Study: Patients Struggle to Control Multiple Chronic Conditions

Research by Kaiser Permanente shows that people with diabetes, high blood pressure, and high cholesterol have difficultly managing the conditions.

Most people who have diabetes, high blood pressure, and high cholesterol have difficultly managing all three conditions; indeed, success is fleeting for those who do manage all three, according to a Kaiser Permanente Institute for Health Research study that appears online in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.

The study of close to 29,000 individuals enrolled at Kaiser Permanente Colorado and Denver Health found that only 30.3 percent at Kaiser Permanente and 16.2 percent of individuals at Denver Health were able to simultaneously control their diabetes, hypertension, and hyperlipidemia (high cholesterol), as measured by risk factor control guidelines defined by the American Diabetes Association. But among those individuals that achieved simultaneous control of their conditions, few were able to maintain it at either institution.

Specifically, the study found that among those individuals with at least 90 days of follow-up after achieving simultaneous control, 39 percent from Kaiser Permanente and 23 percent from Denver Health subsequently lost and then regained control, and 56 percent and 64 percent lost control and never regained it. Only 5 percent at Kaiser Permanente and 13 percent at Denver Health never lost control of their chronic conditions--efforts to understand the strategies used by these individuals to care for their diabetes may provide insight into improving self-care and health outcomes, according to the researchers.

The researchers defined risk factor control using the 2002 guidelines from the American Diabetes Association, which were in place for the majority of the study period.

"Diabetes and other chronic conditions associated with it are very difficult but not impossible diseases to manage, for reasons we're just beginning to understand," said Emily B. Schroeder, MD, PhD, a research scientist with the Kaiser Permanente Institute for Health Research and the lead author of the study. "This research tells us to look more closely at how certain patients are able to control their multiple conditions, so clinicians can help patients recover and avoid greater risks of developing other ailments, including cardiovascular and kidney disease."

Multiple chronic conditions pose a significant and increasing burden in the United States according to the U.S. Department of Health and Human Services, with more than 75 million people in America reporting two or more chronic conditions. These individuals must maintain good nutrition and physical activity, manage complex medication regimens, and monitor themselves for achievement of treatment goals.

"This study highlights the fact that having several chronic health problems is common. We can't treat these conditions in isolation," said Edward Havranek, MD, a physician with Denver Health and co-author on the study. "We need to learn to help patients find ways to manage difficult combinations of conditions through strong relationships with primary care providers, simplified medicine regimens, and training in good diet and exercise."

This study marks the latest effort by Kaiser Permanente to better understand the impacts of diabetes. Earlier this year, a Kaiser Permanente study published in the Journal of the American Board of Family Medicine found that when patients with diabetes experience interruptions in health insurance coverage, they are less likely to receive the screening tests and vaccines they need to protect their health. The study found this was true even when patients received free or reduced-cost medical care at federally funded safety net clinics.

Last month, Kaiser Permanente announced that it was among 11 integrated health systems, with more than 16 million members in sum, that have combined de-identified data from their electronic health records to form the SUPREME-DM DataLink - the largest, most comprehensive private-sector diabetes registry in the nation.

This study was funded by a grant from the National Heart, Lung, and Blood Institute Cooperative Agreement, a grant from the Agency for Healthcare Research and Quality, the Colorado Clinical Translational Sciences Institute, and a ´┐ŻNational Institute of Diabetes and Digestive and Kidney Diseases Training grant.

Additional authors on the study include: Rebecca Hanratty, MD and Edward P. Havranek, MD, with Denver Health; Brenda L. Beaty, MSPH, with the Colorado Health Outcomes Program, University of Colorado Denver; Elizabeth A. Bayliss, MD, MPH, and John F. Steiner, MD, MPH, with the Institute for Health Research, Kaiser Permanente Colorado.

About the Kaiser Permanente Institute for Health Research
The Kaiser Permanente Colorado Institute for Health Research (IHR) publishes and disseminates epidemiologic, behavioral, and health services research to improve the health and medical care of Kaiser Permanente members and the communities it serves. The organization has a specific focus on conducting research that can be translated into clinical practice, health promotion, and policies to influence the health of individuals and populations. Currently, the IHR's staff of over 120 is working on more than 160 epidemiological, clinical, behavioral, community, and health services research projects. Now in its 20th year of operation, the IHR is responsible for many landmark findings. Among the most notable are recent studies about vaccine safety and vaccine refusal, home blood pressure monitoring and research that identified life-saving practices for heart attack patients in the Emergency Room. Teams of investigators collaborate on major research projects with national partners including the Centers for Disease Control and Prevention Vaccine Safety Datalink, the HMO Research Network, and the NIHCardiovascular Research Network and the Cancer Research Network.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health.

Source: Kaiser Permanente

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