New research published today by the Journal of Primary Health Care, which is produced by The Royal New Zealand College of General Practitioners shows that the New Zealand health system is not well set up to deal with multimorbidities.
The research shows that increasing multimorbidity (the co-occurrence of two or more chronic conditions) combined with an aging population and lack of success in addressing negative socioeconomic and cultural determinants of health are major challenges for New Zealand’s primary care sector.
College Medical Director Dr Bryan Betty regularly sees this in evidence in his own practice in Cannons Creek, Porirua and says, "We are increasingly seeing multimorbidities at a younger age.
"Look at Type 2 diabetes, which is often thought of as a disease of older people; 10-15 years ago at my practice we very rarely diagnosed Type 2 diabetes in anyone in their twenties or thirties, but it now happens pretty much every two-three weeks.
"The issue there is that complications often occur 20 years after diagnosis so we’re seeing many more patients with multimorbidities in their 40 and 50s now, whereas that traditionally would have been an aged care issue. The health system is simply not set up to deal with the current population demands, particularly in high-needs areas."
The research found that social determinants of health are recognised as contributing to the earlier development of long-term conditions, yet for people on low incomes, access to a user-pays community medical system remains problematic.
With one in four New Zealanders reporting multimorbidity, and people aged 65 years predicted to double in number by 2050, this research argues that over the next decade, New Zealand requires a health system focused on incorporating self-management support, personalised and integrated care and shared health records.
Acknowledging that the final report of the Health and Disability System Review is expected this week, the health system remains largely unchanged, with limited accommodation and few funding concessions made for the requirements of different approaches and tools.
Adequately funded person and whānau-centred care that is embraced by patients and health professionals requires a cultural and systemic change within New Zealand’s primary care institutions, and for people with multimorbidity in our society.
The research paper, What is the answer to the challenge of multimorbidity in New Zealand? Is written by Anna Askerud, Chrystal Jaye, Eileen McKinlay and Fiona Doolan-Noble and published today in the Journal of Primary Health Care.