The NHS is failing to take care of patients who have multiple long-term conditions, according to a new study published in The Lancet.
The study highlighted the growing number of non-elderly patients living with ‘multimorbidity’ and called for a more patient-centred approach.
Difficulties in primary and secondary care management of such patients combines with a lack of relevant clinical research, the authors said.
The study looked at 1.75 million people across Scotland, and found that 23% had two or more chronic diseases such as heart disease, diabetes, cancer, stroke or depression.
Only 9% of people with heart disease and 23% of those with cancer had no other long-term condition.
The incidence of ‘multimorbidity’ was higher in areas of economic deprivation, where it tended to have an earlier onset.
The study noted that care of such patients was often poorly co-ordinated, with patients being referred to a number of specialists who did not work together.
It also noted a lack of health data on ‘multimorbidity’ due to the limitations of clinical trials, where patients with comorbidities are normally excluded.
Calling for “radical change” in the health system, the authors said: “Existing approaches need to be complemented by support for the work of generalists, providing continuity, co-ordination, and above all a personal approach.”
“The status quo isn’t an option because it leads in the wrong direction,” commented lead study author Graham Watt, Professor of General Practice at Glasgow University. He noted that there is a major unmet need for “someone who can oversee all the problems of a patient”.
In an accompanying article, Dr Chris Salisbury of the School of Social and Community Medicine at the University of Bristol observed: “Expenditure on health care rises almost exponentially with the number of chronic disorders that an individual has. This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways.”
He suggested that the caseloads of GPs in more deprived areas should be reduced, and that hospitals should assign patients with ‘multimorbidity’ to a generalist consultant who would co-ordinate their care.