Having several medical conditions is not more predominant in those who are older; a new study published Online First in The Lancet reveals that the majority of patients who suffer from two or more conditions are actually below the age of 65 years.

A radical health system overhaul is required so that the UK health system and those in other nations developed will be able to cope with the demand, as they were not designed to cater for these scenarios.

One of the key challenges for governments and health-care systems all over the world is to manage the increasing amount of long-term disorders.

At present, the main focus of the current healthcare system lies on individual diseases, delivery of health care and medical education, however, those with multimorbidities need a broader approach. It is burdensome and unsafe for patients having to use different services to manage several diseases in one person, as there is a risk of therapies being duplicated and inefficient due to poor coordination and integration.

Bruce Guthrie, Professor of Primary Care Medicine at UK’s Dundee University, Stewart Mercer, Professor of Primary Care Research at Glasgow University and Graham Watt, Professor of General Practice at Glasgow University and their team estimated the burden of multimorbidity, and of comorbidity, including both physical and mental health disorders, in relation to age and socioeconomic deprivation.

The team took a data summary on 40 common chronic conditions from a database that contained 1.75 million people across 314 medical practices in Scotland. Those who only suffered from one of the 40 conditions were a minority.

The finding revealed that approximately 2 in 5 patients or 42% suffered from one or more conditions, with nearly a quarter, i.e. 23% suffering from two or more conditions, meaning they suffer from multimorbidity. Even though they discovered that the rate of multimorbidity significantly increased with age and that the majority of people over the age of 65 years, i.e. 195,000 suffered from multimorbidity, the absolute number of those with multimorbidity was higher, i.e. 210,500 in those younger than 65 years.

The researchers highlight that the onset of multimorbidity occurred 10-15 years earlier in those who live in the most deprived areas, compared with those living in more affluent areas.

Socioeconomic deprivation was particularly linked to the combination of physical and mental health disorders, whilst the risk of having a mental health disorder increased in relation to the number of increasing physical morbidities. People who suffered from five or more physical conditions were around four times more likely to suffer from a co-existing mental disorder, whilst those in deprived areas were at double the risk to suffer from a co-existing mental disorder compared with those living in affluent areas.

Research trials generally exclude people with multimorbidity on the grounds that they are “too complicated”, however primary care cannot exclude anyone and is generally left to do the best it can under the circumstances, which is providing the most effective care for those suffering from the most complex combinations of problems. The team stresses that more research is required in order to find the best strategies to provide affordable, comprehensive, personalized, and coordinated continuity of care for those with multi morbidity.

They explain:

“Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. Existing approaches need to be complemented by support for the work of generalists, mainly but not exclusively in primary care, providing continuity, coordination, and above all a personal approach for people with multimorbidity. To avoid widening inequality, this approach is most needed in socioeconomically deprived areas, where multimorbidity happens earlier, is more common, and more frequently includes physical -mental health comorbidity.”

According to Nicola Sturgeon, The Scottish Government’s Health Secretary:

“This study adds to the large body of evidence we already have that the most vulnerable in our society are more likely to have more than one condition which puts their health at risk. The Scottish Government continues to work extremely hard to tackle health inequalities and to improve the health of the population as a whole. We are working in partnership with NHS, primary care providers and patients, as well as the research community so that we have effective systems in place to address the needs of people with multiple health conditions and to reduce these health inequalities. I look forward to further results coming from the research team, which is assessing a primary care-led approach with patients as a mechanism for improving the health and quality of life of people with multimorbidity, particularly those living in deprived areas of Scotland.”

Dr Chris Salisbury from the School of Social and Community Medicine at Bristol University in the UK says in a linked comment: “the population is ageing, so the proportion of people with several coexisting medical problems is increasing rapidly. Expenditure on health care rises almost exponentially with the number of chronic disorders that an individual has, so increasing multimorbidity generates financial pressures. This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways.”

According to Dr Salisbury’s suggestions, GPs in more deprived areas should have lower case loads to account for higher levels of multiple morbidity, whilst those with multimorbidity in hospitals should be assigned to a generalist consultant who would be in charge of coordinating their care.

Wrriten By Petra Rattue