Multimorbidity challenge to NHS
MedWire News: Multimorbidity is an under-recognised and poorly understood issue that poses a major challenge to healthcare systems in the UK and worldwide, a study in The Lancet suggests.
The authors say that the NHS was not designed to deal with the rising numbers of people with multiple health problems, and call for radical change in order for the system to cope.
"Our findings challenge the single-disease framework by which most healthcare, medical research, and medical education is configured," write Professor Bruce Guthrie (University of Dundee, Scotland) and co-authors. "A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas."
The researchers undertook a cross-sectional study to examine the distribution of multimorbidity in relation to age and socioeconomic deprivation. From a database of 1.75 million people registered with 314 medical practices in Scotland, they extracted data on 40 physical and psychiatric morbidities.
Overall, 42.2% of patients had at least one morbidity and 23.2% were multimorbid. As expected, the prevalence of multimorbidity increased with advancing age; however, the absolute number of multimorbid patients was greater in the under-65s than in those aged 65 years and older (210,500 vs 194,996).
Importantly, multimorbidity arose 10-15 years earlier in people living in the most deprived areas of Scotland compared with the most affluent. Socioeconomic deprivation was also associated with greater physical or psychiatric comorbidity. Additionally, the risk of having a mental health disorder increased as the number of physical morbidities increased.
In a linked Comment article, Dr Chris Salisbury (University of Bristol, UK), remarked: "Expenditure on healthcare 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."
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By Joanna Lyford