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In medicine, comorbidity refers to the simultaneous presence of two or more medical conditions in a patient; often co-occurring with a primary condition. It originates from the Latin term morbus prefixed with co- ("together") and suffixed with -ity. Comorbidity includes all additional ailments a patient may experience alongside their primary diagnosis, which can be either physiological or psychological in nature. In the context of mental health, comorbidity frequently refers to the concurrent existence of mental disorders, for example, the co-occurrence of depressive and anxiety disorders. The concept of multimorbidity is related to comorbidity but is different in its definition and approach, focusing on the presence of multiple diseases or conditions in a patient without the need to specify one as primary.
Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. The term polypharmacy is often defined as regularly taking five or more medicines but there is no standard definition and the term has also been used in the context of when a person is prescribed 2 or more medications at the same time. Polypharmacy may be the consequence of having multiple long-term conditions, also known as multimorbidity and is more common in people who are older. In some cases, an excessive number of medications at the same time is worrisome, especially for people who are older with many chronic health conditions, because this increases the risk of an adverse event in that population. In many cases, polypharmacy cannot be avoided, but 'appropriate polypharmacy' practices are encouraged to decrease the risk of adverse effects. Appropriate polypharmacy is defined as the practice of prescribing for a person who has multiple conditions or complex health needs by ensuring that medications prescribed are optimized and follow 'best evidence' practices.
A polypill or single pill combination (SPC) is a type of drug combination consisting of a single drug product in pill form and thus combines multiple medications. The prefix "poly" means "multiple", referring to the multiplicity of distinct drugs in a given "pill". In precise usage, a pill is a polypill if it contains at least 4 drugs. An occasional synonym is combopill. A polypill is commonly targets treatment or prevention of chronic conditions.
Behavioral medicine is concerned with the integration of knowledge in the biological, behavioral, psychological, and social sciences relevant to health and illness. These sciences include epidemiology, anthropology, sociology, psychology, physiology, pharmacology, nutrition, neuroanatomy, endocrinology, and immunology. The term is often used interchangeably, but incorrectly, with health psychology. The practice of behavioral medicine encompasses health psychology, but also includes applied psychophysiological therapies such as biofeedback, hypnosis, and bio-behavioral therapy of physical disorders, aspects of occupational therapy, rehabilitation medicine, and physiatry, as well as preventive medicine. In contrast, health psychology represents a stronger emphasis specifically on psychology's role in both behavioral medicine and behavioral health.
A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, chronic obstructive pulmonary disease, autoimmune diseases, genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome. An illness which is lifelong because it ends in death is a terminal illness. It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms.
Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, exercise, sleep, and hygiene. Self-care is not only a solo activity, as the community—a group that supports the person performing self-care—overall plays a role in access to, implementation of, and success of self-care activities.
Multimorbidity, also known as multiple long-term conditions (MLTC), means living with two or more chronic illnesses. For example, a person could have diabetes, heart disease and depression at the same time. Multimorbidity can have a significant impact on people's health and wellbeing. It also poses a complex challenge to healthcare systems which are traditionally focused on individual diseases. Multiple long-term conditions can affect people of any age, but they are more common in older age, affecting more than half of people over 65 years old.
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, heart diseases, cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others. NCDs may be chronic or acute. Most are non-infectious, although there are some non-communicable infectious diseases, such as parasitic diseases in which the parasite's life cycle does not include direct host-to-host transmission.
Chronic care refers to medical care which addresses pre-existing or long-term illness, as opposed to acute care which is concerned with short term or severe illness of brief duration. Chronic medical conditions include asthma, diabetes, emphysema, chronic bronchitis, congestive heart disease, cirrhosis of the liver, hypertension and depression. Without effective treatment chronic conditions may lead to disability.
Victor Montori is a professor of medicine at the Mayo Clinic in Rochester, Minnesota, USA. He was born and raised in Lima, Peru. He completed medical school at Universidad Peruana Cayetano Heredia in Peru, before joining the Internal Medicine Residency Program at the Mayo Clinic. He was named Chief Resident of the Department of Internal Medicine from 1999 to 2000.
Prescription cascade is the process whereby the side effects of drugs are misdiagnosed as symptoms of another problem, resulting in further prescriptions and further side effects and unanticipated drug interactions, which itself may lead to further symptoms and further misdiagnoses. This is a pharmacological example of a feedback loop. Such cascades can be reversed through deprescribing.
Chronic care management encompasses the oversight and education activities conducted by health care professionals to help patients with chronic diseases and health conditions such as diabetes, high blood pressure, systemic lupus erythematosus, multiple sclerosis, and sleep apnea learn to understand their condition and live successfully with it. This term is equivalent to disease management for chronic conditions. The work involves motivating patients to persist in necessary therapies and interventions and helping them to achieve an ongoing, reasonable quality of life.
Carl May FAcSS is a British sociologist. He researches in the fields of medical sociology and Implementation Science. Formerly based at Southampton University and Newcastle University, he is now Professor of Health Systems Implementation at the London School of Hygiene and Tropical Medicine. Carl May was elected an Academician of the Academy of Learned Societies in the Social Sciences in 2006. He was appointed a Senior Investigator at the National Institute for Health and Care Research (NIHR) in 2010. He was elected an Honorary Fellow of the Royal College of General Practitioners in 2020. He has honorary professorial appointments in primary care at the University of Melbourne, and in public health at Monash University.
The Normalization process model is a sociological model, developed by Carl R. May, that describes the adoption of new technologies in health care. The model provides framework for process evaluation using three components – actors, objects, and contexts – that are compared across four constructs: Interactional workability, relational integration, skill-set workability, and contextual integration. This model helped build the Normalization process theory.
