How is multimorbidity treated and managed?
Trends associated with a number of risk factors for chronic conditions among the Australian population continue to put a large number of people at risk of developing chronic conditions: among people aged 18 and over levels of inadequate physical inactivity and fruit or vegetable consumption have remained high since 2007–08, while levels of overweight and obesity have increased (ABS 2018). If left unchecked, trends in chronic condition risk factors, combined with a growing and ageing population and better treatment and management of chronic conditions, will lead to increasing numbers of people living with multiple chronic conditions.
In contrast, smoking rates have consistently declined in Australia over the past two decades, with 11% of Australians aged 14 and over smoking daily in 2019 compared with 24% in 1991 (AIHW 2020). Helping people to make good lifestyle choices and actively self-manage existing chronic conditions, including by accessing available treatments and services and adhering to long-term therapies, can help to keep people in good health and prevent illness. Having an accessible and integrated health care system is also important.
Most care for chronic conditions is provided in the primary health care setting by general practitioners (GPs) and allied health practitioners, with the number of GP visits increasing with increasing number of chronic conditions (Dobson et al. 2020). Mental and behavioural conditions (including anxiety, depression and mood disorders), musculoskeletal (including arthritis), respiratory (including asthma) and endocrine and metabolic conditions (including diabetes) were the most common health concerns managed by GPs in 2019 (RACGP 2019). Effective primary health care can help prevent unnecessary hospitalisations and improve health outcomes (AMA 2017; OECD 2017).
Multiple medications and therapies are often needed to manage multiple conditions, which requires extra attention from clinicians to reduce the risk of overprescribing and treatment conflicts such as dangerous drug interactions (AIHW 2014; Harrison & Siriwardena 2018; Starfield 2006). For example, the presence of coronary heart disease in people with COPD requires more careful management of certain medications such as beta-blockers (Albouaini et al. 2007). And, detailed clinical guidelines advise clinicians on the treatment of asthma when co-existing with COPD, due to the impact of treatment on the individual conditions (National Asthma Council of Australia 2019). More detailed information on the treatment and management of specific chronic conditions can be found on the Chronic disease web pages.
People with chronic conditions can also be more vulnerable to the effects of certain communicable diseases, including Influenza and Coronavirus disease (COVID-19). While most people will only experience relatively mild/moderate symptoms after contracting these diseases, people with chronic conditions including cardiovascular disease, diabetes, chronic respiratory disease and cancer can develop more serious illness (NSW Health 2018; WHO 2020). Vaccination against Influenza (having a ‘flu’ shot) is strongly recommended each year for people with these conditions to reduce the risk associated with contracting Influenza (NSW Health 2018). Likewise, vaccination against COVID-19 is recommended for all Australians but those with an underlying medical condition, including a disability, have been prioritised in Australia’s COVID-19 Vaccine and Treatment Strategy (Department of Health, 2021). To reduce the risk of transmitting or contracting Influenza or COVID-19, hand washing/sanitising, practising appropriate cough/sneeze etiquette, physical distancing and self-isolating (if necessary) is recommended (Department of Health 2020a; NSW Health 2018; WHO 2020).
Within Australia, it is recognised that multimorbidity increases the complexity of patient care (Harrison & Siriwardena 2018), yet it is accepted that, historically, there has been a lack of coordination and communication between different parts of the Australian health care system (Department of Health 2020b).
The Australian Government has implemented a number of approaches with the aim of improving coordination and care for people with chronic conditions, including:
- access to care plans and assessments through the Medicare Benefits Schedule for the planning and management of chronic conditions
- subsidies through the Pharmaceutical Benefits Scheme for a range of medicines used in the treatment of chronic conditions
- trialling Health Care Homes where patients are enrolled with a specific general practice or Aboriginal Community Controlled Health Service to coordinate their care and to facilitate services by a care team. The care team can include a range of health professionals (for example, general practitioner, specialists, allied health professionals, practice nurses) (Department of Health 2020b).
In 2017, all Australian health ministers endorsed the National Strategic Framework for Chronic Conditions (the Framework; AHMAC 2017). The Framework provides guidance for the development and implementation of policies, strategies, actions and services to tackle chronic conditions. It moves away from a disease-specific approach and better caters for shared health determinants, risk factors and multimorbidities across a broad range of chronic conditions.
The Framework outlines 3 objectives that focus on: preventing chronic conditions, and thus minimising multimorbidities; providing efficient, effective and appropriate care to manage them; and targeting priority populations (AHMAC 2017). The Framework will be complemented by the development of a 10-year National Preventive Health Strategy announced by the Minister for Health in June 2019 (Department of Health 2020c).
ABS (Australian Bureau of Statistics) 2018. National Health Survey: First Results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.
AHMAC (Australian Health Ministers’ Advisory Council) 2017. National Strategic Framework for Chronic Conditions. Canberra: Australian Government.
AIHW (Australian Institute of Health and Welfare) 2014. Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: prevalence and incidence. Cardiovascular, diabetes and chronic kidney disease series no. 2. Cat. no. CDK 2. Canberra: AIHW.
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AMA (Australian Medical Association) 2017. General Practice in Primary Health Care – 2016. Viewed 30 January 2020.
Department of Health 2020a. Coronavirus (COVID-19) health alert. Canberra: Department of Health. Viewed 18 November 2020.
Department of Health 2020b. Health Care Homes. Canberra: Department of Health. Viewed 18 November 2020.
Department of Health 2020c. National Preventive Health Strategy. Canberra: Department of Health. Viewed 18 November 2020.
Department of Health 2021. When will I get a COVID-19 vaccine? Canberra: Department of Health. Viewed 19 February 2021.
Dobson A, Forder P, Hockey R, Egan N, Cavenagh D, Waller M et al. 2020. The impact of multiple chronic conditions: Findings from the Australian Longitudinal Study on Women’s Health. Report prepared for the Australian Government Department of Health, May 2020.
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National Asthma Council Australia 2019. Clinical issues—chronic obstructive pulmonary disease (COPD). Viewed 10 January 2020.
New South Wales Ministry of Health (NSW Health) 2018. Don’t spread flu. Sydney: NSW Ministry of Health. Viewed 18 November 2020.
OECD (Organisation for Economic Co-operation and Development) 2017. Health at a glance 2017: OECD indicators. Paris: OECD.
RACGP (The Royal Australian College of General Practitioners) 2019. General Practice: Health of the Nation 2019. Melbourne: RACGP.
Starfield B 2006. Threads and yarns: weaving the tapestry of comorbidity. Annals of family medicine 4(2):101–103.
WHO (World Health Organisation) 2020. Coronavirus. Geneva: WHO. Viewed 18 November 2020.