Chronic Conditions 101
1Defining NCPIE’s Adherence Action Agenda (A3)
The presence of chronic conditions puts a tremendous burden on patients, their families and our healthcare system. With a growing and aging population, coupled with the realities of one or more chronic conditions – multiple doctors, multiple prescriptions and the need to adhere to multiple medication requirements – we’ve created an environment that is conducive to “A Perfect Storm.” Chronic Conditions 101 provides facts that patients, healthcare professionals and policymakers can use to gain a better understanding of the “Perfect Storm.” The following Q & A’s puts a human face on this growing problem.
What are chronic conditions, and what are the most common of these diseases?
While acute conditions are severe and sudden, a chronic condition, by contrast, is a long-developing syndrome that develops and worsens over time.1 According to the Center for Disease Control and Prevention (CDC), seven out of 10 deaths among Americans each year are associated with chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year. And in 2005, 133 million Americans – almost one out of two adults – had at least one chronic illness.2
What is the health impact of chronic conditions?
Chronic diseases are the most prevalent and costly healthcare problems in the US. Many chronic diseases are lifelong conditions, and their impact lessens the quality of life for those suffering from the diseases, as well as for their family members, caregivers and others. Chronic disease is also a major driver of healthcare costs and threatens healthcare affordability. According to the CDC, chronic disease accounts for about 75% of the nation's aggregate healthcare spending – or about $5,300 per person in the US each year.3Placing the spotlight on chronic conditions is critical as the Baby Boomers get older and are experiencing diseases that require the attention of a multi-faceted healthcare team.
What are multiple chronic conditions (MCC)?Individuals have multiple chronic conditions when: They suffer from two or more concurrent chronic diseases. Symptoms may be continual or intermittent. These conditions last a year or more and require ongoing care and/or limit activities of daily living.4
What are the most prevalent multiple chronic conditions?The CDC has identified the most common combinations of chronic diseases. MCC dyads (combination of two chronic conditions) in the United States for men and women are hypertension and arthritis. The most prevalent triad (combination of 3 chronic diseases) for men and women is arthritis, diabetes and hypertension.5 Other chronic conditions worth mentioning are: high cholesterol, heart disease, cancer, depression, substance use disorders, asthma, HIV/AIDS and dementia.6 Check out THE EXAM ROOM to help you visualize the impact of these diseases when someone is experiencing one or more them at the same time.
Who is most at-risk of experiencing multiple chronic conditions?Approximately 27.9% of adults aged 45 to 64 and more than half (51.6%) of adults 65 and over suffer from two or more chronic conditions, with the major burden of MCC on older Americans aged 65 and over. Minorities, especially non-Hispanic black adults, are disproportionately represented in these statistics. CDC also finds a higher prevalence of MCC among women. There is also a connection between income level and multiple chronic conditions. According to one study, an adult living in poverty is twice as likely to have multiple chronic conditions as an adult with income at 400% the poverty level, which translates into $45,960 a year.7
What does the presence of multiple chronic conditions look like “on the ground?”Today, one in four Americans (approximately 75 million people) has multiple chronic conditions.8 It’s not uncommon in hospitals and outpatient clinics for healthcare providers to examine and treat patients with five, six or even seven chronic conditions. Remarkably, older adults with five or more such illnesses have, on average, 50 prescriptions filled, see 14 different physicians, and make 37 physician office visits per year.9 As people develop multiple chronic conditions, their health can become compromised, and it’s understandable that they experience higher mortality rates and suffer from poor functional status sooner than people with fewer chronic conditions.10
What is the economic impact of MCC?MCC place a substantial burden on the U.S. economy. Approximately, 65% of total healthcare spending is dedicated to the care of this population, and healthcare spending in general and total out-of-pocket spending increase with the number of chronic conditions. Patients with more than one chronic condition account for 95% of all Medicare spending, and those with more than five chronic conditions account for 2/3s of Medicare costs. Medicaid recipients follow similar patterns.11 People with MCC also more frequently experience unnecessary hospitalizations – particularly for ambulatory-sensitive conditions; more commonly suffer from adverse drug reactions; and report receiving conflicting medical advice, duplicate tests and more services than those with fewer chronic diseases.12
Why are there poor health outcomes and high costs associated with MCC?There are lots of question marks when treating people with MCC – and for good reason. If you have multiple chronic conditions or are taking care of an aging parent, friend or relative, you’ve experienced this first hand. And interestingly, the news from the former US Surgeon General Dr. Regina Benjamin affirms what you probably already know:
- There is limited understanding of what constitutes optimal care.
