Sunday, 14 October 2012

Multiple chronic diseases

Most neuropsychologists have encountered the difficulties in differential diagnosis for patients with complex comorbidities and chronic disease. There can be so many things that may contributing to cognitive dysfunction that it's hard to pin it down on one cause.  This article talks about how people with multiple chronic conditions suffer from our fragmented and highly specialised medical system, where cardiologists, rheumatologists, neurologists, endocrinologists, and other specialists are great at the disorders they treat, but find it harder to provide integrated care to people with multiple conditions.

I like the idea at the end of the article, of "comprehensive care physicians" who work in hospitals to coordinate care between different specialists. Good physicians do this already, of course, but it's not an easy task, and the information obtained doesn't always filter down to the multidisciplinary team (MDT) who are looking after the patient during their hospital admission. Better communication and documentation of coordinated interdisciplinary care would make a big difference to people with multiple conditions, and I fantasise that ehealth records may make this easier. Though it would be even better if clinicians could pose questions to each other about patient care, to clarify any scenarios not included in the reports included in the patient file.

My hospital has recently opened an Integrated Care Service, and I'm engaged in preliminary discussions about how we can get a interdisciplinary MDT set up to provide services to people with neuro disorders, irrespective of their aetiology - while fragmentation into disease types might work in large cities with no workforce problems, in regional areas, we can't afford to be picky about which patients they see. Health professionals with competencies in neuroscience are scarce, and we need to work together for the betterment of all patients. Well, that's the fantasy, anyway. Funding is still directed to whichever disease has the strongest lobby group, but we'll try to be creative...Memory groups and cognitive skills training groups are one way ahead, and I'm grateful to colleagues like Sharon Naismith, Laurie Miller, Dana Wong and Glynda Kinsella for the research they've shared about the benefits of interventions for people with brain disorders or early cognitive changes.

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