Care co-ordination improves health of older patients with multiple chronic diseases

By Kim Barnhardt, CMAJ

Dr. Sharon Straus

For older adults with multiple chronic diseases, such as diabetes, depression, heart disease and others, care co-ordination appears to have the biggest impact on better health, according to a study published today in CMAJ (Canadian Medical Association Journal).

By 2050, there will be 2 billion people worldwide older than 60 years. Seniors are the fastest-growing demographic in Canada, and almost half have multiple chronic conditions and consume a substantial portion of health care spending. There will be a greater number of people with chronic diseases, yet there is a lack of understanding about the impact of effective approaches to managing multiple chronic diseases in patients.

To fill this gap, researchers conducted a systematic review of all studies on the topic published in any language between 1990 and 2017. In the final analysis, they included 25 studies, many of which were randomized controlled trials, with 12 579 older adults (average age 67 years).

“Older adults with multiple chronic diseases can benefit from care co-ordination strategies,” said Dr. Sharon Straus, director of the Knowledge Translation Program at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Vice-Chair of Mentorship, Equity and Diversity in the University of Toronto’s Department of Medicine and co-author on the study. “In particular, people with depression and diabetes can show better blood glucose control, reduced symptoms of depression and increased access to mental health services with care co-ordination, which requires team changes to happen.”

For example, care co-ordination involving case management, patient self-management and education of patients and providers significantly reduced symptoms of depression in adults with combined depression and chronic obstructive pulmonary disease or in those with combined diabetes and heart disease.

“Our study highlights the lack of interventions specifically focused on managing co-existing chronic illnesses in older adults, especially those that appear in clusters,” said Dr. Monika Kastner, Research Chair in Knowledge Translation and Implementation at North York General Hospital and affiliate scientist at North York General Hospital.

The authors point out that clinical guidelines usually focus on a single disease, so management of multimorbidity can be overwhelming for patients and difficult for health care providers because of the complexity of overlapping or conflicting treatments with potential adverse interactions. They suggest that interventions to manage multiple chronic diseases should not only focus on clinical aspects of care, but also consider patients’ health priorities and goals and their social and emotional well-being.

This paper is an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

St. Michael’s Hospital with Providence Healthcare and St. Joseph’s Health Centre now operate under one corporate entity as of August 1, 2017. United, the three organizations serve patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.