A practice-based analysis of combinations of diseases in patients aged 65 or older in primary care

BMC Family Practice

Research Article

Gwendolyn Goubin¹  Souhila Ghali²  An De Sutter³  Wim Peersman³  Jan De Maeseneer³  Pauline Boeckxstaens⁴  Guy Brusselle⁵ 

[1] Community Health Centre Botermarkt, Ghent, Belgium;Community Health Centre De Sleep, Ghent, Belgium;Department of Family Medicine and Primary Healthcare, Ghent University, Ghent, Belgium;Department of Family Medicine and Primary Healthcare, Ghent University, Ghent, Belgium;Community Health Centre Botermarkt, Ghent, Belgium;Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium;

关键词: Chronic Obstructive Pulmonary Disease;    Family Doctor;    Community Health Center;    Practice Level;    Cumulative Illness Rate Scale;   

DOI  :  10.1186/1471-2296-15-159

 received in 2013-10-28, accepted in 2014-09-16,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMost evidence on chronic diseases has been collected for single diseases whereas in reality, patients often suffer from more than one condition. There is a growing need for evidence-based answers to multimorbidity, especially in primary care settings where family doctors (FD’s) provide comprehensive care for a high variety of chronic conditions. This study aimed to define which disease and problem combinations would be most relevant and useful for the development of guidelines to manage multimorbidity in primary care.MethodsA practice-based cross sectional analysis of clinicians’ chart reviews in 543 patients aged over 65 registered within two family practices in Ghent, Belgium. Main outcome measures were prevalence of disease and problem combinations and association strengths.ResultsThe prevalence of multimorbidity (Cumulative Illness Rating Scale >1) in the study sample is 82.6%. The most prevalent combination is hypertension-osteoarthritis (132/543). Moderate to strong associations (Yules Q > 0.50) are reported for 14 combinations but the corresponding prevalences are mostly below 5%. More than half of these associations show a contribution of a psychiatric problem or a social problem.ConclusionsThis study confirms the high prevalence of multimorbidity in patients aged over 65 in primary care. Hypertension-osteoarthritis is defined as a frequent combination however 94% of these patients have more than two disorders. The low prevalence of specific combinations, the high prevalence of psychiatric and social problems and the general complexity of multimorbidity will hamper the usefulness of randomized trials or guidelines at practice level. There is a need to explore new paradigms for addressing multimorbidity.

【 授权许可】

CC BY   
© Boeckxstaens et al.; licensee BioMed Central Ltd. 2014