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
cwalker@chronicillness.org.au