Dr Chrissy Bishop opened the session by posing a serious question to delegates: Are health systems prepared for MCCs?
She noted that, according to the World Health Organization, by 2020 chronic diseases will account for three-quarters of all deaths worldwide and that 60% of the burden of chronic diseases will occur in developing countries.1 Furthermore, the burdens of chronic conditions, such as heart disease, stroke, chronic obstructive pulmonary disease (COPD) and diabetes, are rising significantly and will be the leading causes of death by the year 2040.2 Each additional chronic condition results in a 51% greater use of physician services and people with three or more chronic conditions have prescription costs that are 6.6 times greater than those without.3
However, Chrissy acknowledged that it’s hard to create interest in this topic because global reporting of MCCs is not standardised and people measure it in different ways.4
Chrissy believes that opportunities to reduce the burden of MCCs lie with healthcare providers, policy makers, the digital health industry and the broader public health community.
Chrissy advocates moving away from single disease guidelines to symptom-based or specific MCC guidelines to create new and consistent models of integrated care. This includes integration of mental and physical healthcare to create guidelines that support services for patients who commonly have two diseases together such as diabetes and depression or heart disease and depression.
Chrissy described a research programme at the Economist Intelligence Unit, sponsored by Teva, which is designed to drive dialogue and action by policymakers around the world on how healthcare systems can be better prepared to deal with the increasing burden of MCCs. The research programme has created a composite index that measures how well-prepared health systems are to manage the increasing burden of MCCs. The MCC index, which includes policy indicators associated with high-quality outcomes, ranks countries according to their success in promoting and funding the right strategies and initiatives.
Preliminary findings from 25 countries across the globe who had the required data indicate that Spain leads the way in terms of MCCs, but the UK isn’t far behind. The UK, which ranks fifth overall, falls in the ‘prepared’ category indicating that its health system has the infrastructure to support the management of MCCs.
Chrissy said that the UK excels because it follows the National Institute for Health and Care Excellence (NICE) guidelines and it has a good policy on integrated care.
To further explore how the UK’s policy and guidance on MCCs translates into clinical practice, Chrissy spoke with consultant pharmacist Dr Nina Barnett, who is a practitioner working in MCC care.
Dr Barnett said that she had used the NICE guidelines on multimorbidity5 to change how pharmacists may achieve a more ‘patient-centred’ conversation with their patients regarding their medication. Dr Barnett notes that a simple way to start the conversation with a patient with multimorbidity is to ask: “If you can get one thing from this consultation what would it be?” She believes that in order to effect a change in practice around the management of medicines in people with multimorbidity, change needs to come from a variety of sources. This may include an evidence-based approach, but it can also be supported by individual and organisational role models, case examples, NHS policy and a political will for change.
Chrissy supports this view and believes that bringing opinions together from different sectors in order to get people to listen to the problem at hand is important when developing an indicator such as the MCC index.
The MCC index report will provide the context to the index. The report will also include details of four key findings for successful MCC management, which require attention in the first instance:
- An in-depth understanding of the epidemiology of MCCs;
- Strong political leadership to make long-term healthcare decisions;
- Information and technology for care co-ordination;
- Input from families and carers.
Teva looks forward to the ongoing collaboration with the Economist Intelligence Unit on this important programme of work. The report that will be generated from the work programme will be independently produced by the Economist Intelligence Unit.