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MULTIMORBIDITY: THE MOST COMMON CHRONIC CONDITION

MULTIMORBIDITY: THE MOST COMMON CHRONIC CONDITION. Katherine Thompson, MD; Mariko Wong, MD; Megan Huisingh-Scheetz , MD, MPH University of Chicago, Pritzker School of Medicine Clinical Skills. MULTIMORBIDITY.

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MULTIMORBIDITY: THE MOST COMMON CHRONIC CONDITION

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  1. MULTIMORBIDITY:THE MOST COMMON CHRONIC CONDITION Katherine Thompson, MD; Mariko Wong, MD; Megan Huisingh-Scheetz, MD, MPH University of Chicago, Pritzker School of Medicine Clinical Skills

  2. MULTIMORBIDITY • Goal: Learn to balance competing recommendations for management of multiple different conditions while simultaneously incorporating patient preferences and available resources • WHEW!! • How best to do this? • Why is it so important?

  3. OBJECTIVES • Describe impact of multimorbidity on health care system • Practice 5 step approach to multimorbid patients • Elicit patient preferences • Consider evidence-based treatment options • Estimate prognosis • Determine clinical feasibility • Prioritize plan

  4. MULTIMORBIDITY • Definition: • Coexistence of multiple chronic diseases • Importance: • What percentage of Medicare recipients (>65yo) have multimorbidity? (guesses?) • ~70%! • How much of our annual healthcare budget is spent on multimorbid patients? • ~2/3 (over 300 BILLION dollars annually) Lochner KA, Cox CS. Prevalence of Multiple Chronic Conditions Among Medicare Beneficiaries, United States, 2010. Prev Chronic Dis 2013;10:120137 http://www.fightchronicdisease.org/sites/fightchronicdisease.org/files/docs/ChronicCareChartbook_FINAL_0.pdf Accessed September 3, 2013.

  5. MULTIMORBIDITY: 5 STEP APPROACH • Step 1: Elicit Patient Preferences • Does the patient prefer to make decisions alone? With caregivers? Does the patient defer decisions to the physician? • Recognize that general preferences may not apply to specific situations. Preferences need to be applied to decision at hand

  6. STEP 2: CONSIDER EVIDENCE-BASED TREATMENT OPTIONS • What evidence is available (if any)? • Does it apply to my patient? • What benefits might be expected? • What are the harms? • How long does the treatment take to achieve benefit?

  7. STEP 3: ESTIMATE PROGNOSIS • Does estimated prognosis or remaining life expectancy affect treatment considerations? • Consider time to treatment benefit

  8. STEP 4: DETERMINE CLINICAL FEASIBILITY • Consider patient ability to adhere to plan • Treatment regimen complexity • Patient education? • Non-pharmacologic measures?

  9. STEP 5: PRIORITIZE CARE PLAN • Putting it all together • Use strategies for choosing therapies that align with patient preferences, optimize benefit, minimize harm, and enhance quality of life for multimorbid patients

  10. PRACTICE! • Review multimorbid patient case in small groups • Work through your 5-step process to create a plan for your patient

  11. Summary/wrap up • Managing multimorbid patients: Not one right answer! • Use patient preferences as starting point and guide • Use decision model to help create an individualized, prioritized plan • Re-evaluate your plan at intervals and adjust as needed

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