Multimorbidity in respiratory patientsPosted on: 18 Jun 2019
This module describes the extent to which patients with respiratory problems are affected by other chronic health problems and how we should take account of this in organising and providing care.
After completing this module, learners should be able to:
Describe the problems and complications that can arise if a patient is reviewed and treated according to single-disease pathways, rather than holistically.
Conduct a comprehensive review that considers the patient as a whole, rather than one specific condition.
Determine, following a review, which condition(s) or complaint(s) are the primary concern for management – taking into consideration the patient’s priorities Screen as appropriate for likely comorbidities, taking into account the patient’s medical history, medication and COPD.
Understand the role of the primary care clinician in providing continuity of care, and how to coordinate care from multiple services.
Recognise when morbidities need management by another healthcare professional/team and refer appropriately.
Appreciate the impact of coexisting diseases upon each other when presenting in the same patient.
Multimorbidity is a rather ugly word – and not a word to be used when talking to patients. It is used in medical language to describe the fact that many of the people whom we look after have more than one chronic condition and it is very important to bear this in mind if we are to give them the best possible care. Much of our chronic disease management thinking and activity is centred around single conditions – such as asthma and COPD in the respiratory field. While we need to make sure that we do everything necessary to optimise the care of those problems, we need also to think about whether we are also attending to the other disorders affecting our patients – which may or may not have been diagnosed yet. We also need to bear in mind the possibility of patient harm through overdiagnosis. Patients with multimorbidity are more at risk of non-adherence to prescribed treatments and more at risk of drug interactions if they do take all their prescribed medicines.
Is this all complicated and difficult? Yes, it is. We have to do our best.
Duncan Keeley is Policy Lead on the Executive Committee of the Primary Care Respiratory Society. He has special interests in respiratory medicine and medical education. He now works as a portfolio GP and GP appraiser, after 24 years as a GP principal at the Rycote Practice in Thame, Oxfordshire.
A Scottish general practice study has shown that people with COPD over the age of 65 have on average 4.5 comorbid conditions.1
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