The "single-disease framework" in which most healthcare in the UK is configured cannot cope effectively with the significant percentage of patients presenting with multiple conditions, according to a recent study published in the Lancet.
Researchers in Dundee and Glasgow analysed data on 40 morbidities from a database of 1.7 million people registered with 314 medical practices in Scotland. They found that 42 per cent of patients had one or more morbidities and 23 per cent were multimorbid. The prevalence of multimorbidity increased substantially with age as would be expected but the absolute number of people with multimorbidity was higher in those younger than 65 years.
In addition the researchers found that onset of multimorbidity occurred 10—15 years earlier in people living in the most deprived areas compared with the most affluent. The prevalence of both physical and mental health disorder was 11 per cent in the most deprived areas compared to 6 per cent in the least deprived.
The researchers concluded: "Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas."
In an accompanying article Dr Chris Salisbury, professor of primary health care at the University of Bristol, wrote: "Increasing multimorbidity generates financial pressures. This economic burden heightens the need to manage people with several chronic illnesses in more efficient ways."
He also commented on the burden placed on primary care: "Doctors working in deprived areas need smaller case loads because of the increased complexity of patients' medical needs. Instead of attending several disease-specific clinics, patients should have all of their chronic diseases reviewed in one visit by a clinician with responsibility for coordinating their care."
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