A DESCRIPTIVE STUDY ON HOMECARE MANAGEMENT AND TREATMENT

OF PATIENT WITH MULTIMORBIDITY IN

PUERTO PRINCESA CITY

PALAWAN NATIONAL SCHOOL

GENERAL ACADEMIC STRAND

Belloc, Guia Nicole D.

Balubal, Angela Rica
Lucero, Kim Karyl D.
Zita, Rachelle Ann M.
Lim, Ronan Jeff
Grade 12 Researchers

Neriza M.Paredes

Adult Sponsor

May 2022

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 Table of Contents

Page

Title Page 1

Table of Contents 2

Acknowledgements 4

Dedication 5

Abstract 6

Chapter 1: 7

Introduction 7

Conceptual Framework 8

Statement of the Problem 9

Significance of the Study 10

Scope and Limitation 11

Definition of Terms 12

Chapter 2: 13

Review of Literature 13

Synthesis 18

Chapter 3: 20

Research Design 20

Research Method and Technique Used 20

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 Population and Sampling 21

Data Collection Procedure 21

Ethical Consideration 22

Statistical Treatment 22

Chapter 4: 23

Presentation, Interpretation and Analysis 23

Chapter 5: 30

Summary 31

Salient Findings 31

Conclusion 33

Recommendation 34

Bibliography 35

Appendix 36

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 ACKNOWLEDGEMENT

First of all, the researchers would like to express their gratitude to almighty

God for enabling them the strength and opportunity to complete the research

paper within the schedule successfully.

Secondly, the researchers would like to express their gratitude to our

Panelists as well as to their Principal (Eduardo G. Santos) who gave us the

golden opportunity to do this wonderful project on the topic “A Descriptive study

on Homecare Management and Treatment of Patients with Multimorbidity”, which

also helped us in doing a lot of research and we came to know about so many

things.

The researchers, would like to express our appreciation to our, Ma’am

Neriza Paredes, for accommodating our needs prior to the presentation of this

paper. Her helping hand allowed the researchers to make it through from the

making to the actual research paper of the study. Her insights and

recommendations enabled the researchers to polish and solidify the ideas of the

study.

The researchers are grateful as well to, Sir Rowel Tiza and his very

informative advice which gave the researchers tips and enlightenments in times of

urgent difficulties. Without his assistance, the study would be compromised and

unclear.

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 DEDICATION

This research study

Is sincerely dedicated to

Our family, friends, colleagues,

And students

To God be the Glory

GNDB
ARPB
KKDL
RAMZ
RJFL

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 ABSTRACT

Multimorbidity is becoming more common with age and socioeconomic

disadvantage, and it has a significant impact on quality of life, employment

capability, disability, mortality, and care processes, as well as healthcare

consumption and costs. These are frequently long-term health issues that

necessitate extensive and continuing treatment. Multimorbidity is on the rise,

posing new problems for healthcare practitioners and systems. Thus, the study

aimed to give useful information on homecare management and treatment of

patients with multimorbidity to raise awareness and promote healthy living.

This study used descriptive design and purposive and snowball sampling.

The data gathered through the use of questionnaires sent through google form.

According to the International Journal of Integrated Care, multimorbidity is

defined as "the co-occurrence of three or more chronic illnesses affecting three or

more different body systems inside one person without identifying an index

chronic condition." People with multiple chronic conditions have a lower quality of

life.

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 CHAPTER 1

THE PROBLEM AND ITS BACKGROUND

Introduction

Multimorbidity is widely introduced as the co-occurrence of two or more

chronic illnesses, and has risen to the top of many health policymakers' and

healthcare practitioners' priority lists. The incidence of multimorbidity is increasing

with age and socioeconomic disadvantage, and it has a substantial influence on

the quality of life, capacity to work, disability, mortality, and care processes, as

well as on healthcare use and expenditures.

