Health outcomes of patients in the Complex Chronic Diseases Program, 2025, Meagher, Nacul, et al.

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BC MEDICAL JOURNAL VOL. 67 NO. 5 | JUNE 2025

https://bcmj.org/sites/default/files/BCMJ_Vol67_No5_complete.pdf

Health outcomes of patients in the Complex Chronic Diseases Program

New approaches and research are urgently needed to improve therapeutic interventions for patients with complex chronic diseases.

CLINICAL: ORIGINAL RESEARCH

Emily Meagher, MPH, Tianna Magel, MSc, Travis Boulter, Carola Muñoz, Nicole Prestley, Wee-Shian Chan, MD, FRCPC, Cassandra Bryden, Luis Nacul, MD, PhD



ABSTRACT

Background:

Complex chronic diseases affect almost 3% of Canadians and lead to persistent, debilitating symptoms. The BC Ministry of Health funded the Complex Chronic Diseases Program to address service gaps for affected individuals. We evaluated health outcomes of the program’s patients.

Methods:

Analysis of data from the Complex Chronic Diseases Program Data Registry (June 2017–September 2022) focused on patient reported outcomes and clinical measures at baseline, 6-month follow-up, and discharge, and on changes in symptoms across these time points.

Results:

Among the 668 participants included in the study, slight improvements in overall physical and mental health were observed between baseline and discharge. However, symptoms such as sleep dysfunction, fatigue, and pain showed no significant changes.

Conclusions:

While participation in the Complex Chronic Diseases Program yielded some health benefits, further research and interventions are required to address symptoms and optimize patient outcomes. The further development and use of objective outcome markers are needed for improved program evaluation.

Ms Meagher and Ms Magel were research assistants at the Women’s Health Research Institute, BC Women’s Hospital and Health Centre, at the time of writing. Mr Boulter is a research coordinator at the Women’s Health Research Institute. Ms Muñoz is a research manager at the Women’s Health Research Institute. Mrs Prestley is a research and knowledge translation manager at the Women’s Health Research Institute. Dr Chan is an investigator at BC Children’s Hospital; head of the Department of Medicine, BC Women’s obstetric medicine lead, BC Women’s; and a clinical professor in the Department of Medicine, University of British Columbia. Ms Bryden was an occupational therapist in the Complex Chronic Diseases Program at BC Women’s at the time of writing. Dr Nacul is a clinical scientist at the Women’s Health Research Institute; a clinical associate professor in the Department of Family Practice, Faculty of Medicine, UBC; and a clinical associate professor in the Department of Clinical Research, CureME, London School of Hygiene & Tropical Medicine. Corresponding author: Ms Emily Meagher, emily.meagher@cw.bc.ca. This article has been peer reviewed.

 

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Direct links —

Link | PDF (British Columbia Medical Journal) [Open Access]

 

[Hutan]

However, symptoms such as sleep dysfunction, fatigue, and pain showed no significant changes.

I appreciate the honesty there.

While participation in the Complex Chronic Diseases Program yielded some health benefits, further research and interventions are required to address symptoms and optimize patient outcomes. The further development and use of objective outcome markers are needed for improved program evaluation.

While I agree with much of what the authors are saying in the abstract, they are claiming 'some health benefits' for their CCD Program. It's possible, perhaps even likely, that the program wasn't even responsible for that. Perhaps the passage of time and the adjustment and learning that tends to come naturally with that time account for any minor benefit.

 

[Trish]

It seems from the abstract that there was no meaningful improvement for patients on the program beyond therapist effect.

 

[Hutan]

From the BC Women's Hospital Complex Chronic Diseases Program

Even if you have had a CCD for a long time, there are steps you can take to feel better and gradually improve your condition. Having your CCD diagnosed as early as possible will help with a better and more rapid recovery.

There's a terrible "Adapt: Returning to physical activity" handout. Have we talked about it already?

It notes that exercise is not recommended as an intervention for people with PEM and that any exercise for people with post-viral fatigue should be guided by a professional with an experience with the condition. BUT, then it goes on to differentiate between physical activity and exercise. And there's no warning about physical activity.

That 10% progression is symptom-contingent Graded Activity Therapy. It's even got the joy-sapping, will-to-live destroying calculation of walking for 10 minutes per day one week and then increasing to 11 minutes/day the next week. They don't call it an exercise program, it's a 'movement program'.

How can these people not understand that, if people can increase activity, they almost surely will, and they don't need a health professional making it more complicated than it is? And it's all written assuming recovery will happen, so long as you put in the work.

I feel quite concerned about this program. Luis Nacul has had plenty of exposure to ME/CFS communities. He should be doing better than this. It's certainly time their materials were reviewed.

Edit to add - it says that the approach has been adapted from the John Hopkins Medical Center. So, that is another organisation that needs to update its approach.