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Patients with multiple chronic conditions (MCC), or two or more conditions have complex care needs. These needs require ongoing home monitoring to prevent an escalation in their disease – such as an exacerbation, admission into hospital, debility and reduced physical functioning.

Healthcare professionals have an opportunity to promote and educate patients on the use and implementation of home monitoring tools, or remote patient monitoring (RPM). These tools when discussed through patient, provider and caregiver shared decision making can promote self-management practices that empower the patient to effectively manage their conditions safety at home.

As part of a person-centered care approach – patients who utilize in home monitoring have more control over their healthcare rather than relying on frequent clinic visits and evaluations. Patients who are living, for example with hypertension (HTN), heart failure (HF), chronic obstructive pulmonary disease (COPD) and/or diabetes can be followed through biometric evaluations at home and monitored by healthcare providers to ensure adherence to therapy and optimize the patient’s quality of life.

Examples of Home Healthcare Tools in Managing MCC

Let’s explore some typical at-home healthcare tools and monitoring devices to support patients living with MCC.

Blood Pressure Monitors

According to the American Heart Association (2024), approximately 47% of Americans are diagnosed with hypertension and require daily blood pressure monitoring.

With at-home blood pressure monitoring, patients and providers can capture blood pressure readings. Abnormal readings can be a signal to both patient and provider on integrating appropriate interventions. Reducing poorly manged HTN can prevent the incidence of co-morbid conditions such as stroke, HF and kidney disease.

Continuous Glucose Monitors

Continuous Glucose Monitors (CGMs) and glucometers are essential tools for managing diabetes, providing real-time tracking of serum glucose levels. This technology is especially beneficial for elderly patients with diabetes, who may face challenges with frequent manual testing.

Similarly to using blood pressure monitors, using CGMs can help patients learn how to manage their serum glucose effectively. Patients and healthcare providers who can evaluate ongoing glucose levels from home can help to determine the need for dietary education, change in medication or increase physical activity. Maintaining a stable glucose reading prevents systemic consequences that can gravely impact patient perceived quality of life

Health Trackers

Health trackers can monitor multiple biometrics and physical changes that can affect overall health and wellbeing. Advanced health trackers and/or smartwatches can monitor blood pressure, pulse, respirations, blood oxygen levels, the number of steps taken, and calories burned. Capturing this data can be used in ongoing graphs and charts that help to identify trends in the patient’s lifestyle. Healthcare providers and patients can utilize this data to make informed changes to their lifestyle that will improve their health and prevent disease progression.

It is important to note that health trackers should not be confused with diagnosing a disease but rather used to prevent disease progression that can lead to a poor prognosis and quality of life (Masoumian Hosseini et al 2023).

Medical Management Applications

Applications such as CareZone and Medisafe can be used to track patient adherence to prescribed medication use. These tools are especially useful in complex medication regimens, or in medications that carry a high at-risk warning.

These tools can help healthcare providers evaluate long-term patient actions on medication use. This information can be used between provider and patient to make any needed changes to the patient plan of care.

The table below summarizes examples of home healthcare monitoring tools:

Common Challenges when Managing MCCs

Let’s break down some common challenges for patients living with MCC patients and how these home healthcare tools can support the comprehensive care needs.

Medication Complexity

Patients living with MCC are at risk for polypharmacy and side effects associated with drug-drug interactions. Online tools can support medication scheduling, prevent adverse events from polypharmacy or drug-drug interactions and ensure enough.

Costly Medical Access

In-home healthcare tools and RPM can help to reduce the number of provider visits and provider greater access to care. Medicare provides incentives for primary and specialty providers on using RPM in patients with MCC.

Identification of Symptoms

It is not always straightforward to identify and track symptoms associated with MCC. Poorly managed symptoms often precipitate a disease exacerbation that leads to admission into hospital and disease progression. Earlier assessment and interventions can proactively prevent an exacerbation and prevent progressive debility.

Mental and Emotional Distress

Utilizing in-home healthcare tools and RPM can help to assess and promptly address anxiety, depression, changes in cognition and even loneliness. These tools help to streamline access to healthcare professionals and empower patients to self-manage and take control of their disease management.

Final Thoughts

If you live with MCCs and are interested in learning more about at-home care and RPM, make sure to ask your healthcare provider for details on support available to you.

References

Cumper, S. (2025). How to Manage Diabetes in the Elderly. In Medshop Australia. Medshop. https://www.medshop.com.au/blogs/news/managing-diabetes-in-the-elderly

Durand, A.-C., Gentile, S., Devictor, B., Palazzolo, S., Vignally, P., Gerbeaux, P., & Sambuc, R. (2011). ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. In The American Journal of Emergency Medicine (Vol. 29, Issue 3, pp. 333–345). Elsevier BV. https://doi.org/10.1016/j.ajem.2010.01.003

Hosseini, M. M., Hosseini, S. T. M., Qayumi, K., Hosseinzadeh, S., & Tabar, S. S. S. (2023). Smartwatches in healthcare medicine: assistance and monitoring; a scoping review. In BMC medical informatics and decision making (Vol. 23, Issue 1, pp. 248–248). BMC medical informatics and decision making. https://doi.org/10.1186/s12911-023-02350-w

Kuebler, K., Monroe, T., Ricciardi, R., Westlake, C., Sorenson, M., Pederson, J., Neft, M., Sandra A Mitchell, Daniel, K., Santo-Madeya, S. D., Renda, S., Henneman, E., & Bruera, E. (2024). Integration of palliative care in the management of multiple chronic conditions: An expert consensus paper with policy implications. In Nursing outlook (Vol. 72, Issue 6, pp. 102273–102273). Nursing outlook. https://doi.org/10.1016/j.outlook.2024.102273

Martin, S. S., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Gibbs, B. B., Beaton, A. Z., Boehme, A. K., Commodore-Mensah, Y., Currie, M. E., Elkind, M. S. V., Evenson, K. R., Generoso, G., Heard, D. G., Hiremath, S., Johansen, M. C., Kalani, R., … Tsao, C. W. (2024). 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. In Circulation (Vol. 149, Issue 8, pp. e347–e913). Circulation. https://doi.org/10.1161/CIR.0000000000001209

Savitz, L. A., & Bayliss, E. A. (2021). Emerging models of care for individuals with multiple chronic conditions. In Health services research: Vol. 56 Suppl 1 (Issue Suppl 1, pp. 980–989). Health services research. https://doi.org/10.1111/1475-6773.13774

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