7 Things You Need To Know About Multiple Chronic Conditions (MCC)

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Multiple chronic conditions (MCC) is one of the least understood, yet most pressing medical issues facing the world’s population and healthcare systems. Here we examine what MMC means, why it’s so important, and the big changes that need to be made if we’re to face up to this rapidly growing challenge.

1. What does MCC mean?

When we talk about Multiple Chronic Conditions, we mean the presence of two or more chronic conditions in a single patient. Chronic diseases are defined broadly as conditions that last one year or more and require ongoing medical attention or limit activities in daily life, or both. [01]

These multiple conditions could be related to each other, or they could be independent of each other.

‘MCC’ is among the most popular descriptions but it’s not the only one. You might also hear people talking about multi-morbidity or polychromic disease (PCD). But whatever you call it, dealing with Multiple Chronic Conditions is one of the biggest healthcare challenges facing the world right now.

2. Why is this such a big deal?

Globally, one in three adults has MCC. [02] That rises to two in three of those aged 65+. [03] So, the impact of this is big. Really big. It disproportionately falls on those in lower socioeconomic groups and in lower income countries. MCCs are also a big problem for countries that have fragmented or disparate health systems.

The human cost can be significant. Patients with Multiple Chronic Conditions can face significant burdens, including deterioration of their quality of life, significant out-of-pocket expenses, difficulties with sticking to their medication regimes, inability to continue work, and symptom control (chronic pain, in particular). This, in turn, takes a considerable toll on families and caregivers.

Treating MCCs can also put a big strain on healthcare systems, both in capacity and financial terms. The chances of having a preventable hospital admission rise by 1200% for patients with two conditions compared to those that have none. An individual’s healthcare costs double with each additional chronic condition, due to greater need to access primary care and specialist physicians, more emergency department visits and hospital admissions, as well as the concurrent use of different medications. [04]

There is potential for this problem to continue to get worse, with the increasing proportion of older adults in the world population.

3. Which conditions are most likely to feature in Multiple Chronic Conditions?

Certain chronic diseases cluster together more frequently, either because they are more prevalent within the population, they share common risk factors, or the different conditions interact with one another. [05]

The most widely reported clusters include cardiovascular disease (CVD) and stroke with depression, tuberculosis (TB) with diabetes, and HIV/AIDS with CVD. Depressive symptoms increase markedly with each additional chronic condition: they rise 21% in patients with two conditions, to 58% when five conditions are present. [06]

4. What are the main causes of MCC?

The five most common lifestyle risk factors [07] are high blood pressure (‘hypertension’), high fasting glucose, smoking, high total cholesterol, and high body mass index. However, there is a long list of risks that can drive Multiple Chronic Conditions, ranging from ambient particulate matter (e.g. from car exhausts), to low fruit intake and eating too much processed meat.
Some of these risk factors are modifiable, like unhealthy diet, physical inactivity, and tobacco and alcohol intake. Others are not, like age, generics, air pollution and socioeconomic status. One’s exposure to all these factors will, in turn, be driven by underlying determinants such as globalization, urbanization, population ageing, and social determinants. [08]

Or, to put it another way: it’s complicated.

5. What are the challenges?

This phenomenon of MCC is not widely reported despite the markedly different cost and personal burdens on patients and healthcare systems. Unfortunately, traditional health systems and major disease programs rarely address chronic diseases that occur together, instead looking at each one in isolation.

The shift from a single-disease focus to Multiple Chronic Conditions will be difficult. It will require a structural shift in how we think about things; a broad, multidisciplinary application of behavioral and social science to all areas of health and medicine.

Such a shift is made all the more difficult by the additional complexities of treating certain conditions that occur together. When considering conditions in tandem, different screening and prevention requirements come into play, as does the reduced efficacy of medications, a lack of joint guidelines, a greater tendency for patients to see specialists over primary care physicians, and greater risk of adverse reactions when multiple drugs are taken together. [09]

The example of diabetes and TB co-existing in a patient shows just how complicated MCC can make treatment. Those with diabetes are 3.1 times more likely to have tuberculosis than those without diabetes. [10] But even as diabetes increases the risk of contracting TB, the treatment of TB can interfere with that of diabetes. [11]

6. What’s the answer?

The leading global risk factors – high blood pressure, cholesterol, diabetes, etc. – are similar across developed and developing countries. They are also all highly amenable to prevention, meaning avoidance of chronic diseases through improvements to lifestyle behaviors (such as smoking, diet, and physical activity) remains the mainstay of primary prevention. As such, prevention – through education, community outreach, and so on – will be a vital tool in tackling Multiple Chronic Conditions.

