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Chronic Disease

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Studies examine disease self-management and quality of life of individuals with multiple chronic illnesses

Individuals who suffer from multiple chronic illnesses must learn how to manage them with a variety of methods, which range from altered diet and exercise regimens to medication. These individuals are more motivated to learn disease self-management skills and are more flexible about which providers care for them than those who suffer from only one chronic illness, according to a study supported by the Agency for Healthcare Research and Quality (AHRQ, HS13008). Certain psychosocial factors are potential barriers to self-management and quality of life of seniors with multiple chronic diseases, concludes a second AHRQ-supported study (HS15476). Both studies are briefly described here.

Noel, P.H., Parchman, M.L., Williams, J.W., and others. (2007, December). "The challenges of multimorbidity from the patient perspective." Journal of General Internal Medicine 22 (Suppl. 3), pp. 419-424.

Skills for managing certain diseases, such as asthma, are specific to that disease. However, skills for managing diseases such as hypertension, heart disease, obesity, and high cholesterol, which involve diet and exercise, may overlap with one another. According to this study, a higher percentage of patients who suffer from several chronic diseases are willing to learn all self-management skills relevant to most chronic diseases than those who suffer from only one. These patients are also more willing than those with a single chronic disease to see 6 of 11 nonphysician health care providers for their care, thus supporting a team-based approach to primary care for chronically ill patients.

The researchers analyzed survey responses from 422 primary care patients from a Veterans Health Administration health care system. They compared responses from veterans who have multiple illnesses with those who have only one in three areas that are highly prevalent among veterans: metabolic, obesity, and psychiatric diseases. For example, a person with one metabolic illness might have hypertension, hyperlipidemia, diabetes, or ischemic heart disease, while patients with multiple illnesses had at least three of the four diseases. The greatest percentage of patients with multiple chronic illnesses endorsed five skills: correctly using medications, monitoring important symptoms, improving sleep, managing pain, and reducing stress.

Currently, two-thirds of primary care providers work in solo or small group practices with limited support staff or capacity to provide disease management skills training and proactive followup with patients. Failure of third-party payers to reimburse these critical aspects of chronic illness care also contributes to lack of self-management support for these patients. Ultimately, group clinics, automated telephone disease management programs, or home visits by physician extenders may help to expand these services to patients who need them, suggest the researchers.

Bayliss, E.A., Ellis, J.L., and Steiner, J.F. (2007, September). "Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities." Annals of Family Medicine 5(5), pp. 395-402.

Several factors are potential barriers to disease self-management and quality of life of seniors with multiple chronic illnesses. According to this study, these factors range from greater financial constraints and persistent depressive symptoms to more complex patient-clinician communication. These barriers to self-management are also significantly associated with poorer physical functioning.

The researchers surveyed 352 elderly HMO members who had coexisting diagnoses of diabetes, depression, and osteoarthritis for the prior 2 years. Of those who responded to the survey, 50 percent reported fair or poor health, and on average, had 8.7 chronic diseases. Higher number of illnesses, lower level of physical functioning, less knowledge about medical conditions, less social activity, persistent depressive symptoms, greater financial constraints, and male sex were associated with lower perceived health status among the elderly surveyed.

Many of these factors are amenable to intervention to improve health outcomes, note the researchers. For example, clinicians can identify and treat depressive symptoms, provide individualized patient education on specific medical conditions, enhance physical functioning through physical therapy, and provide manual aids and other support. They can also help resolve situations in which symptoms and treatments for separate conditions interfere with each other, and strive for collaborative care choices that take into account patients' financial resources.

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