The findings highlight the need for collaborative care, which has support in the proposed 2017 Medicare Physician Fee Schedule.
Chronic conditions, including mental health and substance abuse disorders, now affect more than half of the population—and many Americans have multiple, overlapping conditions that cause their health to decline, according to a new study.
The findings, published in Psychology, Health and Medicine, show that Americans’ health problems are becoming increasingly complex, and that for physicians, the challenge of treating multiple conditions at once is becoming more the norm than the exception.
Researchers Elizabeth Reisinger Walker, PhD, and Benjamin G. Druss, MD, MPH, pooled data from the National Survey on Drug Use and Health for the years 2010 to 2012, which covered 115,921 adults aged 18 years or older. Results found that 52.2% had at least 1 type of chronic conditions, whether it was a medical diagnosis (37.8%), a mental illness in the past year (18.4%), or a substance abuse disorder in the past year (8.6%). Meanwhile, 14.7% were living in poverty.
Compared with adults who did not report any chronic condition, those who were poor were more likely to receive government assistance, have less than a high school education, be unemployed, and have no health insurance. (Notably, the survey years were prior to full implementation of the Affordable Care Act.)
Results highlight the need for collaborative care, which the 2017 Medicare Physician Fee Schedule would support for the first time. In collaborative care, primary medical and mental health care are offered within a single practice, removing both the logistical barriers and the stigma for patients who need these services.
The authors honed in on the likelihood of more than 1 condition to occur at the same time:
· 6.4% of the respondents reported any mental illness and a chronic condition
· 2.2% reported any mental illness and substance abuse or dependence
· 1.5% reported substance abuse or dependence alongside chronic medical conditions
· 1.2% reported all 3 conditions (equivalent to 2.2 million people).
Those with mental illness were more than 3 times as likely to report substance abuse or dependence, and were 1.5 times more likely to report having a chronic medical condition. They were also 1.2 times more likely to live in poverty compared to those without mental illness.
The authors note that clinical practice guidelines for dealing with multiple morbidities often address depression, but these findings show the need to address substance abuse and dependence as well. Patients need to be connected to variety of well-coordinated services, they write.
“Our findings suggest the need to broaden our view of illness complexity beyond the healthcare system to address disadvantage and other social determinants of health,” they write.
Walker ER, Druss BG. Cumulative burden of comorbid mental disorders, substance use disorders, chronic medical conditions, and poverty on health among adults in the USA [published online September 3, 2016]. Psych Health Med. 2016; http://www.tandfonline.com/doi/full/10.1080/13548506.2016.1227855