Other unique findings
In terms of Medicare patients with chronic conditions, the survey found they have multiple concerns and fears, which the surveyed call “hidden hazards.” Forty-three percent worry about getting new conditions, and 27% worry about falling outside and 22% about falling at home.
In some of our most concerning findings is that 15% of patients say they have no one to talk to. Nearly one in five patients (19%) say they struggle to stay on top of their medical issues and need more help. The same percentage admit that “much of the time I feel like a burden because of my different conditions and am hesitant to ask anyone for help.” So, for many older and sicker patients, healthcare is a solitary journey.
And in terms of physicians, the study found that they worry lack of time impedes care quality for their patients with multiple chronic conditions. Ninety-five percent reported that they became a PCP to look at the whole patient, not just the different conditions they have. But 93% wish they had some sort of help available to make sure my patients with multiple chronic conditions were doing all the things they are supposed to be doing; 92% are concerned that their patients struggle to stay on top of their issues; 89% say their office tries to follow up with patients with multiple chronic conditions, but there is only so much they can do; and 88% worry that patients with multiple chronic conditions are not practicing medication adherence, such as taking medications as prescribed.
Top 3 care gaps for patients with chronic conditions
- Patients don’t always recognize or share all health-related issues. “We found patients may not always connect the quality of care they receive from their primary doctor—and social and behavioral factors that occur outside the physician setting—to their overall health,” says Dlott.
Two in five patients with multiple chronic conditions (44%) tell their doctor about their medical conditions, but not other issues they are facing that could affect their health, such as loneliness, financial issues and/or transportation issues. Some patients feel overwhelmed by their medical needs, feel like a “burden” on loved ones, and feel no one understands their concerns.
“That’s significant given other research that finds 80% of health outcomes are related to factors outside the traditional realm of healthcare delivery, including social, economic, and behavioral,” says Dlott.
2. Medication nonadherence is a major concern. Eighty-eight percent of PCPs say they are concerned patients with multiple chronic conditions are not taking medications as prescribed. Patient survey responses suggest this concern is valid: Nearly one-quarter (23%) of patients say there have been times when they forgot to take some of their medications or took the wrong ones. Yet, less than one in 10 (8%) patients reported medication adherence as a concern. That disconnect between their actions and their understanding of the importance of those actions is one of the reasons nonadherence costs are so high.
3. Patients are concerned about limited interaction with their physicians. “While patients overwhelmingly say they feel their PCP gives them enough attention, when probed further, many wish they could spend more time with their doctor,” says Dlott.
More than four in 10 patients (42%) believe that seeing their physician only one or twice a year to manage their multiple conditions “is just not enough.” And their doctors agree: Most PCPs surveyed believe that they should visit with their patients with multiple chronic conditions as often as six to eight times a year, and one in four say it should be monthly, weekly, or as often as needed.
“That’s where CCM services come in. CCM may help illuminate potential health risks before they occur, so individuals can retain their health and independence longer while reducing caregiver needs. With improved monitoring, individuals with multiple chronic conditions may expect a better quality of life,” says Dlott.