The Agency for Healthcare Research and Quality (AHRQ) (2017) defines multimorbidity as the presence of two or more long-term health conditions. These conditions may include (1) physical and/or mental health conditions, (2) conditions such as a learning disability, (3) symptom complexes such as frailty or chronic pain, (4) sensory impairment (sight or hearing loss), and (5) alcohol and substance misuse. Multimorbidities present a challenge, as treatment options for one condition may negatively impact another, and most guidelines for treating any particular condition are drawn from those with only one health concern.
Take into account multimorbidity if patients: (1) find it difficult to manage their treatment or daily activities; (2) receive care and support from multiple services and need more services; (3) have both long-term physical and mental health conditions; (4) have frailty or falls; (5) frequently seek unplanned or emergency care; or (6) are prescribed multiple regular medications (defined as 10-14 medications or fewer than 10 medicines with particular risk of adverse effects) (AHRQ, 2017).
When developing the plan of care, keep in mind principles such as: (1) how the patient's health conditions interact and how the patient's quality of life is affected; (2) the person's individual needs, treatment preferences, health priorities, and lifestyle; (3) benefits and risks from following guidance on single-health conditions; (4) improving quality of life by reducing treatment burden and adverse effects; and (5) improving coordination across various services (AHRQ, 2017).
Develop an individualized plan of care with the patient and healthcare team, keeping in mind the goals and plans for future care; who is responsible for care coordination; who communicates the plan of care; and the timing of follow-up and how to access urgent care (AHRQ, 2017). To help better care for patients with multiple health issues, the American Geriatrics Society (2017) has identified five elements of quality care:
1. The patient plan of care should focus on the patient's preference, values, and outcomes most important to him or her.
2. As those with multimorbidity are often left out of research studies, it can be difficult for providers to know what treatments or medications will work best for a patient with multiple health issues. Be aware of the most recent research about whether a certain approach will work for a patient.
3. Patients need to be informed of the risks and benefits of treatment and the prognosis for their conditions-both with and without treatment. When new medications are prescribed, the patient needs to be aware if it will impact any other healthcare issues they have.
4. Each treatment should be considered based on what it involves. Patients are most likely to follow a plan of care that is not too complicated or difficult. Confirm understanding of the treatment plan and assess the ability of the patient to actually follow the plan over time.
5. The plan of care should maximize benefits and minimize risks. This is especially important in medication therapy, where drugs can interact with others. Try nondrug therapies where appropriate to help minimize these issues.
This holistic assessment will help create a plan of care to help patients live a quality life. Review factors upon a change in health or change in the plan of care. Although this is a challenging scenario, it is one that is becoming more common as the aging population increases.
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