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Author Archives: Christine Walker

Conceptualising multiple conditions in Australia

By Christine Walker

Since the 1970s greater numbers of people are now living with several serious long term illnesses. These include rarer genetic conditions and ‘lifestyle conditions’ as well as those of an idiopathic nature. A recently published article [1] examines the growing need for new terms and concepts that reflect the changes in the lives of people living with long-term serious illnesses.

The Chronic Illness Alliance conducted a workshop with its members who had multiple conditions to scope the problems they faced in receiving health care. A literature review using the principles of meta-synthesis which aims to systematise qualitative concepts provided the means to identify whether the concerns raised by consumers were recognised in the literature. The risks identified by consumers were used both as search terms and analytical terms. While the consumer perspective appeared absent in the literature, many authors showed similar concern about the tardiness of health systems to acknowledge the impact of multi-morbidities for consumers and the associated risks. More importantly the literature review demonstrated that problems associated with concepts, definitions and data collection impact on health care and service delivery. This in turn dictates how consumers receive their health care services and ultimately influences the safety and quality of their health care. The article argues that the adoption of better concepts is a first step to achieving systemic change on behalf of people with multiple conditions.

[1] Walker C. Conceptualising multiple conditions in Australia: First steps to systemic change to meet the needs of people with serious long-term illnesses. Patient Experience Journal, Volume 2, Issue 2 -Fall 2015, pp. 69-76.

Multiple conditions: exploring literature from the consumer perspective in Australia

By Christine Walker

The article “Multiple conditions: exploring literature from the consumer perspective in Australia”, published in Health Expectations October 2012 (doi:10.1111/hex.12015), arose from a workshop held by The Chronic Illness Alliance in Melbourne Australia. Participants were people who had more than one health condition. Some participants had co-morbidities, others had iatrogenic conditions, others had conditions arising from treatments while others simply had unrelated conditions. In all cases participants considered having more than one condition made them vulnerable in a health system that still focused on the care of single conditions.

Workshop participants wanted to argue for better recognition of their complex health needs and requested that a literature review be undertaken to identify if the needs of consumers with multiple conditions had been recognised in other countries.

The resulting literature review is based on the parameters set by the workshop participants who were concerned about the quality of care and the resultant quality of their lives. This meant that a qualitative analysis of literature, that is, a meta-synthesis was more appropriate than a systematic review of literature. Our review found that the consumer perspective was not explored in literature on multi-morbidities though many of the problems identified in health services research were clearly relevant to improving the quality of care for people with multiple conditions. Identified problems include issues of polypharmacy and adverse events, poor recognition of depression and problems of identifying which condition requires most attention. At the same time the meta-synthesis revealed there were problems with consistent definitions of co-morbidity and multi-morbidity which compounded the accurate collection of data relating to multi-morbidity. Many of these problems were reproduced and compounded in health policies. We argue that specific reform to health services and policies are required to better meet needs of people with more than one condition.

Christine Walker
Chronic Illness Alliance
587 Canterbury Rd
Surrey Hills VIC 3127