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Intervention may reduce treatment burden in patients with multiple chronic conditions
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For older adults with multiple chronic conditions, an intervention program designed to align patient care with individual health goals may be associated with reductions in treatment burden and unwanted health care, according to a study published in JAMA Internal Medicine.
“Older adults with multiple chronic conditions receive large amounts of health care, much of which is of uncertain benefit,” Mary E. Tinetti, MD, professor in the department of medicine at Yale School of Medicine and the department of chronic disease epidemiology at Yale School of Public Health, and colleagues wrote.
To determine if care consistent with the goals and values of patients with multiple chronic conditions could improve outcomes and reduce unwanted care, researchers conducted a nonrandomized clinical trial to compare outcomes in patients who received an intervention or usual care. The intervention, which researchers developed and called patient priorities care (PPC), is a program in which providers help older patients identify and communicate their health care goals and administer care consistent with those goals.
The study was conducted at two primary care practices — one where clinicians were trained to use patient priorities care, and one that continued usual care.
A total of 366 patients were include in the study. Patients in the PPC group were older (mean age = 77.6 years) compared with those in the usual care group (mean age = 74.7 years) and had lower physical and mental health scores at baseline.
At follow up, patients in the PPC group reported a decrease in Treatment Burden Questionnaire scores that were five points greater than those in the usual care group (beta = –5; P = .01), indicating lower treatment burden in the PPC group.
Within the PPC group, 66.3% of patients had health-priorities–based discussions noted in electronic health record documentation. No patients in the usual care group had records of health-priorities discussions.
Researchers found that PPCs were more likely to have their medications stopped during follow-up compared with those in the usual care group (weighted comparison, 52% vs. 33.8%; adjusted OR = 2.05; 95% CI, 1.43-2.95).
Compared with usual care patients, PPC patients were also less likely to have diagnostic tests ordered (80.8% vs. 86.4%; adjusted OR = 0.22; 95% CI, 0.12-0.4) and have self-management tasks added (57.5% vs. 62.1%; adjusted OR = 0.59; 95% CI, 0.41-0.84)
In a related editorial, Ian G. Hargraves, PhD, and Victor M. Montori, MD, of the knowledge and evaluation research unit at the Mayo Clinic, wrote that “[PPC], as demonstrated by what is to our knowledge the first clinical trial, may be a practical approach to achieving minimally disruptive medicine, a way to organize care that pursues patient goals while minimizing the burden of treatment.”
“Although PPC advances careful and kind care, we are challenged by how much farther we can go,” they added. – by Erin Michael
Disclosures: Hargraves, Montori and Tinetti report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.