Multimorbidity, which includes both physical and mental health issues, is

linked to a higher risk of quality and safety issues. Physicians are less likely to

address nonspecific symptoms such as pain and respiratory problems in patients

who are in poor health. Some people are more vulnerable to poor quality

treatment than others. These include children, the elderly, inhabitants of

residential nursing homes, and adults with a variety of health issues. People who

suffer from both mental and physical health issues are more likely to experience a

safety event

The term "multimorbidity" is used consistently to refer to people with

multiple health conditions. These are often long-term health conditions that

require complex and ongoing care. Multimorbidity is becoming increasingly

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common and poses challenges to healthcare providers and systems. Studies

examining the relationship between multimorbidity and quality of care have

reached mixed conclusions.

Conceptual Framework

Input Process Output

Data gathering
Homecare
via face to face
management of interview and on Brochure
patient with call interview.
Multimorbidity

Conceptual Framework shows that the input is profile of respondents

according to Age, Sex, Date of birth and Socioeconomic. The process

includes collection and analysis of data through: Survey/Questionnaires,

and Snowball sampling. The final output of this study is a brochure for

Homecare Management and Treatment of patients with Multimorbidity.

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Statement of the Problem

This study entitled, “A Descriptive Homecare Management and Treatment

of Patient with Multimorbidity” aims to answer the following problems:

1.What are the demographic profile of the respondents?

a. Age

b. Gender

c. Occupation

d. Marital Status

2. What are the health profile of the respondents Presence of chronic conditions?

a. Presence of chronic conditions

b. Previous illnesses

c. Early symptoms

3. Which of the following practices of homecare Management of patient with

Multimorbidity are observed regularly?

a. Hygiene practices

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 b. Exercise

c. Diet

d. Medication

Significance of the Study

The purpose of this study was to give useful information on a descriptive

study on homecare management and treatment of patients with multimorbidity. It

is intended that by understanding how homecare management affects people in

both positive and negative ways, this study will not only generate data that will be

useful to them, but also to the following groups of people

For the Health Professionals, the information provided by this study can

or may serve as a relevant guide to Health professionals prior to putting up their

services since the scope of the study aims to determine homecare management

highly used and how it affects the participants’ healthcare and medication.

For the Students, this study may help them to be aware of Homecare

Management and Treatment of a Patient with Multimorbidity. They were the end-

beneficiary of this research. The improvements that the schools will implement

based on the findings of the study will greatly affect them.

And for the Future Researchers, the result of this research may be the

basis of future studies and can be useful as related literature, comparing and

contrasting the data for the determination of the progress when it is their turn to

further the study.

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Scope and Limitation

The study will cover the Homecare Management and Treatment advantage

and disadvantage of the patients with Multimorbidity health status behavior. The

features that will be included are limited Homecare Management and Medication,

the primary subject of this study will be individuals residing within the vicinity of

Puerto Princesa City. The researchers are expected to have a total of 6

participants. Furthermore, the researchers will purposely select and qualify the

respondents to prevent complications during the individual interview and Focused

Group discussion. The collection of data will begin in the 3rd week of May,2022.

Locale

The study was conducted at Brgy. Bagong Silang, Puerto Princesa City.
The researchers conduct a combined face to face and online interview.

Time Frame, the study started from May 23 and will end in June 2022.

The map of Puerto Princesa City is presented on next page of the paper.

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Photo credits: https://earth.google.com/

Definition of Terms:

Multimorbidity: Multimorbidity is the presence of 2 or more chronic conditions in

a person at the same time.

Homecare Management: Homecare (also spelled as home care) is health care

or supportive care provided by a professional caregiver in the individual home
where the patient or is living, as unlike to care provided in group accommodations
like clinics or nursing homes.

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Treatment: The treatment of a patient in order to combat disease or disorder. All
treatments not otherwise excluded from medical therapy are included

Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

In conducting the study entitled “A Study on Homecare Management and

Treatment of Patients with multimorbidity,” the researchers seek for relevant

contexts from various materials, including books, research journals, e-book and

gray literatures to critically analyze and scrutinize the topic’s background and

other related point and agruments.

A. Multimorbidity

Based on the World Health Organization (WHO), Multimorbidity Is

Associated with socioeconomic deprivation. A study in one developed country

found that those living in the most deprived areas suffer more multi-morbidity,

which develops 10 to 15 years younger than in the least deprived decile of the

population.

