As the Baby Boomers age in the next 10 to 20 years, multimorbidity is going to become one of the world’s most pressing health care challenges. A person with multimorbidity has two or more chronic diseases. As the number of chronic conditions they have increases, so does the burden of their symptoms, complexity of treatment, and even risk of early death. The effects of multimorbidity will be particularly challenging for publicly funded universal health care systems like in Denmark, where over half of the population over 65 has two or more chronic conditions. Alexandra Jønsson, a PhD student in medical anthropology at the University of Copenhagen, researches multimorbidity to give health care providers a leg up on how to effectively plan treatments.
Before starting her PhD research, Alexandra was a project manager at an umbrella organisation of Danish patient groups where she conducted research about patient involvement, multimorbidity, and patient experience. Through her research, she realised that multimorbidity treatment plans didn’t take into account the priorities of actual patients living with multiple chronic conditions. Using the insights from her project manager role, Alexandra decided to do a PhD on the subject and bring a new perspective to patient care. She wants patients to be involved in the planning of their treatment so that the treatments fit better into their everyday lives, and ease navigation of the health care system. In addition to improving overall patient well-being, involving patients in the development process could lower health care costs and allow resources to be better allocated.
Although Denmark has universal health coverage for every Danish citizen, Alexandra’s ethnographic research in rural communities showed that there are still inequalities in health care. Her research focuses on this group of the Danish population which is often ignored. Elderly patients with severe chronic conditions who are of lower socioeconomic status and have low levels of education are more likely to engage in behaviours that will negatively affect their health, such as smoking or be incompliant due to the complexity of the treatment plans. This frustrates their doctors since it seems like the patients don’t want to follow their treatment plans. Alexandra’s research suggests some ways to increase compliance among this group.
She has identified three major ways to improve compliance among multimorbidity patients. Her first recommendation is that health care needs to be customized. These patients need ongoing medical attention and are being treated for multiple diseases at the same time by specialists who often don’t know the details of the patient’s other treatments. These different treatment plans can be conflicting and Alexandra has found that if they ignore the realities of a patient’s everyday life, the patient will not follow treatment. For example, a patient in a band might continue to eat unhealthy food with their band mates against doctor’s orders because “that’s part of being in a band.”
Her second recommendation calls for recognition of gendered expectations towards multimorbid patients: Doctors, relatives and even patients themselves seem to lower their expectations when it comes to older men and their ability to follow treatment plans and self-care. These subconscious re-enactments of gender roles actually worsen men’s health as consequently doctors make fewer demands on men to follow their treatment plans.
Alexandra’s third recommendation is that treatment plans should take a more holistic approach to self-care. While patients might not follow their doctor’s recommendations to the letter, their noncompliance activities have a positive impact on their social and psychological health. If a patient’s prescribed walk may zap all their energy for the day, they may choose instead to drive to meet their friends and spend the energy socialising.
Putting Alexandra’s recommendations into practice would help doctors take a more realistic approach to multimorbidity care and give patients a larger role in their own health decisions. It could also optimize the allocation of resources like busy specialists and costly subsidized medications and lead to a better quality of life for multimorbidity patients.
The validation that Alexandra gets from her colleagues and patients inspires her to continue her research. She is bringing more attention to the issue of patient engagement and even received a Fox International Fellowship for one fully funded year of study at Yale. She hopes to come up with strategies to fight some of the inequalities identified through her research and effect policy changes both in Denmark and the rest of the world. “I feel like I can actually make a positive difference to people in a vulnerable position.”