A new research analysis published in the April issue of Health Affairs is providing an international perspective on the challenges facing disease management and care management initiatives in Europe. The article, “Multimorbidity And Health Outcomes In Older Adults In Ten European Health Systems, 2006-15,” provides a very broad overview of the situation in several European nations.
The authors—Raffaele Palladino, Francesca Pennino, Martin Finbarr, Christopher Millett, and Maria Triassi—examined the issue in depth, using health outcomes data from ten European countries between 2006 and 2015, and finding that “the prevalence of multimorbidity rose from 38.2 percent in 2006–07 to 41.5 percent in 2015,” even as they note that, “Despite the increase in awareness of chronic disease, little is known about whether multimorbidity—defined as two or more coexisting chronic conditions—has had a diminished impact on health in Europe in the past decade.” The ten nations from which the researchers derived data to analyze were Austria, Belgium, the Czech Republic, Denmark, France, Germany, Italy, Spain, Sweden, and Switzerland. The data used for the study was extracted from the Survey of Health, Ageing and Retirement in Europe (SHARE), a European panel database that consists of nationally representative samples of respondents ages 50 and older in 20 European countries, and includes information on respondents’ sociodemographic characteristics, health status (including presence of chronic conditions and disability), and health care use and spending.
In their study, the researchers focused mainly on the presence of more than one of the following chronic conditions: “heart attack/problem; high blood pressure; stroke/cerebral vascular disease; diabetes/high blood sugar; chronic lung disease; arthritis/rheumatism; cancer; stomach/duodenal/peptic ulcer; Parkinson disease; cataracts; hip or femoral fracture; other fractures; Alzheimer disease/dementia/organic brain syndrome/senility/other serious memory impairment; and clinical depression. Both hip or femoral fracture and other fractures are indicative of fragility,” they note, “as fractures are associated with frailty in most cases.”
Worrisomely, however, the researchers have found that, “In many European countries chronic disease management programs have focused on single chronic conditions such as diabetes or COPD [chronic obstructive pulmonary disease], given the increased risk of avoidable hospital admissions and worse health outcomes for people with these conditions,” the researchers wrote. “Quality of care might, therefore, have improved differently for people with these conditions, compared with those affected by other chronic conditions.”
But the reality on the ground, the article’s authors have found, is that, “With aging populations, consequent longer exposure to risk factors, and improvements in medical technology, the increasing prevalence of multimorbidity has become a major challenge. European health care systems have been slow to respond, with care pathways typically fragmented and organized around single diseases. Exceptions include France, Germany, Spain, and the UK (which is not part of the Survey on Health, Ageing and Retirement in Europe project), where experimentation with integrated care approaches that target people with multimorbidity is under way. However, in the majority of cases, these approaches have not been rolled out nationally—with the exception of the UK, which has recently issued national guidelines for the assessment and clinical management of people with multimorbidity.”
As a result, the researchers conclude that “The prevalence of multimorbidity in Europe has increased since 2006–07. During this period associations between increasing numbers of chronic conditions and primary care use, reduced functional capacity, and self-perceived health have decreased in some European health care systems, while the impact on hospital admissions and quality of life has remained unchanged.”
