The complex care of people with multiple conditions

The care of people with multiple conditions is often complex, is delivered by many parts of the NHS, and can demand much time and interaction with the health care system., In our analysis, we took a detailed look at care for those with multiple conditions to learn about the complexity of the care they receive and which parts of the NHS they have to navigate. As our analysis is based on information available from electronic health records in primary care and administrative data in secondary care, it summarises the number of visits they made to primary and secondary care, but does not include community health care and social care. Neither does it capture the experience from the patient’s perspective, and so may omit important elements such as the difficulty of arranging transport to attend appointments, the impact of care on their daily lives, and which elements of NHS care they find most valuable.,

Figure 4: Most common additional conditions for people with cancer, cardiovascular disease, chronic obstructive pulmonary disease or a mental health condition

Patients with multiple conditions make more visits to outpatient departments (Figure 5) than patients with a single condition. Over the 2 years of our study, those with 4+ conditions averaged 8.9 outpatient visits in 2.8 specialties. Traditionally, specialists in outpatient departments are not set up to provide joined-up treatment, though increasingly there are examples of specialties working together. If a patient is receiving treatment from multiple specialists, those specialists might be treating the patient according to condition-specific guidelines, rather than considering what other conditions the patient has and coordinating their advice and treatment. It is important to develop greater collaboration between specialists, as otherwise information from different specialists will only be brought together by the GP and the patient.

Figure 5: Outpatient and primary care interactions by number of conditions

Unsurprisingly, we found that the number of primary care consultations a patient has increased with each additional condition (Figure 5). Over the 2-year study period, those with 4+ conditions had an average of 28.9 consultations, compared with 10.0 consultations for those with a single condition. Most of the consultations (24.6/28.9) for patients with 4+ conditions were face-to-face GP consultations. The process of recording the patient’s symptoms, diagnosing, and identifying appropriate medications is likely to be more complex for those with multiple conditions, yet the average GP consultation time was not strongly related to the number of conditions. Patients with 4+ conditions received only an additional 14 seconds per consultation on average, compared with patients with a single condition.

Patients with 4+ conditions were prescribed an average of 20.6 different medications or other therapies by their GP over the study period. Taking more medications increases the risk of side effects and drug interactions. Taking multiple medications on strict schedules can be challenging, so patients may find it difficult to adhere to the treatment their doctor prescribes.

Over the 2-year study period, three times as many people with 4+ conditions (3/100) were admitted to hospital than people with a single condition (1/100). We might expect patients with more conditions to have more hospital admissions as an appropriate part of their care, and both routine and emergency admissions were more common for people with multiple conditions. However, we know that hospital admissions are often undesirable for patients, and there is some evidence that if GP care is managed by the same practitioner over a long period of time, patients have fewer emergency admissions. We also know that some patients with multiple conditions find it difficult to manage their own health away from the NHS, and that those who find it difficult to manage their own health have more emergency admissions. Further work is needed, but research suggests that emergency admissions are not inevitable for patients with multiple conditions, and could be avoided through improved continuity of care, or if patients were supported to improve their ability and confidence to manage their own health conditions.

Previous Next