Nearly a quarter of our patients are over 65 years of age. Many of them have multiple long-term conditions; as people age, the number of conditions that afflict them increase.
Long term conditions such as chronic obstructive airways disease and diabetes don’t go away. Management, rather than cure, involves routine work to avoid exacerbation events, detect and avoid recurrence, and to mitigate – and sometimes prevent – disease progression. For each condition, there are guidelines for the best management, and these guidelines have become a yardstick to measure performance of clinical teams.
If you have many conditions, each one with guidelines, and specialist nursing teams and clinics, then the work of looking after each condition becomes considerable. For our rural patients, each trip to the surgery or hospital can be costly and hard to arrange, calling on favours from friends and family. Medications all have side effects, and monitoring with blood tests puts clinicians in judgement of the success of your labours and of your compliance.
Over the last five years, there has been discussion in the journals about how to manage this dilemma. How should we measure burden of treatment, and how should we minimise it? There are measurement tools such as PETS (Patient Experience with Treatment and Self-management) – but this has 48 questions, and is surely devised as a research tool rather than something that can be slipped into General Practice
How do we optimise the workload for patients? The answer lies in the following big ideas:
- Patient-centred rather than disease centred care.
- Good communication about risks and benefits, including the treatment burden of each intervention.
- Patient-centred goal-setting based on good communication.
It will be interesting to see how well we can move more in this direction as we contemplate ‘going live’ with House of Care this spring.
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602768/ Assessing the burden of treatment (Journal of General Internal Medicine)
- www.sspc.ac.uk › media › media_484740_en Treatment burden – the Scottish School of Primary care
- BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4065 (Published 12 October 2018) Clinical guidelines should recognise the burden of treatment on patients
- https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-281 Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness
Hebridean Adventures in Realistic Medicine 