The causes and consequences of having multiple health conditions

Posted by jchoules

1 December 2016

Many people (58% of the English population) have multiple health conditions. Having multiple health conditions is associated with worse quality of life, depression, reduced functional status, increased risk of premature death, and more potentially avoidable hospital admissions.

HSPRG team

In the Health Services and Policy Research Group at Exeter, we have been conducting research into the causes of having multiple health conditions, and the consequences on the quality and safety of healthcare for these patients. Reviews conducted by our wider research team found large gaps in current knowledge regarding both the determinants of having multiple conditions, and the impact on healthcare. Over the past 18 months we have been establishing a new program of work that seeks to find answers to some of the most pertinent questions.

Using data from 4,564 people aged 50 or over participating in the English Longitudinal Study of Ageing, we have explored which characteristics of people predict whether they develop multiple health conditions over a ten year period. We found that people were at greater risk of having multiple health conditions if they were older, female, less wealthy, had lower levels of physical activity, had a history of smoking, or if they felt that life events were outside of their control. The good news from this is that many of these factors are amenable to change. Interventions aimed at reducing the burden of multiple conditions should include evidence-based components addressing behavioural change for promoting healthy lifestyles, and empower patients to improve their health trajectories.

Over the next six months, we will be exploring the impact of having multiple health conditions on the quality of care received, using this same dataset. The English Longitudinal Study of Ageing asks targeted questions to participants reporting certain conditions to establish whether they received recommended care, as established in the Assessing Care of Vulnerable Elders project. The highest quality study to date in this area, conducted in the US, found that quality of care increases as the number of conditions a patient has increases. We will investigate if this (initially counter-intuitive) result holds for our English data.

Using data from 1,244 patients who completed the Patient Reported Experiences of Safety in Primary Care (PREOS-PC) questionnaire – a patient reported outcome measure (PROM) developed by our wider research team – we will also investigate the impact of multiple health conditions on patients’ experiences of safety problems in primary care. Safety problems refer to issues such as being given the wrong diagnosis or medication, or not receiving an examination or treatment when needed.

If you are interested in learning more about these projects, please visit the Health Services and Policy Research Group website and follow us on twitter @uemshspr.

Dr Luke Mounce on behalf of Health Services & Policy Research Group, UEMS