There is also significant opportunity for collaboration between healthcare systems and key stakeholders, such as health insurers and pharmaceutical manufacturers. Working together to tackle clusters, rather than the individual diseases, can result in interventions, systems and new technologies being created that directly address the difficulties faced by MCC. These include medication design, approaches to screening and detection, and care guidelines.
The combination of cross-condition management (that offers a holistic approach to care) with simplified medication regimens (which can increase medication adherence and control of conditions) [12] can help reduce the impact. [13] Using multidisciplinary teams, such as the Medical Home model in the U.S.., has been shown to be effective in improving outcomes of therapy.

7. Taking the fight to Multiple Chronic Conditions

Teva produces over 3500 products and is the world’s largest manufacturer of generic medicines. The scale of our portfolio and level of expertise across the medical landscape means that Teva is well positioned to meet the needs of patients who are affected by MCC.

“Teva has a very large medicine cabinet,” says Dr. Riad Dirani, VP of Global Health Economics and Outcomes Research and Epidemiology. “This enables us to focus on developing solutions to tackle MCCs and establish partnerships globally to further improve the health of people living with MCCs.”

For example, Teva produces many of the medicines featured on the WHO’s Essential Medicines List, including: 93% of mental health treatments, 87% of pain treatments, 83% of cardiovascular treatments, 73% of cancer treatments and 100% of treatments for respiratory conditions. [14]

For the last four years, Teva has also partnered with Direct Relief and Volunteers in Medicine (VIM), providing funding to VIM clinics to support innovative primary and preventive health care programs. A particular focus of the funding has been the holistic treatment of patients with multiple chronic conditions, something which one in three Americans suffer with.

Damon Taugher, Vice President of Global Programs at Direct Relief, says the project has been crucial in serving patients who struggle to access healthcare systems, as well as laying the foundations to help many more in the future.

[01] https://www.cdc.gov/chronicdisease/about/index.htm

[02] Violan, Concepció, et al. “Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies.” PloS one 9.7 (2014): e102149.

[03] Marengoni, Alessandra, et al. “Aging with multimorbidity: a systematic review of the literature.” Ageing research reviews 10.4 (2011): 430-439

[04] https://www.tevapharm.com/globalassets/tevapharm-vision-files/teva_mcc_report.pdf p6

[05] McPhail, Steven M. “Multimorbidity in chronic disease: impact on health care resources and costs.” Risk management and healthcare policy 9 (2016): 143

[06] Pruchno, Rachel A., Maureen Wilson-Genderson, and Allison R. Heid. “Multiple chronic condition combinations and depression in community-dwelling older adults.” Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences 71.7 (2016): 910-915.

[07] Lim, Stephen S., et al. “A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.” The lancet 380.9859 (2012): 2224-2260.

[08] https://www.tevapharm.com/globalassets/tevapharm-vision-files/teva_mcc_report.pdf p19

[09] https://www.tevapharm.com/globalassets/tevapharm-vision-files/teva_mcc_report.pdf p7

[10] https://www.tevapharm.com/globalassets/tevapharm-vision-files/teva_mcc_report.pdf p.7

[11] https://www.tevapharm.com/news-and-media/feature-stories/chronic-conditions-70th-world-health-assembly/

[12] Bangalore, Sripal, et al. “Fixed-dose combinations improve medication compliance: a meta-analysis.” The American journal of medicine 120.8 (2007): 713-719

[13] This statement from this infographic: https://www.tevapharm.com/globalassets/tevapharm-vision-files/teva-mcc2-pager.pdf

[14] (Internal citation) Statistics verified by Global Portfolio team (accessed December 2020).

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NPS-ALL-NP-00399 AUGUST 2021

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