Treatment For Chronic Illness Must Be Less Disruptive In The Daily Lives Of Patients

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Main Category: Primary Care / General Practice
Also Included In: Public Health;  Caregivers / Homecare
Article Date: 12 Aug 2009 - 0:00 PDT

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A paper published today on bmj.com reports that many patients with complex chronic illnesses are overwhelmed by their treatment.

The authors explain that the burden is caused by the healthcare systems themselves. In order to be effective, care must be less disturbing in the daily lives of patients.

Professors Carl May, Victor Montori, and Frances Mair write: "Chronic disease is the great epidemic of our times, but the strategies we have developed to manage it have created a growing burden for patients". This treatment burden leads to poor observance, wasted resources, and poor results.

For instance, this is illustrated by the case of a man being treated for heart failure in UK primary care. He turned down the offer to attend a specialist heart failure clinic to optimize management of his condition. He explained that in the preceding two years he had spent the equivalent of one full day every two weeks making 54 visits to specialist clinics for consultant appointments, diagnostic tests, and treatment.

In such settings, the authors argue that there is a need for minimally disruptive medicine that seeks to mold treatment strategies to the realities of the daily lives of patients. This approach could significantly improve the care and quality of life for patients.

They remark: "The work of being a patient includes much more than drug management and self monitoring." It involves organizing doctors' visits and laboratory tests. Patients may also be required to undertake the organizational effort of transferring basic information about their care between different healthcare providers and professionals. In addition in some countries, they must also tackle the challenging demands of insurance and welfare agencies.

"Patients are thus overwhelmed not just by the burden of illness, but by the ever present and expanding burden of treatment," explain the authors.

Moreover, a number of of these problems are caused by healthcare systems themselves. Clinicians are not prepared to act adequately in response to this problem.

The authors advise that clinicians and researchers should have reliable tools to identify overburdened patients. They also advise that there is a need for a move towards better coordination of care and the development of clinical guidelines for managing multiple chronic conditions.

In addition they claim that patients and their caregivers must have an essential part in the task of improving the coordination of their care.

"We need to think more about the burdens of treatment," conclude the authors. "Thinking seriously about the burden of treatment may help us begin to think about minimally disruptive medicine - forms of effective treatment and service provision that are designed to reduce the burden of treatment on their users."

"We need minimally disruptive medicine"
Carl May, Victor M Montori, Frances S Mair
doi=10.1136/bmj.b2803
bmj.com

Written by Stephanie Brunner (B.A.)
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