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Prevalence of multimorbidity in general practice: a cross-sectional study within the Swiss Sentinel Surveillance System (Sentinella).

ABSTRACT: OBJECTIVES:To estimate the prevalence of multimorbidity using a list of 75 chronic conditions derived from the International Classification for Primary Care, Second edition and developed specifically to assess multimorbidity in primary care. Our aim was also to provide prevalence data for multimorbidity in primary care in a country in which general practitioners (GPs) do not play a gatekeeping role in the health system. SETTING:A representative sample of GPs within the Swiss Sentinel Surveillance Network. PARTICIPANTS:118 GPs completed a paper-based questionnaire about 25 consecutive patients of all ages between September and November 2015. There were no patient exclusion criteria. Recorded data included date of birth, gender and the patients' chronic conditions. PRIMARY AND SECONDARY OUTCOME MEASURES:We estimated the prevalence of multimorbidity, defined as ?2, and ?3?chronic conditions stratified by gender and age group, and adjusted for clustering by GPs. We also computed the prevalence of each chronic condition individually and grouped by system. RESULTS:Data from 2904 patients were included (mean age (SD)=56.5 (20.5) years; male=43.7%). Prevalence was 52.1% (95% CI 48.6% to 55.5%) for ?2?and 35.0% (95% CI 31.6% to 38.5%) for ?3?chronic conditions, with no significant gender differences. Prevalence of two or more chronic conditions was low (6.2%, 95%?CI 2.8% to 13.0%) in those below 20 but affected more than 85% (85.8%, 95%?CI 79.6% to 90.3%) of those above the age of 80. The most prevalent conditions were cardiovascular (42.7%, 95%?CI 39.7% to 45.7%), psychological (28.5%, 95%?CI 26.1% to 31.1%) and metabolic or endocrine disorders (24.1%, 95%?CI 21.6% to 26.7%). Elevated blood pressure was the most prevalent cardiovascular condition and depression the most common psychological disorder. CONCLUSION:In a country in which GPs do not play a gatekeeping role within the health system, the prevalence of multimorbidity, as assessed using a list of chronic conditions specifically relevant to primary care, is high and increases with age.

SUBMITTER: Excoffier S

PROVIDER: S-EPMC5855161 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Project description:ObjectivesPrevalence estimates of multimorbidity vary widely due to inconsistent definitions and measurement methods. This study examines the independent effects on prevalence estimates of how 'disease entity' is defined-as a single chronic condition or chapters/domains in the International Classification of Primary Care (V.2; ICPC-2), International Classification of Disease (10th revision; ICD-10) or the Cumulative Illness Rating Scale (CIRS), the number of disease entities required for multimorbidity, and the number of chronic conditions studied.DesignNational prospective cross-sectional study.SettingAustralian general practice.Participants8707 random consenting deidentified patient encounters with 290 randomly selected general practitioners.Main outcome measuresPrevalence estimates of multimorbidity using different definitions.ResultsData classified to ICPC-2 chapters, ICD-10 chapters or CIRS domains produce similar multimorbidity prevalence estimates. When multimorbidity was defined as two or more (2+) disease entities: counting individual chronic conditions and groups of chronic conditions produced similar estimates; the 12 most prevalent chronic conditions identified about 80% of those identified using all chronic conditions. When multimorbidity was defined as 3+ disease entities: counting individual chronic conditions produced significantly higher estimates than counting groups of chronic conditions; the 12 most prevalent chronic conditions identified only two-thirds of patients identified using all chronic conditions.ConclusionsMultimorbidity defined as 2+ disease entities can be measured using different definitions of disease entity with as few as 12 prevalent chronic conditions, but lacks specificity to be useful, especially in older people. Multimorbidity, defined as 3+, requires more measurement conformity and inclusion of all chronic conditions, but provides greater specificity than the 2+ definition. The proposed concept of "complex multimorbidity", the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person without defining an index chronic condition, may be useful in identifying high-need individuals.

Project description:ObjectivesTo explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).DesignCross-sectional study.SettingAustralian general practice.Participants69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).Primary and secondary outcome measuresPrevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).ResultsMean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.ConclusionsMultimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.

Project description:BACKGROUND:Since 2010 the National Institute for Health and Care Excellence has recommended screening adults for excessive alcohol consumption to try and help prevent alcohol-use disorders. Little is known about the extent to which these recommendations are followed, and the resulting completeness and validity of alcohol-related data recording in primary care. OBJECTIVE:To investigate the completeness and accuracy of recording of alcohol use within primary care records in the UK. DESIGN AND SETTING:Cross-sectional study in the Clinical Practice Research Datalink. PARTICIPANTS:We included all adult patients registered on 1st January 2018 with ?1 year of follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES:We calculated prevalence of alcohol consumption recording overall and within patient groups. We then validated alcohol consumption data against recommended screening tools (Alcohol Use Disorders Identification Test (AUDIT)) as the gold standard. We also calculated how prevalence of alcohol recording changed over the preceding decade. RESULTS:In 2018, among 1.8 million registered adult patients, just over half (51.9%) had a record for a code related to alcohol in the previous 5 years. Recording of alcohol consumption was more common among women, older people, ex-smokers and those from more deprived areas, who were overweight/obese, or with comorbidities. A quarter of patients had units per week recorded in the last 5 years, but <10% had an AUDIT or Fast Alcohol Screening Test (FAST) alcohol screening test score. The recorded alcohol measures corresponded to results from gold standard AUDIT scores. The distribution of consumption among current drinkers was similar to the Health Survey for England. CONCLUSIONS:Half of adults in UK primary care have no recorded alcohol consumption data. When consumption is recorded, we have demonstrated internal and external validity of the data, suggesting greater recording may help identify opportunities for interventions to reduce harms.

