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Table 5 Managing multiple conditions

From: “Was that a success or not a success?”: a qualitative study of health professionals’ perspectives on support for people with long-term conditions

Multi-morbidity could extend or complicate assessments of success in all three broad categories of aspects and elements of success. These comments are from an interview with Lucy, clinical psychologist, diabetes, London.
For example, someone I saw with diabetes and heart disease… So he was, I suppose, quite suicidal really when I saw him initially, and by the time we’d finished much more assertive, confident and the suicidal ideation had diminished, able to have constructive relationships with family members, so that was a good outcome. However, the medical conditions sort of were either maintained or slightly deteriorated, so there wasn’t really progress on that front…
I supposed there’s staged outcomes that we see sometimes as – sometimes you’re treating the depression and anxiety first before they’re in a position to feel motivated enough to then self-manage appropriately…. And the next stage might be to form a healthier relationship with their health team, so just thinking about the rapport they have and how confident they feel about asking questions in consultations, so you’re kind of facilitating that bit and then they might be in a position to start addressing their long term condition in a more helpful way…
Another factor [relevant to success] is patient co-morbidities because that comes up a lot. So they’re roughly juggling more than one long-term condition. And so if that other long term condition starts to deteriorate it impacts on their – but even ability to come to appointments regularly, and the number of medications people have to take, and not understanding what’s for what. I’m really passionate about the idea that often people need some kind of co-ordinator figure in order for them to self-manage well and that’s not – we haven’t quite got there yet in health care systems… I mean there’s a lack of joined up thinking across long term conditions and that’s not compatible with the reality which is that patients are juggling long term conditions - that’s often a barrier to successful outcomes.