Defining healthcare needs for chronic illness

A research paper in the latest issue of Medical Journal of Australia has provided the first insight into the prevalence and patterns of multimorbidity in Australia. About three in 10 people who saw a GP in 2005, and one in four Australians have multimorbidity (two or more types of chronic conditions).

Professor Helena Britt, Director of the Family Medicine Research Centre at the University of Sydney, and her co-authors studied the multimorbidities of more than 9,000 patients who attended GPs between July and November 2005.

Professor Britt said knowing the common combinations of multimorbidity may help in planning the health services needed for our ageing population.

"The current health care system in Australia focuses on single diseases - creating challenges for GPs, who care for the 'whole' person, rather than on only one body system. "Calls are growing for a more holistic consideration of the patient, because multimorbidity has a negative impact on quality of life and increases health service use" she said.

Prevalence of multimorbidity was estimated at 37.1 per cent of surveyed patients, which translates to 29 per cent of people who attended a GP in 2005 and 25.5 per cent of the Australian population. Among the elderly, 83 per centof the surveyed patients had multimorbidity.

The most common morbidity combinations were: arthritis/chronic back pain and vascular disease (15 per cent); a psychological problem and vascular disease (10.6 per cent); and arthritis/chronic back pain plus a psychological problem (10.6 per cent)

The most common combination among patients with four or more types of morbidity was arthritis/back pain, vascular disease, gastro-oesophageal reflux and a psychological problem.

Professor Britt said some multimorbidity combinations were particularly problematic for both clinician and patient, particularly where the drug therapy for one problem may have negative effects on the other.

"These issues are often not considered in management guidelines for individual conditions," she said.

In a separate research paper in the latest issue of Medical Journal of Australia, ProfessorBritt and her co-authors estimated the prevalence of selected diagnosed chronic diseases and compared their findings to those of the National Health Survey (NHS).

"Reliable estimates provide a marker of the health of a community and assist planning of health services and health promotion," Professor Britt said.

Some results aligned with the National Health Survey: one in five Australian have a cardiovascular problem, one in 10 had asthma, and 15 per centarthritis. However this study suggests that one in five Australians have a diagnosed psychological problem, and one in nine have high cholesterol problems, about double the prevalence estimates from the NHS.

"Our method has the benefit of the input of a medical practitioner, which probably leads to greater accuracy than self-report alone. This study could be repeated annually to augment other data sources and better define existing health needs in the population" she said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

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