Sample Research Paper on Evidence Review

Evidence Review

Empirical studies indicate that, one of the greatest challenges facing the current global healthcare system in the 21st century is the relatively increased burden of the chronic illnesses. As discovered by the World Health Organization (WHO), in order to promote the patient empowerment, chronic conditions often require a complex response from coordinated inputs by a wide range of healthcare professionals, access to valid monitoring systems and essential medicines over an extended period of time. However, as these chronic conditions continue to prolong, creation of a contradictory and range of diverse needs is often experienced. Multi-morbidity per se is a facet of patient complexity that deters the delivery of effective medication (‘Brien et al, 2014). For example, depression condition in patients with chronic conditions such as hypertension and chronic obstructive pulmonary disease. Such malfunctions often confront patients and health care professionals with a broad spectrum of needs in order to manage (Anonymous, 2012). Further, factors such as episodic, acute health care models and ill-equipped healthcare systems, often pose most of these chronic conditions to go untreated until more acute complications arise.  

Multi-morbidity and Co-morbidity

In order to determine the prevalence occurrence of multi-morbidity and co-morbidity on the chronic respiratory disease, the World Health Organization carried out a disease code and drug searches within computerised database in Australia.  The research employed a univariate (Person X2) statistics and multivariate (logistic regression models) with the best fit measured by the Hosmer-Le Cessie test.  The socio-economic status, age and gender were considered in all the variations.  The disease code and drug searchers revealed that out of total number of screening, 20% had a chronic respiratory condition and 90% had a morbid condition (Kelly et al, 2011).  The chronic obstructive pulmonary disease was the most commonly detected respiratory disease in the study at about 54% of the total sample. Unfortunately, two thirds of the individuals who were experiencing the chronic obstructive pulmonary condition and hypertension were also subjected to depression and hypertension.  The univariate analysis identified that aged female patients who lived in relatively low economic status areas had significantly higher rates of chronic obstructive pulmonary condition and hypertension as compared to their male counterparts.  The study also found that 50% of the female patients aged 45 years and above had more than two chronic conditions. The study used relatively large primary-care database that is a regarded as a representation of the wider global population. As recommended, it shares the limitations of other demographic studies particularly on data reliance and quality recording.

All these results indicate that multi-morbidity condition of chronic obstructive pulmonary condition, hypertension and depression is a prevalent condition across the globe in all aged female in poor socio-economic conditions.  Despite the constant improvements in health care sector since 1900s, the multi-morbidity problem of the chronic conditions continues to remain, with recent estimates looming to be rising (Committee on Living well et al, 2011). As the strong relationship of multi-morbidity condition of chronic obstructive pulmonary condition, hypertension and depression with age across all the genders is well recognized, it is important to note that these multi-morbid condition often results into a co-morbid conditions. Critical analysis indicates that most of the clinicians treating the multi-morbid patients also had a high prevalence of both physical and mental health disorders (Kelly et al, 2011).

As noted in many circumstances, Individuals with multi-morbid conditions often exhibit poor functioning status, health outcomes and relatively low quality of life. Across all nations, improvement and coordination of care for patients with multi-morbid disorders is often a key challenge. This is due to the medical specialities and facilities that are often required by these patients (Khan et al, 2007).  As compared to the co-morbid conditions which entails a closely related condition thus may require a specialist, multi-morbid often requires a generalised standards in order to manage. The microeconomics studies also reveal that these chronic conditions often pose salient econometric challenges to the nations that are involved in treatment and management. Therefore, relevant policy routes should be formulated in order to provide the best interventions on how to cube these global challenges (Wissam et al, 2008).

