NZ’s Hidden Chronic Health Burden Is Even Bigger Than We Thought – New Analysis

Katrina
Poppe, University
of Auckland, Waipapa Taumata Rau

In
New Zealand, more
than 80% of healthcare costs go toward caring for people
with long-term or chronic conditions.

Startling as
that statistic might seem, it won’t be so surprising to
those working in our hospital wards and general
practices.

Conditions such as diabetes, heart
disease and asthma are common, and many people live with two
or more at once – something called multimorbidity.

It’s
well known this requires ongoing care, often at a high
level. What is less understood, however, is just how much of
this need is missing from the hospital records health
planning and funding greatly rely on.

As these
records don’t always capture conditions managed by GPs in
the community, it can be difficult to establish the full
extent of multimorbidity.

Our recently
published research takes us closer to this – and
suggests hospital records alone may fail to identify more
than half of those found to have multiple long-term
conditions.

Building the bigger
picture

We examined the health records of 374,071
adults enrolled with general practices belonging to ProCare, a primary
health organisation serving the greater Auckland
region.

We linked their GP records with national
hospitalisation data, looking for evidence of 61 long-term
conditions, including cardiovascular disease, diabetes,
respiratory illnesses and cancer.

The records
covered patients enrolled in January 2014, so our findings
provide a historical snapshot rather than a measure of
today’s prevalence.

Using hospital records alone,
we found 14% of adults had two or more long-term conditions.
But when we included information recorded by their GPs, that
figure rose to 31%.

This meant another 62,453
people were identified as having multimorbidity only when GP
records were taken into account.

Across all age
groups, hospital records underestimated multimorbidity more
for women than men, with the largest differences generally
occurring between ages 55 and 84.

The overall
burden also increased markedly with age. More than 60% of
people aged 65-74 were living with at least two long-term
conditions, rising to nearly 80% among those aged
75-84.

Why do hospital records miss so
much?

Many long-term conditions are managed
primarily by GPs and other healthcare professionals in the
community, without patients needing hospital
treatment.

Even when someone is admitted to
hospital, conditions unrelated to the reason for their
admission may not be recorded.

Among the most
common conditions identified through GP records were high
blood pressure, joint and spinal disorders, diabetes and
chronic respiratory diseases such as
asthma.

Managing several conditions at once can be
complicated, requiring careful consideration of treatments,
possible drug interactions and side effects. In GP clinics,
these account for a sizeable share of
consultations.

Our findings suggest hospital
records capture only part of this workload, leaving much of
the care provided in the community unaccounted for when
assessing patients’ needs.

What this means for
the health system

Our findings have implications
for patients, healthcare professionals and those responsible
for planning and funding health services.

At
present, New Zealand lacks a fully integrated national
record of long-term health conditions across general
practice and hospitals. Important information held by GPs
may therefore not be available to hospital clinicians when
patients need treatment.

This can complicate
decisions about caring for patients with several long-term
conditions, particularly when treatments or medications
interact.

Incomplete medical histories might also
increase the risk of adverse events, potentially
contributing to longer hospital stays or avoidable
re-admissions.

There are obvious implications for
healthcare planning. Relying heavily on hospital data risks
underestimating the demand for ongoing care in the
community, along with the workforce and funding needed to
provide it.

General practices are already under
pressure, while hospital emergency departments face high
demand. As New
Zealand’s population ages, the number of people living
with multiple long-term conditions – and the complexity of
their care – is likely to increase.

The unsung
care of multimorbidity in the community is happening despite
a shortage of GPs, which has
long been documented.

And soon, more GPs will
be leaving the system than entering it. A 2022 Royal New
Zealand College of General Practitioner survey
reported that 37% of GPs intended to retire by 2027 and 55%
by 2032.

Our research highlights the need to bring
together information from general practice and hospitals,
giving health planners a more complete understanding of
patients’ needs and the resources required to meet
them.

The author acknowledges the
contribution of Susan Wells, Honorary Professor, School of
Population Health, University of Auckland, and Allan
Moffitt, Clinical Director, ProCare Health.

Katrina
Poppe, Associate Professor of Health Data Science,
University
of Auckland, Waipapa Taumata Rau

This article is republished from The Conversation
under a Creative Commons license. Read the original
article.