Patients with complex chronic illnesses are overburdened by their treatment, doctors have warned.

According to a paper published today on bmj.com, treatment for patients suffering from conditions such as diabetes and heart failure can be unnecessarily disruptive and, in some cases, make health problems even worse.

Frances Mair, Professor of Primary Care research at the University of Glasgow and co-author of the paper, said their findings showed that some of the illnesses the chronically ill experience are actually induced by the healthcare systems themselves and that, to be effective, care must be less disruptive to the daily lives of patients.

"Our conclusion is that we need to think more about the burdens of treatment and better coordination of care," said Professor Mair.

"Thinking seriously about the burden of treatment may help us begin to consider minimally disruptive medicine - forms of effective treatment and service provision that are designed to reduce the burden of treatment on users. The treatment burden leads to poor adherence, wasted resources and poor outcomes," she continued.

The paper comes after 10 years of research. Among the illustrative cases it highlights is that of one man, treated for heart failure in primary care health care services in the UK. According to the authors, the individual rejected the offer to attend a specialist heart failure clinic to improve his condition because he said that, in the past two years, he had made 54 individual visits to specialist clinics for consultant appointments, diagnostic tests and treatment – the equivalent of one full day every two weeks.

"It is against this background that we are calling for minimally disruptive medicine that seeks to tailor treatment regimens to the realities of the daily lives of patients," added Professor Mair. "Such an approach could greatly improve the care and quality of life for patients," she said.

The paper led by Carl May, Professor of Medical Sociology, Institute of Health and Society, Newcastle University, also states that the ‘work’ of being a patient includes much more than drug management and self monitoring.

"It includes organising doctors' visits and laboratory tests. Patients may also need to take on the organisational work of passing basic information about their care between different healthcare providers and professionals. And in some countries, they must also take on the contending demands of insurance and welfare agencies. Patients are thus overwhelmed not just by the burden of illness, but by the ever present and expanding burden of treatment, say the authors," said Professor May.

The experts also suggest that clinicians and researchers need reliable tools to identify overburdened patients. Moreover, they have called for a shift towards improved coordination of care, the development of clinical guidelines for managing multiple chronic conditions and the improvement of the role patients and carers play in coordinating care and treatment.

Latest Open Access Paper: http://www.implementationscience.com/content/4/1/29

For more information, contact Eleanor Cowie in the University of Glasgow Media Relations Office on 0141 330 3683 or email e.cowie@admin.gla.ac.uk

First published: 11 August 2009

<< August