- The majority of clinical guidelines don’t contain specific recommendations for patients with multiple conditions, so clinicians tend to follow several single, disease-specific guidelines.
- It’s not clear how often this population is included in clinical trials.
- The combination of diseases this population experiences varies, and as such, information on how best to treat certain combinations is limited.
Do healthcare professionals feel that they are prepared to address the needs of those with MCC?Many healthcare professionals feel their training did not adequately prepare them to deal with patients with MCC. And it’s true – how can you effectively treat a patient who is in chronic pain, for example, while at the same time ensure that your treatment regimen isn’t going to impact one of the other diseases he/she is experiencing? Likewise, even if these clinicians are prepared, there are few provider incentives in the current healthcare financing system for care coordination and disease management across multiple conditions. Finally, it’s unclear whether the benefits of self-care management, including in-home and community-based services designed to help individuals better manage their conditions, are being fully realized.13
Why should we be concerned about multiple chronic conditions?As the Baby Boomers age, the number of multiple chronic conditions and the medications used to treat their diseases will be on the rise. In 2000, 57 million people experienced multiple chronic conditions, and it’s estimated that by 2020, that number will rise to 81 million.14 That’s a lot of people, a lot of potential diseases and a lot of medicines!
What is being done to address the growing rise of multiple chronic conditions in the US?Given that this is such an important issue, the U.S. Department of Health and Human Services (HHS) has developed a Strategic Framework to achieve optimum health and quality of life for individuals with MCC. The Framework serves as a national-level roadmap for assisting HHS programs and public and private stakeholders to improve the health of individuals with MCC and focuses on such issues as strengthening the healthcare and public health systems; empowering patients to use self-care management; equipping healthcare providers with tools, information and other interventions; and supporting effective interventions and targeted research about individuals with MCC.15 In 2013, the National Council on Patient Information and Education (NCPIE) launched a new program called the Adherence Action Agenda or the “A3 Project,” bringing together nearly two dozen professional societies and voluntary health organizations, government agencies and industry leaders to identify the major gaps in current medicine adherence efforts and create a new Adherence Action Agenda for the nation. Intended to accelerate progress in safe and appropriate medicine use, this new agenda calls for an increased focus on the overlooked challenges for treatment of multiple chronic conditions where the need for patient adherence is most acute and offers realistic solutions for improving medication adherence through improved care coordination, harnessing new technology and supportive government policies. Contact NCPIE at firstname.lastname@example.org for more information on how you can become a part of this important initiative.Footnotes:
- 1. Acute vs. Chronic Conditions. MedlinePlus, U.S. National Library of Medicine. http://www.nlm.nih.gov/medlineplus/ency/imagepages/18126.htm.
- 2. Chronic Diseases and Health Promotion. Center for Disease Control and Prevention. http://www.cdc.gov/chronicdisease/overview/index.htm.
- 3. About the Crisis. Partnership to Fight Chronic Diseases. http://www.fightchronicdisease.org/facing-issues/about-crisis.
- 4. Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda, A National Action Plan to Address America’s “Other Drug Problem.” National Council on Patient Information and Education.
- 5. Ibid.
- 6. Prevalence of Multiple Chronic Conditions among US Adults: Estimates from the National Health Interview Survey, 2010. Center for Disease Control and Prevention. http://www.cdc.gov/pcd/issues/2013/12_0203.htm.
- 7. Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda, A National Action Plan to Address.
- 8. Chronic Conditions: Making The Case For Ongoing Care. Partnership for Solutions, Johns Hopkins University. http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf.
- 9. Multiple Chronic Conditions: A Public Health Challenge. Regina M. Benjamin, MD, MBA. Public Health Reports, Association of Schools of Public Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924996/#B2#B2.
- 10. Ibid.
- 11. Multiple Chronic Conditions: A Public Health Challenge. Regina M. Benjamin, MD, MBA. Public Health Reports, Association of Schools of Public Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924996/#B2#B2.
- 12. Ibid.
- 13. Ibid.
- 14. Chronic Conditions: Making the Case for Ongoing Care. Partnership for Solutions. Robert Wood Johnson Foundation. 2002. http://www.partnershipforsolutions.org/DMS/files/chronicbook2002.pdf.
- 15. Multiple Chronic Conditions: A Strategic Framework. US Department of Health and Human Services. http://www.hhs.gov/ash/initiatives/mcc/Implementation/address-mcc.html#framework.
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