Nursing Interventions

Critical evidence suggests that in most circumstances medical beneficiaries with multi-morbid conditions often receive suboptimal care. In various conditions, the services are often fragmented, uncoordinated and inefficient thus leading to poor medical outcomes (Acton, 2012).  Over a long period of time, putative remedies such as disease management programmes and diseases specific guidelines have proved to be ineffective.  A decade of research and demonstration from well established clinical bodies have well established “care coordination” approach that will improve the beneficiary outcome and reduce the expenses that are often incurred in the healthcare sector (Blum, 2011). These successful coordination management approaches can be grouped into three broad classes; transitional care, self-management and care coordination interventions.

The Transitional Care Intervention

The well tested model was designed has been recommended by Lamprecht et al, (2011) to cater for the patients who were mainly hospitalized multi morbid conditions and were assigned highly trained practice nurses (APNs). In their model, the specialist recommended the APNs nurses to constantly meet the patients in health facilities and make regular visits to their homes even after the discharge. This process was necessary to provide the patients with relevant education on the various medications and self care approach. In a typical example, the intervention was employed in patients suffering from the depression condition in patients with chronic conditions such as hypertension and chronic obstructive pulmonary disease that lasted for a period of 12 weeks (Lubkin & Larsenm, 2011). The process was revaluated as recommended intent-to-treat approach was employed. To the discovery, the number of rehospitalisation per patient was reduced to dramatically as compared to the control group. The other successful transitional care model ever to be used was the Colman 2006 model (Nici & ZuWallack, 2011). The Colman model targeted purely multi-morbid patients were vulnerable to exhibiting a co-morbid condition. The model proved to promote cross-site communication, encouraged patients to take more active roles in managing their health and encouraged continued care and guidance to the patients by the medical professionals. Medical records reveal that transitional care intervention reduces the cost of hospitalization by approximately 65%, thus proving to be one of the most relevant and effective models of dealing with the multi-morbid condition on patients.

Self Management and care Intervention

Educating patients on the best methods on how to manage themselves has also proven to be one of the effective approaches to manage the multi-morbid chronic conditions. Lynch et al (2014) in their study developed one of the effective self-management models to intervene in these conditions. The model mainly focuses on four basic factors which include; patient’s goal identification, self management skills improvement, building the self efficacy sense and finally, assessing the mastery of the aforementioned skills. Powers, Oddone, Olsen  & Bosworth, (2009) in their study, offered a community based self management programme to patients suffering from the depression condition with chronic conditions such as hypertension and chronic obstructive pulmonary disease who were  40 years and above. In a six weeks group session, the medical specialist provided the patients with relevant instructions, cognitive symptom management and use of medication among other relevant topics. The approach was re-evaluated with intent to treat approach.  Compared to control exercises, the educated subjects demonstrated incredible improvements in the cognitive symptom management, communication and other positive health practices. The treated subjects generated 31% fewer individuals who visited hospitals and 43% lower costs thus reducing the average health expenditure (Thomas, 2011).

Care coordination basically incorporates deliberately organizing patient care issues and sharing of valid information among all the stakeholders who are concerned with the safer care of the patient in order to achieve a better and more effective care. This approach prefers that the patient individual preferences and needs are delivered to the home caregivers, nurses and specialists at the right time. It is also important that the delivered information is used to give safe and effective health care to the subjects. Nurses have relatively well established relationship with the local healthcare systems and the physicians (Chizobam et al, 2009).


Multi-morbid and co-morbid as discussed mainly refers to a medical condition for the majority of patients with varied chronic ailments. It is associated with varied adverse outcomes such as reduced functioning status, increased healthcare services and even death.  In order to improve the primary care, the varied studies together with the recommended interventions reflect some of the specific approaches and therapies that emphasize the varied ways to capture co-morbidity and multi-morbidity conditions. It is important to note that more rigorous examination on the various heterogeneity related to the conditions are necessary in order to provide valid therapy (ACCCN, 2011).   Further current research in line with the already produced results can be considered very useful in order to provide modest changes on the topic.  These researches will expose a combination of potentially valid factors that will address the knowledge gaps and modify the various risks and benefits of the therapies recommended.


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