In addition, People with multiple conditions may have a higher overall

vulnerability to diseases and less resistance to acute health threats (for example,

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higher susceptibility to infections). The interacting influences lead to a complex

pattern in the use of health services. Multimorbidity leads to an increased

likelihood of referrals between different providers of healthcare. This can increase

costs and lead to more fragmented care, thus compromising patient safety

through poor integration of care, and poor communication and coordination.

As mentioned by Michaela L. Schiøtz Nov 18 (2017), prevalence of

multimorbidity is rising and increases with age and socioeconomic deprivation and

multimorbidity affects quality of life, ability to work, disability, mortality, and

processes of care and has a significant impact on healthcare utilization and costs.

According to Stokes, Jonathan January (2016), Health Systems

Internationally face a common set of challenges: aging populations, increasing

numbers of patients suffering from multiple long-term conditions (multimorbidity)

and severe pressure on health and care budgets. ‘Quality of care’ is pitched as

the solution to current health system challenges.

Based on the International Journal of Integrated Care, Multimorbidity is a

term that can be defined as the “co-occurrence of three or more chronic

conditions affecting three or more different body systems within one person

without defining an index chronic condition". People suffering from multiple

chronic conditions suffer from poor quality of life.

As mentioned by Dorte Høst & Anne Frølich (2017), the relationship

between multimorbidity and quality of care has been examined in recent years.

Quality of care for patients with multimorbidity is most appropriately measured by

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processes, rather than outcomes. Some studies have found that higher

comorbidity burden is associated with better quality of care, but this relationship

has not been consistently demonstrated.

B. Quality of Care

Quality of care appears to vary substantially by how time- consuming care

processes are, rather than by the complexity or number of conditions. Several

studies have documented quality of care deficiencies when patients have

discordant or unrelated comorbidities. Each condition with unrelated

pathophysiology or requiring different care includes risk suboptimal management

that include missed diagnoses, inadequate treatment and access, and

communication barriers

In addition, treatment for multimorbidity often requires multiple condition-

specific medications, resulting in polypharmacy and attendant risks.

According to Smith SM (2012), multimorbidity that includes both physical

and mental health conditions is associated with a greater risk of quality and safety

issues. Physicians are less likely to address diffuse symptoms like pain and

breathing problems among patients with poorer health status. Multiple studies in

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primary care settings suggest that the quality of preventive care is not associated

with increasing multimorbidity.

C. Risk of Multimorbidity

Some people are at greater risk of safety incidents in quality of care. These

include children, older people, those living in residential career nursing homes and

people with multiple health conditions. People with simultaneous mental health

and physical health issues are also at increased risk of safety incidents.

Focusing on groups at higher risk may improve the quality and safety of

care by providing more personalized care and ensuring smooth transitions

between and within services. For instance, upskilling professionals in how to

identify and treat depression may have an impact given the high rate of adverse

events among those with combined mental and physical health issues.

Across the world, most systems were not designed to care for people with

multimorbidity. Systems may thus need to focus more on what can be done to

improve care for people with multiple conditions, including whether social

interventions would be more worthwhile than increasing medicalization.

As stated by Payne K (2012), people who live in poorer areas often have

worse access to safe and high quality of care, including longer waiting times to

see a primary care provider and a shorter consultation length. Primary care

providers in deprived areas have also been found to be more stressed due to the

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greater demand and clinical complexity of patients. Burnout of health care staff is

more common under such circumstances and poses a threat to patient safety.

Based on the World Health Organization (WHO), lack of time has been

identified as a barrier to providing quality of care for patients with multimorbidity.

Longer consultations result in more preventive health advice, less prescribing, and

increased patient satisfaction. The quality of care for care management software

integrated into patients’ EHRs has also been previously reported and related

challenges posed by lack of adequate patient information are well known. A

pervasive and persistent need for systemic medication reconciliation exists across

care settings, particularly during transitions between home and hospital care.

Torres 27 March (2016), Multimorbidity is even more important when each

condition may influence the quality of care for the other condition(s) through

limitations of life expectancy, interactions between therapies, and/or direct

contraindications to therapy for one condition by other conditions themselves.

D. The Prevalence of Multimorbidity

The prevalence of multimorbidity increases with age, but is not just an

issue for older adults. As a result of advances in quality of care and public health,

a growing proportion of people have multimorbidity.

