Treatment for chronic illness "disruptive to daily life"
Many patients with complex chronic illnesses are overburdened by their treatment, according to a paper published on bmj.com today.
The authors argue that some of these problems are induced by healthcare systems themselves and that, to be effective, care must be less disruptive to the daily lives of patients.
Chronic disease is the great epidemic of our times, but the strategies we have developed to manage it have created a growing burden for patients, write Professors Carl May, Victor Montori, and Frances Mair. This treatment burden leads to poor adherence, wasted resources, and poor outcomes.
The work of being a patient includes much more than drug management and self monitoring, they explain. 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.
Furthermore, some of these problems are induced by healthcare systems themselves, and clinicians don't have the tools to respond adequately to this problem.
"We need to think more about the burdens of treatment," conclude the authors. "Thinking seriously about the burden of treatment may help us begin to think about minimally disruptive medicine - forms of effective treatment and service provision that are designed to reduce the burden of treatment on their users."
"Effective health education and good preventive ill health advice should I hope reduce the burden on the chronically ill in the future. I for one find it difficult sometimes to isolate the effects of one illness from another in patients with multiple chronic diseases and often wonder whether it might be useful for patients to start afresh with particularly the use and effects of medication on individual illnesses but multiple problems" - V Henry, London