Patient-centred Approach to Counter Multi-Morbidity
By Express News Service | Published: 22nd May 2014 09:47 AM |
BHUBANESWAR: At least one in four persons attending any primary healthcare set-up in Odisha suffers from two or more chronic diseases, a first ever study to explore the extent of multi-morbidity on the population in the State has revealed.
Prevalence of multi-morbidity or presence of more than one chronic condition like hypertension, diabetes, arthritis or other musculoskeletal problems, respiratory diseases, acid peptic disease (APD) and visual disorders has been found to be over 28 per cent in primary care settings, necessitating re-designing of treatment modalities to be patient-specific rather than the conventional disease specific approach.
The research on “Prevalence pattern and correlates of multi-morbidity on primary care setting in Odisha,” was conducted by Indian Institute of Public Health in collaboration with the State Health and Family Welfare department across 10 districts.
Patients attending 20 Community Health Centres (CHCs) in the four KBK districts of Koraput, Balangir, Rayagada and Gajapati along with Khurda, Dhenkanal, Boudh, Sundargarh, Deogarh and Mayurbhanj were assessed during the period between April and September, 2013.
Of all the chronic diseases, APD was leading at a prevalence rate of 30.8 pc followed by hypertension 16.4 pc and arthritis 15.4 pc. Prevalence of diabetes was 6.4 pc and nearly 12 pc were suffering from chronic back pain. Chronic lung disease and TB afflicted 2.8 pc and 1.5 pc patients respectively.
“It is noteworthy that in five districts, one in every three persons had two or more chronic conditions. Sundargarh, Mayurbhanj and Gajapati had the multi-morbidity frequency as high as 34.39 pc, 33.47 pc and 32.44 pc respectively while Koraput and Balangir were at the bottom with a prevalence rate of less than 18 pc,” principal investigator Dr Sanghamitra Pati said.
APD was seen as the most common co-morbidity with most of the chronic conditions. Hypertensive patients shared APD, arthritis, diabetes and vice versa. There was a steep increase in multi-morbidity with age as 40 pc of patients over 50 years had more than one chronic disease against around 25 pc of the patients between 30 and 50 years.
“This is a serious issue as multi-morbidities often require almost diametrically opposite treatment. One suffering from APD or gastric disorder cannot be prescribed Nonsteroidal Antiinflammatory Drugs (NSAIDs) for managing arthritis or chronic back pain. Beta blockers for hypertensives counteract with Chronic Obstructive Pulmonary Disease (COPD) like asthma in situation of multi-morbidities. Thus, a single disease-based treatment should be discouraged and patient-centred approach adopted while managing comorbidities,” Dr Pati said.
While the study recommends development of a standard treatment protocol for management of multi-morbidity, State nodal officer for National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes (NPCDCS) Dr P K B Patnaik stressed on orientation of physicians to recognise the importance of multi-morbidity as a critical and complex healthcare issue. Increasing awareness levels among patients should also be a priority, he said.