Due to the aging of the population, the prevalence of chronic diseases is

increasing and most older adults experience the co-occurrence of multiple

diseases, a condition known as multimorbidity. It has been estimated that 60% of

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persons aged 65 years or older are affected by multimorbidity, the reason why the

condition is sometimes referred to as the “most common chronic disease”. The

appearance of clusters and patterns of patients and diseases in different context

and populations group has been also demonstrated. Advanced age, female

gender, low socioeconomic status, and education are among the main risk factors

for the development of multimorbidity. This suggests, for example, that early life

learned risk behaviours may affect the development of this condition.

Compared to those with single conditions, persons with multimorbidity are

more likely to experience negative health outcomes, including mortality,

hospitalization, and functional and cognitive decline, leading ultimately to poorer

quality of life and increased care costs. Persons with multimorbidity have the most

complex health needs but, due to the current disease-oriented approach in

healthcare, they face highly fragmented quality of care that leads to incomplete,

inefficient, ineffective, and even potentially harmful interventions.

Synthesis

In one developed country, a large study found that more than 40%of the

population (all ages included) had at least one long-term condition and almost

25% of the entire population had more than one long-term condition.

Recent work has also shown high levels of multimorbidity in low- and

middle income countries. This means that there is a potential increase in

problems associated with multimorbidity, which may impact on patient safety.

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 People often have both physical and mental health issues simultaneously.

A systematic review of 86 studies found that people with mixed mental and

physical multimorbidity had the highest risk of active patient safety incidents and

precursors of safety incidents.

The prevalence of multimorbidity increases substantially with age.

However, the absolute number of people with multimorbidity has been found to be

higher in those younger than 65 years due to the age distribution of the

population. This is especially true in areas of high deprivation. Thus, a life cycle

approach to multimorbidity and to the challenges it poses to safety in primary care

is vitally important.

One study found that above the age of 55 years, multimorbidity was most

likely to comprise people with multiple physical health conditions. In younger age

groups, multimorbidity was most likely to involve mixed physical and mental health

conditions. This was two to three times more common in the most deprived

compared with the least deprived groups. Depression and pain were featured in

the top five conditions across all age groups. (Vogeli, C, Shields, AE, Lee, TA,

Gibson, TB, Marder, WD,

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 CHAPTER 3

RESEARCH DESIGN AND METHODOLOGY

This chapter presents design, sampling, instrumentation, data collection

procedures and analysis, and the other considerations in this study.

Research Design

Qualitative Research

This chapter concentrates on discussion of the research methods and

procedures adhered to by the researcher in order to answer systematically the

specific problems posed for investigation. Specifically, the research method

population and samples research instrument data gathering procedure and

statistical treatment of the data used for the accurate data analysis and

interpretation were explained in this chapter.

Research Method and Technique Used

Qualitative methods were used to discuss the with the principal objective

analyzed and associated. The study manipulated A Study on Homecare

Management and Treatment of Patient with Multimorbidity.

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Population

The target population for this study are the people who had a

multimorbidity with chronic condition with 6 respondents. since, this study

particular for the people who had multimorbidity.

Sampling

The researchers used stratified sampling in choosing the respondents, we

used stratifieEd which can be partitioned into subpopulations. In statistical

surveys, when subpopulation within an overall population vary, it could be

advantageous to sample each subpopulation independently.

Data Collection Procedure

This study will have interview method in the process of data collection. We

will conduct interview through face to face and online interview. The data gathered

from the test will be carefully recorded and analyzed and interpreted accordingly

based on the survey.

Inclusion Exclusion

Must be 18-70 years old Below 18 years old

Must be residing within vicinity of Outside of Puerto Princesa City

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 Puerto Princesa City

Must have 2 or more chronic conditions Patients without 2 or more chronic

in a person at the same time. conditions.

Ethical Consideration

Upon proceeding to the collection of data, the researchers asked for the

participant approval to be part of the study by providing information about the

given set of questions.

Statistical Treatment

Responses to the questionnaire by Patients with Multimorbidity were

statistically analyzed with the data requirements of the study. Students statistically

analyzed with the data instruments of the study.

