Multi-Morbidity and Complexity in the GP Flashcards
What is a complex patient
Individuals who have either multiple complex medical conditions, multiple
detrimental social determinants of health, or a combination of both that contribute to preventable
service utilization and poorer overall healthcare management that ultimately negatively impacts the
individual’s overall health status
What are the drivers for complexity?
Ageing population-understanding the implications – more chornic disease, more survivors of cancer and the consequences of this
Health resource allocation – if patient is living longer what does this mean from the capacity to deliver care to patients
Frameworks to support clinicians and policy makers in decision making
What is the definition of multi morbidity
definition: 2 or more
long-term conditions
How much of the population does multi-morbidity effect
Affects 25% of UK population
- effects 2/3 of the population in over 65y
What is the commonest pair for multi-morbidity
Cardiometabolic (E.G. diabetes ICH) + joint pain
What is the commonest triad for multi-morbidity
cardiometabolic + joint pain + mental health (such as depression and anxiety)
Why is the evidence for multi-morbidity lacking
Evidence is Lacking!
- Problematic with terms as no global understanding or agreement in what multi-morbidity means for example people use other terms such as co-morbidity
What is an indepndent risk factor for A and E attendance
multi morbidity
What factors impact on multi morbidity
- Age
- Socioeconomic status - poorer people get sicker earlier on in life and are sicker for longer
What are the NICE guidelines for multi-morbidity
how the person’s health conditions and their treatments interact and how this affects quality of life
the person’s individual needs, preferences for treatments, health priorities, lifestyle and goals
the benefits and risks of following recommendations from guidance on single health conditions
improving quality of life by reducing treatment burden, adverse events, and unplanned care
improving coordination of care across services.
What is the transitional model for multi-morbidity verusus the multi-morbidity modem
Traditional model
- this is the idea that there is a single condition focused approach to care, idea that each condition is single and there are multiple treatments for each condition
Multi-morbidity approach to care
- idea that conditions overlap, how the persons health conditions and their treatments interact and affect the quality of life, the persons individual needs and preferences for treatments, benefits and risk of recommendations from the guidance on single health conditions, improve quality of life by reducing treatment burden, adverse events and unplanned care, improving coordination of care across services
What is the definition of frailty
Frailty is a distinctive health state related to the ageing process.
Multiple body systems gradually lose their in-built reserves.
How many patients over the age of 65 and over the age of 85 have frailty
- around 10 percent of people aged over 65 years have frailty
- rises to between a 1/4 and a 1/2 in those over aged 85
Why is frailty important
- nursing home admissions
- A&E admissions – practises get charged for patients going to A and E
Name some frailty measuring tools
- Timed get up and go test
- Do they have to stop to talk to walk
- E frailty index (eFI)
- QFrailty
- recognition of a frailty syndrome
- Prisma 7
describe timed up and go test
Timed Get Up and Go Test-walk 4m-taking 5 seconds or longer may indicate frailty
describe do they have to stop to talk to walk test and what it is a predictor of
- do they have to stop talking to walk
- It is a predictor of frailty and falls
Describe the E frailty index
-embedded on common GP computer systems.
- Searches for 36 variables from the last year such as what age they are, admission to hospital, what medication they are on
= Mild - 0.12-0.24
= Moderate = 0.24-0.36
= Severe >0.36
What is QFrailty
= QMortality and QAdmissions algorhythms-identify as low/mod/high levels frailty
Name factors that can be a predictor of suspicions of frailty
- Falls (e.g. ‘collapse’, ‘legs gave way’, ‘found lying on floor)’
- Immobility (e.g. sudden change in mobility, ‘gone off legs’ ‘stuck on toilet’)
- Delirium (e.g. acute confusion, worsening of pre-existing confusion/short term memory loss)
- Incontinence (e.g. new onset or worsening of urinary or faecal incontinence)
- Susceptibility to medication side effects (e.g. confusion with codeine, hypotension with antidepressants).
What are the Prisma 7 questions
1] Are you more than 85 years?
2] Male?
3] do you have any health problems that require you to limit your activities
4] Do you need someone to help you on a regular basis?
5] do you have any health problems that require you to stay at home?
6] In case of need can you count on someone close to you?
7] Do you regularly use a stick, walker or wheelchair to get about?
What was the aim, funding and criteria for the health 1000 experience for complexity
Funding : Prime Ministers Challenge Fund
Aim: To recruit 1000 complex patient across 3 East London boroughs
Criteria: Need 5 of 8 medical conditions identified to join the Health 1000 GP practice
What is the definitions of complexity
Medical complexity
Psychological complexity
Social complexity
