Living with chronic conditions can have a substantial impact on an individual’s health and their health service use. Analysis of the National Hospitals Morbidity Database, National Mortality Database and Australian Burden of Disease Study 2015 data shows the 10 selected chronic conditions:
- were involved in 5 in 10 hospitalisations (51%) in 2017–18
- contributed to nearly 9 in 10 deaths (89%) in 2018
- contributed to around 66% of the total burden of disease (fatal and non-fatal) in Australia in 2015 (excluding burden associated with osteoporosis which is not available within current burden of disease estimates) (AIHW 2019). See Burden of disease for more information on definitions and the burden of disease associated with these conditions.
Living with chronic conditions can also affect a person’s quality of life and have social and economic effects. The impact is even greater for people living with multimorbidity. Based on self-reported data from the 2017–18 NHS, people with multimorbidity were less likely to be in the labour force (working or seeking work) than people with no chronic conditions. Of all people aged 18–64 with multimorbidity, 71% were working or seeking work compared with 86% of people aged 18–64 with no chronic conditions (ABS 2019).
Compared with those with no long-term conditions, people aged 18 and over with multimorbidity also had higher levels of:
- disability, restriction or limitation (50% of people aged 18 and over with multimorbidity experienced disability, restriction or limitation compared with 7.9% of people of the same age with no long-term conditions)
- high or very high psychological distress (35% compared with 4.3%)
- bodily pain experienced in the previous 4 weeks (88% compared with 55%)
- fair or poor health (32% compared with 5.3%) (ABS 2019).
These comparisons adjust for differences in the age structure of the populations being compared.
Many chronic conditions share common risk factors that are largely preventable or treatable, for example: tobacco smoking, physical inactivity, poor diet , overweight and obesity and other biomedical risk factors such as high blood pressure. Preventing or modifying these risk factors can reduce the risk of developing a chronic condition and result in large population and individual health gains by reducing illness and rates of death.
As with chronic conditions, these risk factors tend to be more prevalent in the lowest socioeconomic areas and in regional and remote areas (see: Health across socioeconomic groups and Rural and remote health).
Most care for chronic conditions is provided in the primary health care setting by general and allied health practitioners. Mental and behavioural conditions (including anxiety, depression and mood disorders), musculoskeletal (including arthritis), respiratory (including asthma) and endocrine and metabolic conditions (including diabetes) were the most common health concerns managed by general practitioners in 2019 (RACGP 2019). Effective primary health care can help prevent unnecessary hospitalisations and improve health outcomes (AMA 2017; OECD 2017). See: Primary health care and Potentially preventable hospitalisations.
Within Australia, it is recognised that multimorbidity increases the complexity of patient care (Harrison & Siriwardena 2018). People living with multiple chronic conditions have more medical appointments and medications to manage (RACGP 2019), yet historically there has been a lack of coordination and communication between different parts of the Australian health care system (Department of Health 2018; RACGP 2019).
The Australian Government has implemented a number of approaches with the aim of improving coordination and care for people with chronic conditions, including:
- access to care plans and assessments through the Medicare Benefits Schedule for the planning and management of chronic conditions
- subsidies through the Pharmaceutical Benefits Scheme for a range of medicines used in the treatment of chronic conditions
- trialling Health Care Homes where patients are enrolled with a specific general practice or Aboriginal Community Controlled Health Service to coordinate their care and to facilitate services by a care team. The care team can include a range of health professionals (for example, general practitioners, specialists, allied health professionals and practice nurses) (Department of Health 2018).
In 2017, all Australian health ministers endorsed the National Strategic Framework for Chronic Conditions (the Framework). The Framework provides guidance for the development and implementation of policies, strategies, actions and services to tackle chronic conditions. It moves away from a disease-specific approach and better caters for shared health determinants, risk factors and multimorbidities across a broad range of chronic conditions.
The Framework outlines 3 objectives that focus on preventing chronic conditions, and thus minimising multimorbidities; providing efficient, effective and appropriate care to manage them; and targeting priority populations (AHMAC 2017). The Framework will be complemented by the development of a 10-year National Preventative Health Strategy announced by the Minister for Health in June 2019 (Department of Health 2019).
Where do I go for more information?
For further information on chronic conditions and multimorbidity, see:
Visit Chronic disease for more on this topic.
References
ABS (Australian Bureau of Statistics) 2018. National Health Survey: first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.
ABS 2019. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. Findings based on detailed Microdata analysis. Canberra: ABS.
AIHW (Australian Institute of Health and Welfare) 2019. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015—summary report. Australian Burden of Disease Study series no. 18. Cat. no. BOD 21. Canberra: AIHW.
AHMAC (Australian Health Ministers’ Advisory Council) 2017. National Strategic Framework for Chronic Conditions. Canberra: Australian Government.
AMA (Australian Medical Association) 2017. General practice in primary health care—2016 . Viewed 30 January 2020.
Department of Health 2018. Health Care Homes. Canberra: Department of Health. Viewed 30 August 2019.
Department of Health 2019. National Preventive Health Strategy. Canberra: Department of Health. Viewed 6 January 2020.
Harrison C and Siriwardena A 2018. Multimorbidity: editorial. Australian Journal of General Practice. Volume 47(1–2). Viewed 30 August 2018.
OECD (Organisation for Economic Co-operation and Development) 2017. Health at a glance 2017: OECD indicators. Paris: OECD.
RACGP (The Royal Australian College of General Practitioners) 2019. General practice: health of the nation 2019. Melbourne: RACGP.