CHAPTER 4

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 PRESENTATION, INTERPRETATION, AND ANALYSIS

Study Characteristics

This chapter provides a presentation of the data relative to the problems

posted in a statement of the problem. The corresponding result interpretation and

analysis of the data are incorporated in this portion of the study.

The Results and Interpretation of Data

The researchers were able to gather the data from the respondents. This

shows that their comments are important to the study because they meet the

criteria set by the researchers.

Problem 1: What is the demographic profile of the interviewed

participants?

Results

Problem 1. What is the demographic profile of the interviewed

participants?

The answers to this problem are resented below and on the following pages

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 Demographic Profile of the Respondents

A. Age

Age Frequencies Percentage

46-50 3 33.3%
51-55 3 33.3%
61-65 2 22.2%
71-75 1 11.1%

Table 1-A shows the demographic profile (age) of the respondents. Among

9 respondents, 3

B. Sex

Sex Frequencies Percentage

Male 5 55.5%
Female 4 44.4%

C. Marital Status

Status Frequencies Percentage

Single 2 22.2%
Married 6 66.6%
Widowed 1 11.1%

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 Problem 2: What are the health profile of the respondents?

Results

Problem 2. What are the health profile of the respondents?

The answers to this problem are presented below and on the following pages:

R1

Name: CORALES , NEBRE P.

Age: 49 years old

Sex Male

Height: 5’5 ft

Weight: 78 kg

Blood Pressure: 190/40

Illnesses: (1.) Arthritis

(2.) Hypertension

Symptoms: Joints Pain

First Time Illness Occurred: When she was:

(1.) 40 years’ old

(2.) 5 years ago

How long the Illness lasts (1.) 9 years ago

(2.) 5 years ago

Previous Illness(es) N/A

Early Symptoms of the Prftevious N/A

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 Illness(es)

R2

Name: Destura Marilyn

Age: 54 years old

Sex Female

Height: 5’3 ft

Weight: 46 kg

Blood Pressure: 100/80

Illnesses: (1.) Arthritis

(2.) Ulcer
(3.)Pancreas Enlargement
Symptoms:

First Time Illness Occurred:

How long the Illness lasts

Previous Illness(es)

Early Symptoms of the Previous

Illness(es)

R3

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 Name:

Age:

Sex

Height:

Weight:

Blood Pressure:

Illnesses:

Symptoms:

First Time Illness Occurred:

How long the Illness lasts

Previous Illness(es)

Early Symptoms of the Previous

Illness(es)

R4

Name:

Age:

Sex

Height:

Weight:

Blood Pressure:

Illnesses:

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 Symptoms:

First Time Illness Occurred:

How long the Illness lasts

Previous Illness(es)

Early Symptoms of the Previous

Illness(es)

R5

Name:

Age:

Sex

Height:

Weight:

Blood Pressure:

Illnesses:

Symptoms:

First Time Illness Occurred:

How long the Illness lasts

Previous Illness(es)

Early Symptoms of the Previous

Illness(es)

R6

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 Name:

Age:

Sex

Height:

Weight:

Blood Pressure:

Illnesses:

Symptoms:

First Time Illness Occurred:

How long the Illness lasts

Previous Illness(es)

Early Symptoms of the Previous

Illness(es)

R7

Name:

Age:

Sex

Height:

Weight:

Blood Pressure:

Illnesses:

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 Symptoms:

First Time Illness Occurred:

How long the Illness lasts

Previous Illness(es)

Early Symptoms of the Previous

Illness(es)

R8

Name:

Age:

Sex

Height:

Weight:

Blood Pressure:

Illnesses:

Symptoms:

First Time Illness Occurred:

How long the Illness lasts

Previous Illness(es)

Early Symptoms of the Previous

Illness(es)

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 Problem 3: What are the homecare management of patient with

Multimorbidity?

Results

Problem 3. What are the homecare management of patient with

Multimorbidity?

The answers to this problem are presented below and on the following pages

31
 CHAPTER 5

This chapter presents the summary and conclusion derived in the conduct

of the study which is “A study on Homecare Management and Treatment of

patients with Multimorbidity”. The study was conducted at Brgy. Bagong Silang,

Puerto Princesa City through the face to face interview and on call interview

where the participants were selected using convenience sampling. It employed

qualitative research and utilized the descriptive case study, and used content and

narrative analysis as the means for interpreting and analyzing the data.

