are extensive, and their preferences are consistent with team-based primary care. Alternative methods of providing support and chronic illness care may be needed to meet the needs of these complex patients.

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Available from: John W Williams, Sep 30, 2015
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    • "Such problematic interactions with health care professionals leads to reports from patients of conflicting advice, disappointment with care, a lack of attention to personal preferences, poor communication and a lack of shared decision making. These issues can lead to reduced motivation and a lack of understanding which limits the patient's ability to engage in selfmanagement or to fully understand their conditions (Boyd et al., 2007; Fortin et al., 2007; Noel et al., 2007; Smith et al., 2012). Self-care is the cornerstone of chronic disease management (Department of Health, 2012) but often multimorbidity complicates the patient's ability to self-care since symptom recognition, appropriate lifestyle modifications and drug adherence are all more complex (Bayliss et al., 2003; Vogeli et al., 2007; Riegel et al., 2012). "
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    • "More alarming findings indicate that sleep disturbance is common among suicide attempters (Sjostrom, Waern, & Hetta, 2007) and unresolved insomnia is a risk factor for mental health disorders (Taylor et al., 2007) commonly reported by returning veterans. Fortunately, strategies to improve sleep are one of five self-management skills veterans with multiple comorbidities are most willing to learn (Noel et al., 2007). A strong evidence base exists to support cognitive-behavioral treatment for primary and comorbid insomnia (CBTI) including systematic reviews and meta-analyses (Irwin, Cole, & Nicassio, 2006; Montgomery & Dennis, 2004; Morin et al., 1999, 2006; Pallesen, Nordhus, & Kvale, 1998). "
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    • "Patient perspectives were gathered in a cross-sectional study conducted by Noel et al in 422 patients.20 The study results indicate that standardized group classes, such as Lorig’s chronic disease self-management program, may not adequately address all of the concerns of patients with complex multimorbidity.44 "
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