Project description:BackgroundExpected growth in the demand for health services has generated interest in the more effective deployment of health care assistants. Programs encouraging German general practitioners (GPs) to share responsibility for care with specially qualified health care assistants in the family practice (VERAHs) have existed for several years. But no studies have been conducted on the tasks German GPs are willing to rely on specially qualified personnel to perform, what they are prepared to delegate to all non-physician practice staff and what they prefer to do themselves.MethodsAs part of an evaluation study on the deployment of VERAHs in GP-centered health care, we used a questionnaire to ask about task delegation within the practice team. From a list of tasks that VERAHs are specifically trained to carry out, GPs were asked to indicate which they actually delegate. We also asked GPs why they had employed a VERAH in their practice and for their opinions on the benefits and limitations of assigning tasks to VERAHs. The aim of the study was to find out which tasks GPs delegate to their specially qualified personnel, which they permit all HCAs to carry out, and which tasks they do not delegate at all.ResultsThe survey was filled in and returned by 245 GPs (83%). Some tasks were exclusively delegated to VERAHs (e.g. home visits), while others were delegated to all HCAs (e.g. vaccinations). About half the GPs rated the assessment of mental health, as part of the comprehensive assessment of a patient's condition, as the sole responsibility of a GP. The possibility to delegate more complex tasks was the main reason given for employing a VERAH. Doctors said the delegation of home visits provided them with the greatest relief.ConclusionsIn Germany, where GPs are solely accountable for the health care provided in their practices, experience with the transfer of responsibility to other non-physician health care personnel is still very limited. When HCAs have undergone special training, GPs seem to be prepared to delegate tasks that demand a substantial degree of know-how, such as home visits and case management. This "new" role allocation within the practice may signal a shift in the provision of health care by family practice teams in Germany.

Project description:OBJECTIVE:This study aimed to report prevalence and evaluate the association between multimorbidity and associated risk factors in the adult population of Bangladesh. DESIGN:A cross-sectional study was conducted using a multistage clustered random sampling strategy. SETTING:The study was conducted among the general population of 58 districts in Bangladesh. PARTICIPANTS:A total of 12?338 male and female individuals aged ?35 were included for analysis in this study. Identified through a household listing conducted prior to the study, from 15?297 individuals meeting the inclusion criteria, 12?338 participants were included based on availability during data collection, consent and health condition. OUTCOME MEASURES:Multimorbidity in terms of hypertension, diabetes, cancer, cardiovascular diseases, stroke and chronic obstructive pulmonary disease. RESULTS:Approximately 8.4% (95%?CI 7.0 to 9.7) of individuals suffer from multimorbidity, of which hypertension accounted for (30.1%) followed by diabetes (10.6%). The mean age of the population was 58.6 (SD ±9.2) years. The prevalence of multimorbidity was lower among men (7.7%) compared with women (8.9%). The likelihood of having multimorbidity among obese individuals were more than double than people with normal body mass index (BMI). Physical activity protected individuals from developing multimorbidity: however, the physical activity adjusted OR was 0.5 (95% CI 0.2 to 1.2). After adjusting for all covariates, higher age, higher educational status, economic status, and higher BMI were found to be significantly associated with the odds of developing multimorbidity, with an overall adjusted OR of 0.02 (95% CI 0.01 to 0.02). CONCLUSION:This study reported a high prevalence of multimorbidity in Bangladesh, although it explored the burden and identified risk factors considering only six chronic diseases. Further detailed exploration through longitudinal studies considering a wider range of diseases is needed to document the actual burden, develop effective preventive measures and clinical guidelines to improve the quality of life of the population.

Project description:BACKGROUND:Botswana is currently undergoing rapid epidemiological transition indicated by a decline in infectious diseases and an increase in chronic non-communicable diseases and their associated risk factors. The main aim of this study was to assess prevalence and correlates of multimorbidity among the adult population in Botswana. METHODS:A cross-sectional study called Chronic Non-Communicable Diseases Study (NCDs study) was conducted in March, 2016. Using multistage cross sectional sampling design, 1178 male and female respondents aged 15 years and above were interviewed across 3 cities and towns, 15 urban villages and 15 rural villages. Participants were interviewed face-to-face using a structured questionnaire. Adjusted multinomial logistic regression analysis was used to assess covariates of multimorbidity. The statistical significant level was fixed at p <0 .05. RESULTS:Prevalence of multimorbidity in the sampled population was estimated at 5.4%. Multivariate results indicate that the odds of multimobridty were significantly high among women (AOR = 3.34, 95% C.I. = 1.22-21.3) than men. On the other hand, the odds of multimorbidity were significantly low among young people aged below 24 years (AOR = 0.01, 95% C.I. = 0.00-0.07), currently married people (AOR = 0.24, 95% C.I. = 0.07-0.80) and individuals in the 2nd wealth quintile (AOR = 0.20, 95% C.I. = 0.05-0.75) compared to their counterparts. For behavioural risk factors, alcohol consumption (AOR = 4.80, 95% C.I. = 1.16-19.8) and overweight/obesity (AOR = 1.44, 95% CI = 1.12-2.61) were significantly associated with high multimorbidity prevalence. CONCLUSION:Multimorbidity was found to be more prevalent among women, alcohol consumers and overweight/obese people. There is need to strengthen interventions encouraging healthy lifestyles such as non-consumption of alcohol, physical activity and healthy diets. Moreover, there is need for a holistic approach of health care services to meet the needs of those suffering from multimorbidity.

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Prevalence of multimorbidity in general practice: a cross-sectional study within the Swiss Sentinel Surveillance System (Sentinella).

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