WEDNESDAY, June 13, 2007 (HealthDay News) -- Having multiple chronic health conditions won't diminish the quality of health care you receive. In fact, having more than one chronic problem appears to slightly improve that care, a new study concludes.
With each additional chronic illness, the researchers found that health-care quality improved by about 2 percent.
"The assumption has been that, as patients get more complex, the health-care system will have trouble dealing with them, that time will be too short. The surprising finding here was that quality-of-care did not go down," said the study's lead author, Dr. Paul Shekelle, a staff physician at the Greater Los Angeles Veterans Administration Healthcare System, and a health researcher for the RAND Corporation in Santa Monica, Calif.
The study findings are published in the June 14 issue of the New England Journal of Medicine.
Sixty-five percent of people on Medicare have more than one chronic health condition and 32 percent have at least four conditions, according to the study.
Shekelle and his colleagues looked at three different groups of more than 7,500 adults to assess the quality of medical care, using "process" items rather than outcomes.
Process items are the expected elements of standard care. Examples would include: Did the patient receive a flu shot? If he has high blood pressure, were other heart disease risk factors addressed? Were women told to have mammograms if they were a certain age? Did smokers with heart disease receive smoking-cessation counseling?
The study found that, the more health problems a person had, the more likely he or she was to get the recommended health care. Common chronic illnesses examined included diabetes, heart failure, depression, high blood pressure and heart disease.
"The quality of care, measured according to whether patients were offered recommended services, increases as a patient's number of chronic conditions increases," the study's authors wrote.
"We found this in all three different data sets, so it's probably a real phenomenon," Shekelle said.
There are several reasons why people with chronic conditions might get better care, Shekelle explained. One is that they may simply have more opportunities to get the necessary procedures because they're at the doctor's office more often. Another possibility is that people with chronic conditions may also be receiving care from a specialist.
Not everyone is convinced, however, that the study's criteria are the best way to gauge quality in health care.
"This is an interesting study, but you shouldn't just look at process indicators, you should also look at outcomes, like mortality, hospital readmission and quality of life," said Dr. Louis Teichholz, division director of cardiology at Hackensack University Medical Center in New Jersey.
Plus, he added, a 2 percent difference may be statistically significant, but it's the clinical impact that really counts. "Clinically, whether you gained 2 percent or not, what difference does that make in the long run?" he said.
A potentially more important finding in this study, Teichholz said, is how far the health-care system needs to go to even meet the process indicators.
On a scale of zero to 100, all three of the data sets scored in the 50s or 60s, which, Teichholz said, means, "overall, we're not doing very well for these measures."
He added that the study showed that "quality is a never-ending battle, and we have to continue to improve."
Shekelle agreed. "We still have a long way to go to get the health-care delivery system where we're delivering all the care patients need all the time," he said.
Both Teichholz and Shekelle said people can improve their own care by becoming knowledgeable about whatever condition they have, and what the goals of treatment are.
"The patient is a partner and needs to be aware and better educated. If a patient can learn more and is compliant with medications and follow-up visits, quality of care will go up," Teichholz said.
More information
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