Normalization process theory (NPT) is a sociological theory, generally used in the fields of science and technology studies (STS), Implementation Science, and healthcare system research. The theory deals with the adoption of technological and organizational innovations into systems, recent studies have utilized this theory in evaluating new practices in social care and education settings. It was developed out of the normalization process model.
Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. First used in this sense in 1924, the term was introduced to sociology in 1976 by Ivan Illich, alleging that industrialized societies impair quality of life by overmedicalizing life. Iatrogenesis may thus include mental suffering via medical beliefs or a practitioner's statements. Some iatrogenic events are obvious, like amputation of the wrong limb, whereas others, like drug interactions, can evade recognition. In a 2013 estimate, about 20 million negative effects from treatment had occurred globally. In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990.
Childhood chronic illness refers to conditions in pediatric patients that are usually prolonged in duration, do not resolve on their own, and are associated with impairment or disability. The duration required for an illness to be defined as chronic is generally greater than 12 months, but this can vary, and some organizations define it by limitation of function rather than a length of time. Regardless of the exact length of duration, these types of conditions are different than acute, or short-lived, illnesses which resolve or can be cured. There are many definitions for what counts as a chronic condition. However, children with chronic illnesses will typically experience at least one of the following: limitation of functions relative to their age, disfigurement, dependency on medical technologies or medications, increased medical attention, and a need for modified educational arrangements.
Digital therapeutics, a subset of digital health, are evidence-based therapeutic interventions driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. Digital therapeutic companies should publish trial results inclusive of clinically meaningful outcomes in peer-reviewed journals. The treatment relies on behavioral and lifestyle changes usually spurred by a collection of digital impetuses. Because of the digital nature of the methodology, data can be collected and analyzed as both a progress report and a preventative measure. Treatments are being developed for the prevention and management of a wide variety of diseases and conditions, including type 1 & type II diabetes, congestive heart failure, obesity, Alzheimer's disease, dementia, asthma, substance abuse, ADHD, hypertension, anxiety, depression, and several others. Digital therapeutics often employ strategies rooted in cognitive behavioral therapy.
The taxonomy of the burden of treatment is a visualization created for health care professionals to better comprehend the obstacles that interfere with a patient's health care plan. It was created as a result of a worldwide, qualitative-based study that asked adults with chronic conditions to list the personal, environmental, and financial barriers that burden a patient. The purpose of this visualization is to help health care providers develop personalized management strategies that the patient can follow through a narrative paradigm. The goal is to target interventions, achieve an interpersonal doctor-patient relationship, and improve health outcomes.
Goal-oriented health care, also known as goal-directed health care, goal-oriented medical care, and patient priorities care, is a form of health care delivery that is based on achieving individualized goals that are created through collaborative conversations between patients and providers in health care settings. It is a form of Patient Centered Care/Person-Centered Care as the goals are unique to the individual patient and direct the plan of care. This is in contrast to problem-oriented or disease-driven care where the focus is on correcting biological abnormalities. This philosophy of practice is become attractive in the medical community especially in primary care practices worldwide.
References
- ↑ May, Carl; Montori, Victor M.; Mair, Frances S. (2009-08-11). "We need minimally disruptive medicine". BMJ. 339: b2803. doi:10.1136/bmj.b2803. ISSN 0959-8138. PMID 19671932. S2CID 3948302.
- ↑ May C, Finch T. Implementation, embedding, and integration: an outline of Normalization Process Theory. Sociology 2009;43:535-54
- ↑ May C, Mair FS, Finch T, MacFarlane A, Dowrick C, Treweek S, Rapley T, Ballini L, Ong BN, Rogers A, Murray E, Elwyn G, Legare F, Gunn J, Montori VM. Development of a theory of implementation and integration: Normalization Process Theory. Implementation Science 2009;4.
- ↑ Tran, Viet-Thi; Montori, Victor M; Eton, David T; Baruch, Dan; Falissard, Bruno; Ravaud, Philippe (December 2012). "Development and description of measurement properties of an instrument to assess treatment burden among patients with multiple chronic conditions". BMC Medicine. 10 (1): 68. doi: 10.1186/1741-7015-10-68 . ISSN 1741-7015. PMC 3402984 . PMID 22762722.
- ↑ Gallacher, K., et al., Understanding patients' experiences of treatment burden in chronic heart failure using normalization process theory. Ann Fam Med, 2011. 9(3): p. 235-43.
- ↑ Eton, D.T., et al., Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Related Outcome Measures, 2012. 2012:3: p. 39-49.
- ↑ Gallacher K, Jani B, Morrison D, Macdonald S, Blane D, Erwin P, May CR, Montori VM, Eton DT, Smith F, Batty DG, Mair FS. Qualitative Systematic reviews of treatment burden in stroke, heart failure and diabetes - Methodological challenges and solutions. BMC Medical Research Methodology 2013;13(10).
- ↑ Jani B, Blane D, Browne S, Montori V, May C, Shippee N, Mair FS. Identifying treatment burden as an important concept for end of life care in those with advanced heart failure. Current Opinion in Supportive and Palliative Care 2013;7(1):3-7.
- ↑ Vijan S, Hayward RA, Ronis DL, Hofer TP: Brief report: the burden of diabetes therapy: implications for the design of effective patient-centered treatment regimens. J Gen Intern Med 2005, 20(5):479-482.
- ↑ Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, Magid DJ: Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med 2006, 166(17):1836-1841.
- ↑ Tran, V.T., et al., Development and description of measurement properties of an instrument to assess Treatment Burden among patients with multiple chronic conditions. BMC Med, 2012. 10(1): p. 68.