Chronic illness epidemic forcing system shift

 Ever heard of neurodiabesity? How about osteocanceritis, respicardiotis, arthrostrokoma or fibrodepressile?

While these names are made up, they represent the idea that many older adults are living with multiple chronic health conditions, according to Marian Walsh, president and CEO of Toronto's Bridgepoint Health.

That's because modern medicine is so successful that people are surviving conditions that they would have died from in the past, and are going on to develop new conditions.

Walsh was the guest speaker at a Oct. 12 forum on chronic disease and prevention put on by the North East Local Health Integration Network.

Bridgepoint Health, as well as providing complex and rehabilitation care, does research in the area of how to best treat complex patients with more than one condition, and is also the site of a family health team.

According to information from a 2008 international survey looking at those with at least one chronic condition, 62 per cent of Canadians polled actually had more than one chronic condition.

In the past two years, 47 per cent of those polled had been hospitalized, 29 per cent had undergone major surgery, 32 per cent saw four or more doctors and 42 per cent were taking more than four prescription medications regularly.

But Walsh said the Canadian health-care system isn't set up to meet the needs of those with multiple chronic conditions.

Currently, the system goes something like this: a patient goes to the hospital emergency room, is admitted to the hospital, is eventually discharged into rehabilitative care, and is sent home or to long-term care. 

That's until they get sick again, and end up in the emergency department, thus starting the whole loop once again. 

With the way our current system is set up, 170,000 Ontarians use $9 billion in health care resources every year. The way things are going, the epidemic of chronic illnesses could end up swamping the province's budget in short order, she said.

“What the research shows is that in fact today, 70 per cent of all of our health care resources are not going to treating the first lifesaving event,” Walsh said.

“Actually, what we're using 70 per cent of health-care resources on are the ongoing management of a lot of these underlying illnesses that we haven't cured, but we're keeping people alive with.”

She said she'd instead like to see a number of services wrapped around the patient, such as primary care and ambulatory care, so that they don't get so sick that they end up in the hospital.

“We're saying we've got to change it up,” Walsh said. 

“The hospital should be the last place that people go, because the community is very well organized and acting as a hub, and wrapping around the patients who are complicated, and providing a lot of intensive care and support, and working together to do it.”

Given that those living in northeastern Ontario have traditionally been sicker than those living in the rest of the province, health-care providers in this region probably have “more compelling reasons” to implement this type of model, she said.

Walsh said she's impressed that the North East LHIN put on the forum in the first place. “You have some challenges in terms of how to get that organized to serve people right across the north, but I believe that just by talking about it, the LHIN is focused on the right issue,” she said.

Institutions such as Bridgepoint Health and the St. Joseph's Complex Continuing Care facility in Sudbury also have a role to play in transforming the system to better serve those with multiple chronic conditions, Walsh said.

“They haven't had a mandate to do it, but I think they should be given a mandate to do it, in partnership with LHINs and with community care providers,” she said. “I'm convinced we can make it happen.”

Dr. Ian Cowan, a North Bay family doctor who serves on the board of the North East LHIN, said he thinks Walsh talk was “one of the most exciting things I've heard in a long time.”

He said the reason the North East LHIN hosted the chronic disease forum is because “we realize that the way we're managing chronic disease is not working as well as it should, and it's economically costing more than it should.”

Cowan said he thinks family health teams, which consist of health-care professionals from multiple disciplines working together to help patients, should be the wave of the future.

“We need to expand that whole model,” he said. “The hospital needs not to be the area where you access all these services. You should be able to tackle these problems without them having to go to the hospital first.”