A scientific study has revealed that almost 40% of patients with chronic conditions consider the “burden of treatment” to be unsustainable in terms of the energy, time and money invested.
1| Chronic diseases are a major public health challenge
The management of chronic or noncommunicable diseases is complex and represents a major public health challenge.
The HAS (French National Authority for Health) states that “the prevalence of chronic diseases is increasing steadily due to longer life expectancies”.
According to the French National Health Insurance system, long-term conditions are diseases for which the “seriousness and chronic nature require long-term treatment and particularly expensive therapies”.(1)
The World Health Organization confirms that chronic diseases (heart disease, stroke, cancer, chronic lung disease, diabetes, etc.) are, collectively, the biggest cause of death worldwide. They are estimated to be responsible for 63% of deaths (WHO, 2008).(2)
There are currently more than 9 million people with a long-term condition, and the figure is tending to increase with population aging and people often suffering from multiple conditions. Over the past 10 years, we have witnessed an increase in these diseases of around 5% every year.
For patients with long-term conditions, lifelong management involves significant investment in terms of follow-up exams, treatments, lifestyle and dietary measures and the organization of medical and paramedical consultations (for example nutritional consultations in metabolic diseases). These long-term investments can become a burden in patients’ everyday lives, representing genuine obstacles to the management of the diseases.
2| More than a third of French patients with chronic diseases say that they can no longer cope with the burden of treatment
A recent French study conducted by Dr Viet-Thi Tran and Prof. Philippe Ravaud among patients with chronic diseases concludes that 38% of patients consider their “burden of treatment” to be unsustainable in terms of the energy, time and money invested. This study was conducted via ComPaRe, a database dedicated to the Community of Patients for Research.(3)
Just over 2,400 people with chronic diseases voluntarily answered the researchers’ questions. The sample included 73.8% women and the average age was around 48 years.
The purpose of the study was to understand the follow-up difficulties involved in the management of chronic diseases in order to improve this follow-up and evaluate patients at risk of abandoning their treatment.
In particular, the questionnaire completed by the patients assessed the burden represented by medication, blood tests, consultations, self-monitoring, lifestyle and dietary measures, as well as the burden of administrative formalities. For example, diabetic patients need to dedicate more than two and a half hours per day to managing their condition.
The main reasons for the difficulties reported by patients concerned, in particular, the regularity of care procedures and the financial cost, as well as making appointments and relationships with healthcare professionals.
Based on the answers provided, a Patient Acceptable Symptom State (PASS) tool was created by the researchers to assess the “treatment burden”. The tool helps identify patients at risk of burn-out and to determine the acceptable treatment burden.(3)
1. Prendre en charge une personne âgée polypathologique en soins primaires, outil d’amélioration des pratiques professionnelles [Managing an elderly person with multiple conditions in the primary care setting, a tool to improve professional practices], HAS, 2015
3. Viet-Thi Tran, Victor M. Montori, Philippe Ravaud, Is My Patient Overwhelmed? Determining Thresholds for Acceptable Burden of Treatment Using Data From the ComPaRe e-Cohort, Mayo Clinic Proceedings, 2019, DOI: https://doi.org/10.1016/j.mayocp.2019.09.004