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Patients struggle to manage multiple chronic conditions

Managing multiple chronic conditions is still elusive for most patients, according to a Kaiser Permanente Colorado Institute for Health Research study that found only "fleeting" success for a minority of MCC patients.

The findings highlight enormous challenges for payers and providers, and come as the National Center for Health Statistics recently reported an increase in the number of adults with two or more chronic conditions during the last decade. 

The study, published in the journal Circulation: Cardiovascular Quality and Outcomes, followed about 29,000 adults with diabetes, high blood pressure and high cholesterol at Denver Health and Kaiser Permanente Colorado from 2000 to 2008. 

About 16 percent of Denver Health patients and 30 percent of Kaiser Permanente patients kept all three conditions in check. Yet even for those who achieved "simultaneous control," the success was temporary. Only 5 percent at Kaiser Permanente and 13 percent at Denver Health retained control of their chronic conditions.

"Diabetes and other chronic conditions associated with it are very difficult but not impossible diseases to manage, for reasons we're just beginning to understand," Emily Schroeder, MD, PhD, the study's lead author, said in a press release.

The study did not find a correlation between social demographics and successful risk control, said John Steiner, MD, MPH, senior director of KP's Institute for Health Research Colorado. A factor that stood out was the level of compliance with medication regimens, which is also among the "most modifiable" factors, Steiner said.

"It comes back to patient behavior, which is also a measure of system performance," Steiner said.

Another step toward better and more cost-effective care of multiple chronic conditions is integrating primary and speciality care, using EHR data as well as patient outreach. Along with integration and developing EHRs, Steiner said Kaiser Permanente is increasingly emphasizing patient outreach through nurses and pharmacists as a way, for instance, to help patients follow medication guidelines.

Streamlining how doctors and other caregivers detect changes in a patient's condition is an area ripe for improvement across the healthcare system.

The new study, and efforts by Kaiser Permanente and others to integrate and innovate chronic care, comes as more than 75 million people in America report having two or more chronic conditions and as the federal government puts pressure on payers and providers to curb costs and improve quality.

That's no small task when 75 percent of annual U.S. healthcare spending – some $1.5 trillion – is now devoted to treating chronic illness, which the Institute of Medicine described as "moving toward crisis proportions."

The prevalence of multiple chronic conditions is obviously bad for people who suffer from them, said Nancy Chockley, president of the National Institute for Health Care Management, and it's also financially unsustainable for the healthcare system as a whole.

In addition to preventing multiple chronic diseases in the long-term, Chockley said, for the time being, "(i)t's terribly important to understand our ability to manage people with multiple chronic conditions and we have to get better at it."