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The Challenge of Managing Multiple Chronic Conditions

Joanne is 78 years old and has six medical conditions that have required long-term treatment ― diabetes, high blood pressure, heart failure, emphysema, arthritis and depression.   She is discouraged because she doesn’t have much energy and often can’t do what she’d like.  She constantly juggles doctor visits and medications.  Joanne feels overwhelmed with all of her medical issues and wishes one of her doctors would coordinate, prioritize and streamline all of her visits, medicines, tests and instructions. She knows she needs more help in preparing nutritious meals, but doesn’t really know where to turn for assistance. Her daughter lives too far away to be helpful on a regular basis.   Joanne’s neighbor looks in on her frequently and is beginning to worry.

 Sound familiar?  Joanne and those who care about her are grappling with an increasingly common challenge ― the management of what many health experts refer to as “multiple chronic conditions.”  In fact, estimates suggest that about two-thirds of older adults live with two or more chronic conditions.  And the aging baby boomer population will only increase the magnitude of this challenge. 

Chronic conditions are those that last a year or more and require ongoing medical attention and/or limit activities of daily living.  Examples include arthritis, diabetes, heart disease and hypertension.  Behavioral health conditions are also increasingly common and include substance use and addiction disorders, as well as mental illnesses, dementia and other cognitive impairments. 

The management of multiple chronic conditions has major cost implications.  Increased spending on chronic diseases is a key factor driving the overall growth in Medicare spending. And the cost of medications for these conditions can be considerable. There are also non-financial challenges faced by those with multiple chronic conditions, such as learning how to manage fatigue, emotional distress and activity limitations.

And although most individuals have more than one chronic condition, the health care system is primarily organized to provide care on a disease-by-disease basis.  So when individuals see a number of specialists, the opportunity for confusion escalates. The most common example involves the use of multiple medications: the use of one may contraindicate the use of another.  In short, all of this can result in fragmented care.  Care coordination is often the missing link. If care is coordinated, then medical and social service providers bring their respective expertise to bear on each individual’s health problems in the most effective and coordinated manner.

The U.S. Department of Health and Human Services is focusing on this important issue with the development of a new “Framework on Multiple Chronic Conditions.” This Framework will be implemented through public-private partnerships and will be bolstered by some of the provisions in the new health reform law.  For more information, read the plan at: www.hhs.gov/ash/initiatives/mcc/.