By David Kipkorir
The number of Kenyans with three or more long-term conditions continues to grow, putting pressure on the health care system.
World Health Organisation (WHO) terms multimorbidity as the coexistence of two or more chronic conditions, a significant problem in most healthcare systems and common in clinical practice.
A study published in the Journal of Comorbidity estimates a prevalence of multimorbidity of at least 50 percent in the elderly population, ranging up to 99 percent in primary care population aged 80 and above.
Kenyans with such conditions often visit hospitals many times than the general population and is associated with increase mortality and aging population.
Although exact prevalence estimates depend on the type and number of conditions considered in the definition of multimorbidity, most experts agree that more than one in four adults globally have at least three chronic conditions such diabetes mellitus, hypertension, HIV/AIDS, specific organ-system failure such as heart, kidney, lung, liver or brain among others.
Experts say multimorbidity is a rising healthcare burden locally, and as a result, policy and lawmakers need to ensure that this complex population have access to evidence-based and sustainable interventions.
The African Journal of Hospital and Scientific Medicine (MEDICOM) in a recent edition indicated that each and every detail about all other parts of the history of the patient in front of the clinician are relevant and important.
In clerking a new patient with presenting symptoms, the emphasis must necessarily be on the ‘chief complaints, then the rest can follow, says Prof. Peter Odhiambo, a thoracic and cardiovascular surgeon.
Clerking is taking full history, performing a physical examination, recording one’s findings in the patient’s notes, and writing a problem list and care plan.
One of the rarely appreciated sections of clerking is ‘past medical history’ or ‘history of past illnesses’, added the surgeon.
“Many times patients, and even some clinicians in a hurry, tend to ignore what they perceive as minor,” Prof Odhiambo explained.
The majority, if not all, multimorbidities in a given patient will require simultaneous recognition and management. At the very least, the clinician must keep them in mind during the entire process of clerking and management of a patient, including physical examination, investigations, treatment and follow-up.
Taking history is an important and strategic moment of acquaintanceship between the two that the doctor should not squander.
“Often-times, it ends up influencing, determining, directing and cementing patient compliance with the rest of the doctor’s orders,” says Prof Odhiambo.
Paying attention to the patient’s multimobidities adds to the overall recovery and subsequent wellness. Without proper attention and care of the patient, his or her treatment (however perfect) will be incomplete, states the journal.
Kenya’s healthcare systems are largely designed to manage individual diseases or episodes of illness rather than patients with complex multiple health care needs.
Many nations including Kenya are spending resources to increase the proportion of single-disease interventions instead of integrating multimorbidity interventions into existing healthcare systems to support implementation and sustainability and to apply and build on the evidence regarding effective interventions for single diseases to people with multimorbidity.
People with multimorbidity also have high rates of emergency hospital admissions and attendance at out-patient appointments impacting negatively on the economy.
Evidence shows that exercise and education can improve outcomes, mitigating the progression of many chronic diseases and is recommended in guidelines for many single diseases. Exercise-based rehabilitation for people with multimorbidity may have a role to play in addressing common symptoms and risk factors for multiple chronic diseases, rather than only focusing on management of one disease.
There is need for a new relationship between patients and health care professionals, which will engage patients more in managing their health conditions themselves.
Healthcare providers need to increase the focus on minimising multimorbid patients’ burden of treatment.
