Multiple Chronic Conditions
PCORI Answers Critical Questions
PCORI funds studies to help patients and those who care for them answer a range of questions about multiple chronic conditions, such as:
Patient: After starting medication for bipolar disorder, I gained weight. Despite doing my best to change my diet and exercise, I have not been able to lose it. Could taking the drug metformin be an effective and safe long-term way to lose weight?
Clinician: Many of my patients put nonhealth issues, such as paying the electric bill, ahead of their health. When I’m unaware of these problems, our already short appointments are less effective for diagnosis and treatment. Would partnering with community health workers or patient navigators improve my patients’ health outcomes?
Patient: I have two chronic conditions and often find it difficult to manage my time at doctors’ appointments. What are the most effective strategies for prioritizing concerns I want to raise with my doctor?
Study Results that Support Better-Informed Decisions
|Comparing Ways to Treat Back Pain Using a Stratified Risk Approach
A PCORI-funded study aimed to test whether a risk-stratified approach to treatment in primary care settings would result in lower rates of patients with acute back pain developing chronic back pain. To assess chronic pain risk, researchers at the University of Pittsburgh asked patients questions about how they were coping with back pain and assigned them to either low-, medium-, or high-risk groups. Patients who scored high risk were placed into two groups: usual care or usual care plus psychologically informed physical therapy, which also teaches patients coping skills to manage back pain. As reported in EClinical Medicine, among patients at high risk, 50 percent developed chronic back pain regardless of type of care, while 20 percent of low-risk and 33 percent of medium-risk patients developed chronic low back pain.
|Patient Portals Can Boost Office Visits, Cut ER Use
Access to a patient portal can increase engagement in outpatient visits by patients with diabetes and those with multiple complex chronic conditions, according to a PCORI-funded study spotlighted in PLOS One. The study showed that portal use was associated with significantly fewer emergency room visits and preventable hospital stays for patients with multiple complex conditions. By increasing patient office visits, a portal could potentially help clinicians address unmet clinical needs and reduce health events that lead to emergency and hospital care. The observational study compared visit rates for 165,000 patients with and without portal access in a large healthcare system.
|Long- and Short-Term Smoking Cessation Interventions Show Similar Results
Among smokers with chronic obstructive pulmonary disease (COPD), the number who quit after receiving 23 months of nicotine-replacement therapy (NRT) and six counseling sessions was nearly the same as the number who quit after receiving 10 weeks of NRT and four counseling sessions, according to findings of a PCORI-funded study published in JAMA Network Open. While there were insignificant differences in the number of cigarettes smoked per day between the groups, both saw decreases in exposure to unhealthy chemicals and adverse cardiac events. The study followed nearly 400 adults.
Multiple Chronic Conditions Study Spotlights
It can be effective to have a nurse or social worker coordinate the care across multiple healthcare providers for people with multiple chronic conditions. But case management is resource-intensive. Clinicians and others would like to know which elements are most vital or which patients are most likely to benefit. This study is comparing case management of older patients with multiple chronic conditions with standard care of similar patients to answer these questions.
This study is comparing two ways to treat high blood pressure. One focuses on improving how clinic staff measure and track patients’ blood pressure. The other method connects patients to community health workers, who come to their homes and help address factors that might make their blood pressure hard to control. In this method, if patients’ blood pressure still doesn’t improve, they get additional care from specialists.
Community health workers can lower barriers to receiving care and managing health for low-income patients with more than one chronic condition. This project is testing whether goal setting plus support from a community health worker compared with goal setting alone better helps patients reach their disease-management goals, such as feeling better, avoiding hospitalizations, and feeling more in control of their health.