Entete 3

Monthly Archives: December 2012

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


Multimorbidity, polypharmacy, referrals, and adverse drug events

By Amaia Calderón and Alexandra Prados-Torres

A paper entitled “Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well?” was recently published in the British Journal of General Practice. The work was carried out by members of the EpiChron Research Group on Chronic Diseases of the Aragon Health Sciences Institute in Spain, and its objective was to shed light on the interrelations between multimorbidity, polypharmacy, multiple referrals to specialised care, and the occurrence of adverse drug events (ADEs), in the context of a national healthcare system.

Results of this observational study demonstrate that multimorbidity, polypharmacy and multiple referrals are strongly and independently associated to occurrence of ADEs, even after adjusting for potential confounders. As the clinical situation of the patient becomes more complex and requires the intervention of different specialists, the likelihood of a lack of coordination among professionals and potential interactions among prescribed medications could favour the occurrence of undesirable effects, such as ADEs.

As indicated by Starfield et al[1] a decade ago, it is necessary, now more than ever, to design strategies that focus on individual’s health problems in their totality, rather than examining each of the patient’s illnesses individually. This approach is important given the high frequency of multimorbidity in all stages of life, the proved risk of interactions between illnesses and medications or among medications, and the acknowledged impact of not doing so both for the healthcare system and the health of the patient.

This research, financed by the Spanish Institute of Health Carlos III, is framed within a wider project focused on the epidemiology of multimorbidity, utilization patterns and the response of healthcare systems to populations suffering from it.

[1] Starfield B, Lemke KW, Bernhardt T, et al. Comorbidity: implications for the importance of primary care in ‘case’ management. Ann Fam Med 2003; 1(1): 8–14.