title: Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement.
abstract: OBJECTIVE
  The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement.
  
  
  BACKGROUND
  Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis.
  
  
  METHODS
  A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005.
  
  
  RESULTS
  Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study.
  
  
  CONCLUSIONS
  Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.
authors.affiliation: School of Nursing, The University of Melbourne, Carlton, Victoria, Australia. afw@unimelb.edu.au
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.forename: Trisha
authors.initials: T
authors.lastname: Dunning
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000451:nursing / Q000523:psychology*; D002908:Chronic Disease; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000451:nursing / Q000523:psychology*; D020370:Osteoarthritis, Knee / Q000451:nursing / Q000523:psychology*; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires