Coordinating Health Care for People with Multiple Chronic Conditions
Talking to Your Health Care Providers Is Vital

Nine in 10 older Americans, age 65 and older, have at least one chronic health condition, and 77 percent have multiple chronic conditions. The average 75-year-old has three chronic conditions and takes five prescription drugs. A Centers for Medicare & Medicaid Services (CMS) study found that older adults with five or more chronic health conditions have an average of 37 doctor visits, 14 different doctors and 50 separate prescriptions each year.

It is not surprising that studies show as the number of doctors and specialists involved in a patient's care increases, patients are likely to find it more difficult to coordinate their care. A large numbers of older adults with multiple chronic health conditions report duplicate tests and procedures, conflicting diagnoses for the same set of symptoms, contradictory medical information, and not receiving adequate information about potential drug interactions when they fill prescriptions, according to a study conducted by Johns Hopkins University. People with five or more chronic health conditions experience avoidable hospitalizations at 15 times the rate of those with one condition.

Improving health care quality is a team effort. The most important thing consumers can do to improve their health care and the care of their loved ones is to take an active role and communicate with their doctors. However, a number of studies illustrate the challenges faced in patient-provider communications. A national survey found one out of every three respondents had not talked with their doctor about all of their different medications in the last 12 months. Results indicated that many patients fail to talk to their doctors about changes in their medication regimens, including 40 percent of older adults who reported not adhering to their prescribed medication regimens.

Consumers who ask questions about their care, diagnosis, treatment and any medications prescribed can enhance the quality, safety and effectiveness of their health care. The answers they get can help them make better decisions, receive a higher level of care, reduce medical mistakes and feel better about their health care.

The U.S. Department of Health & Human Services Agency for Healthcare Research and Quality (AHRQ) offers tips to help consumers communicate with their health care providers:

• Tell your health care professional about your health history, symptoms, the other doctors you have seen and medical tests and procedures you have had.
• Write down questions in advance of an office visit.
• Take a list of all your medications to each appointment, including all over-the-counter medications, vitamins and supplements. Include the name of the drug, dosage and how often you take it.
• Take notes or ask the clinician to write down clear instructions for you. Go over your notes or instructions before you leave.
• Bring a family member with you to help you remember instructions or to catch anything you may miss.

AHRQ's Web site features a "Question Builder" to allow patients to select from a series of targeted questions and print out a customized list that they can bring with them to help make their medical appointments more efficient.

Coordinating care for a loved one with chronic health conditions can place a heavy burden on the caregiver. Better coordinated health care is crucial to older adults with multiple chronic health conditions and their family caregivers.

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