Exploring Polydoctoring: Insights from Two Recent Studies on Multimorbidity and Care Fragmentation
Published: 1 October 2024
Care fragmentation has emerged as a critical issue in managing patients with multimorbidity—those dealing with multiple chronic conditions. In a previous blog post, I introduced polydoctoring, a term we’ve developed to describe when multiple healthcare providers treat a single patient with multimorbidity. To investigate this issue, we have published two articles that shed light on the impact of polydoctoring in multimorbid older adults.
1. Association of Polydoctoring and Mortality Among Persons Over 85 Years with Multimorbidity: A Prospective Cohort Study
Published in BJGP Open
In this prospective cohort study, we have investigated the relationship between polydoctoring and all-cause mortality. Utilizing the dataset from the Kawasaki Aging and Wellbeing Project, we followed 968 patients over several years to investigate how polydoctoring impacts survival rates. Our findings revealed that polydoctoring could be beneficial for patients with moderate levels of multimorbidity (2–4 chronic conditions). These patients showed reduced mortality rates when regularly visiting multiple healthcare facilities. However, this benefit did not extend to those with five or more chronic conditions. As the number of chronic conditions increases, the treatment burden might exceed the patient’s capacity, possibly nullifying the benefits of specialist care. Additionally, patients with five or more comorbidities who did not regularly visit healthcare facilities had significantly higher mortality rates, emphasizing the importance of consistent care for this vulnerable group.
Key findings: Polydoctoring can be beneficial in reducing mortality for patients with moderate multimorbidity, but care coordination becomes more challenging and less beneficial among severe multimorbidity (5 or more chronic conditions).
2. Determinants of Polydoctoring Among Multimorbid Older Adults: A Cross-sectional Study
Published in Journal of General and Family Medicine
This cross-sectional study investigates the determinants of polydoctoring among elderly
individuals aged 85–89 years residing in an urban locale in Japan. We examined the healthcare utilization patterns of nearly 1,000 participants.
The study found that certain chronic conditions, such as eye diseases, osteoporosis, prostate diseases, and osteoarthritis, are significantly associated with increased polydoctoring. Interestingly, these conditions often fall within the scope of family medicine and general practice, suggesting that better training for primary care providers could reduce the need for multiple specialist consultations, thereby alleviating the treatment burden on patients and cutting healthcare costs.
Key findings: Polydoctoring is associated with specific chronic conditions, and enhancing the capacity of general practitioners to manage these conditions could improve healthcare efficiency and reduce care fragmentation.
A Global Call to Action
These insights, though based on Japan’s healthcare system, have global relevance. Improving care coordination and empowering primary care providers is essential to addressing care fragmentation. Let’s work together to develop strategies that improve care for multimorbid patients worldwide.
For more details, both studies are open access and linked below.
References: 1. Ando, T., et al. (2024). BJGP Open. DOI: 10.3399/BJGPO.2024.0016
2. Ando, T., et al. (2024). Journal of General and Family Medicine. DOI: 10.1002/jgf2.728
Author of this article
Takayuki Ando, M.D., MPH, PhD
Assistant Professor, Center for General Medicine Education, Keio University School of Medicine.
First published: 1 October 2024
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