Screening for Accumulating Treatment Burden in Adults With Multimorbidity

Abstract

The growing prevalence of multimorbidity among adults poses significant challenges in clinical management, particularly due to the accumulating treatment burden that often accompanies complex care regimens. This review explores the epidemiology, pathophysiology, risk factors, clinical features, diagnostic strategies, and management approaches for treatment burden in multimorbid adults. Evidence-based recommendations and recent advances are discussed, providing clinicians with practical, guideline-driven insights for optimizing patient-centered care and mitigating the negative impact of treatment burden on health outcomes.

Introduction

Multimorbidity, defined as the coexistence of two or more chronic medical conditions in an individual, is increasingly prevalent in aging populations worldwide. As guidelines and disease management protocols multiply, many patients with multimorbidity experience a substantial treatment burden encompassing the workload of healthcare, medication management, lifestyle adjustments, self-monitoring, and healthcare appointments. Identifying and screening for accumulating treatment burden is crucial, as excessive burden can undermine adherence, compromise quality of life, and diminish clinical outcomes. This article systematically reviews the clinical and scientific aspects of screening for accumulating treatment burden in adults with multimorbidity, with emphasis on evidence-based practice and recent research advances.

Epidemiology / Disease Burden

Multimorbidity affects an estimated 25-60% of adults in developed countries, with higher prevalence in older adults and socioeconomically disadvantaged populations. The treatment burden associated with multimorbidity is a key contributor to healthcare disparities, frequent hospitalizations, and poor patient-reported outcomes. Studies such as the UK General Practice Research Database (GPRD) and international cohort analyses highlight a direct correlation between the number of chronic conditions and the intensity of treatment burden. Notably, the cumulative impact of multiple therapies can lead to polypharmacy, conflicting care plans, and substantial time and financial costs for patients. The World Health Organization and national health agencies recognize treatment burden as an emerging determinant of care quality, necessitating systematic screening and targeted intervention strategies.

Pathophysiology

While treatment burden is not a biological pathophysiological entity, it is mechanistically linked to the interplay of disease complexity, healthcare system fragmentation, and patient capacity. The cumulative workload imposed by myriad self-management tasks, medication regimens, and healthcare navigation can overwhelm patients' cognitive, emotional, and physical resources. The Minimally Disruptive Medicine (MDM) model posits that excessive treatment burden disrupts patients' ability to maintain daily function and effectively self-manage chronic illness. Neurobehavioral pathways such as decision fatigue, medication nonadherence, and stress-induced physiologic changes further compound clinical vulnerability in multimorbid populations.

Risk Factors

Risk factors for accumulating treatment burden include advanced age, low health literacy, cognitive impairment, limited social support, financial constraints, and the presence of ≥3 chronic conditions. Polypharmacy, frequent medication changes, and lack of coordinated care also elevate risk. Certain conditions such as diabetes, heart failure, and chronic kidney disease are associated with particularly high regimen complexity. Socioeconomic factors, including limited access to healthcare resources and transportation barriers, further exacerbate treatment burden in vulnerable groups.

Clinical Features

Clinically, treatment burden manifests as decreased medication adherence, missed appointments, patient-reported overwhelm, and deteriorating functional status. Patients may express frustration, confusion regarding medical instructions, or a sense of futility in managing their health. Instrument-based assessments, such as the Treatment Burden Questionnaire (TBQ) and Multimorbidity Treatment Burden Questionnaire (MTBQ), offer validated means to quantify burden and identify at-risk individuals. Early recognition of these features is critical to prevent adverse outcomes such as disease destabilization and avoidable hospitalization.

Diagnosis

Diagnosis of accumulating treatment burden relies on structured screening tools, comprehensive medication reviews, and patient-centered interviews. Instruments like the TBQ, MTBQ, and Patient Experience with Treatment and Self-management (PETS) questionnaire facilitate systematic assessment. Clinical judgment, informed by multidisciplinary collaboration, is essential in interpreting results and contextualizing burden within each patient's life circumstances. Integrating burden assessment into routine care especially during transitions of care or medication changes has demonstrated efficacy in identifying patients who may benefit from tailored interventions.

Treatment & Management

Mitigating treatment burden necessitates a multifaceted approach. Key strategies include deprescribing unnecessary medications, simplifying regimens, enhancing care coordination, and aligning treatments with patients' preferences and life goals. Shared decision-making and care planning are central to optimizing adherence and reducing unnecessary interventions. Interdisciplinary teams, including pharmacists, nurses, and social workers, play pivotal roles in burden reduction. Structured medication reconciliation, patient education, and the use of digital health tools can further streamline self-management and improve outcomes.

Recent Advances / Emerging Therapies

Recent research emphasizes the utility of personalized care planning, digital monitoring platforms, and artificial intelligence-based decision support in reducing treatment burden. Trials evaluating telehealth interventions, pharmacist-led medication reviews, and community-based care models demonstrate improved patient satisfaction and decreased hospital utilization. The advent of integrated electronic health records and interoperable care pathways facilitates better communication among providers, enhancing continuity and reducing redundant or conflicting therapies. Implementation science frameworks are being applied to translate these innovations into routine practice.

Guideline Recommendations

International guidelines, including those from the National Institute for Health and Care Excellence (NICE) and the American Geriatrics Society (AGS), advocate for routine assessment of treatment burden in adults with multimorbidity. Recommendations include periodic screening using validated tools, individualized care planning, and prioritization of interventions that offer maximal benefit with minimal disruption to daily life. The adoption of principles from the MDM framework is encouraged, with explicit attention to patient capacity, preferences, and social context. Ongoing education for clinicians on the recognition and management of treatment burden is also emphasized.

Conclusion

Screening for accumulating treatment burden is an essential component of high-quality care for adults with multimorbidity. A structured, patient-centered approach grounded in evidence-based assessment tools, interdisciplinary collaboration, and guideline-driven management can mitigate the adverse effects of excessive treatment workload. As the prevalence of multimorbidity rises, ongoing research and innovation will be critical to refining screening methods and optimizing care delivery to support the well-being of this vulnerable population.