Summary

Respondents were asked to indicate which types of care for people with

multi-morbidity were provided by the practice, which included types of diseases,

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diagnostics, medical, medical care, homecare, medical treatments, reintegration,

and monitoring. The survey included one question about the types of illness and

homecare management involved in the practice. There are thus contributing

factors to the people with multimorbidity.

The findings were reported in accordance with the explanation of the

difficulties in Chapter 1. The coexistence of two or more chronic illnesses in the

same person, known as multimorbidity, has significant consequences for primary

care safety. It is critical to examine the care of persons with multiple conditions in

primary care to increase safety. Multimorbidity is also more prevalent among

disadvantaged groups, contributing to health inequities.

This study article gives an outline of the issue as well as some potential

remedies. The outcomes of studies on the association between multimorbidity and

care quality have been mixed. The goal of this study was to look into the quality of

care given to people who have several chronic illnesses. Several obstacles to

providing high-quality care were found.

Lastly, in terms of patients, the study discovered that there are some

issues and answers for Homecare Management and Treatment of Multimorbidity

Patients.

Salient Findings

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 The majority of the respondents are mostly ages between 51-55 years

old, and our respondents are primarily female. The majority of our respondents

are from San Jose and Bancao-bancao. Health Profile of the respondents

reveals that Hypertension is the chronic conditions that prevails among the

respondents, and lastly treatment is the most common practice done for patient

who is under homecare management.

Conclusions

The findings reveal a scarcity of high-quality care for those who have

multiple conditions. Suggestions for bettering the care of people with many

diseases include legally assigning responsibility for coordinating care, financial

incentives to reward outstanding care, and disease prevention-focused

treatment. There will be structural modifications as well as the implementation of

a shared medical record system.

Multi-morbidity is on the rise, posing new problems for healthcare practitioners

and systems. Various studies looking into the link between numerous illnesses

and care quality have come to different results. Despite the frequency of

numerous diseases and their impact on individuals and the healthcare system,

there is no evidence of multi-disease care.

Previous therapies have a variety of advantages, but they may be more

effective when risk factors or specific functional issues are targeted. Patients with

34
various diseases must be diagnosed properly, and cost-effective and targeted

interventions must be implemented to enhance health outcomes.

As a result, Homecare Management and Medication makes every effort to

ensure that patients are satisfied with their service and that they feel connected to

healthcare professionals by allowing them to contribute their ideas, opinions,

feedback, and evaluations. Management includes implementing a comprehensive

strategic plan with the purpose of providing high-quality Homecare Management

and Medication that is effective in treating, engaging, influencing, and satisfying

patients.

Recommendation:

Community- The researchers advise that everyone in the community learn

more about good and effective therapy since it will benefit them in the future.

Homecare Facility- The researchers suggest that they learn more

understanding and provide them with proper treatment and financial support for

their therapy.

Health Professionals - The researchers suggest that more guidelines for

health professionals be developed so that they can treat patients properly and

provide them with what they require.

35
 Bibliography

Vogeli, C, Shields, AE, Lee, TA, Gibson, TB, Marder, WD, Weiss, KB and
Blumenthal, D

(2007). Multiple Chronic Conditions: Prevalence, Health Consequences, and

Implications for Quality, Care Management, and Costs. Journal of General

Internal

Medicine 22(S3): 391–395, DOI: https://doi.org/10.1007/s11606-007-0322-1

Health Quality Ontario (2013). In-home care for optimizing chronic disease
management in the community: an evidence-based analysis. Ontario Health
Technology
Assessment Series September 201313(5): 1–65.
https://www.ijic.org/articles/10.5334/ijic.2493/

Tinetti, ME, Fried, TR and Boyd, CM (2012). Designing Health Care for the Most

Common Chronic Condition—Multimorbidity. JAMA 307: 2493–2494, DOI:

https://doi.org/10.1001/jama.2012.5265
Quality of care for people with multimorbidity – a case series

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694163/#!po=21.8750

(https://www.ijic.org/articles/10.5334/ijic.2493/)

(https://www.health.vic.gov.au/patient-care/identifying-and-responding-to-
multimorbidity)

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