Abstract
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.
Highlights
Most evidence on chronic diseases has been collected for single diseases whereas in reality, patients often suffer from more than one condition
A disease code on low back pain might relate to a patient that only consulted for advice but the same disease code could relate to a patient with severe impairment, decreased quality of life or intensive need for physiotherapy
Chart review Medical records in the participating practices are based on the problem-oriented medical record model as proposed by Weed (1968) [10] in which the patient's history, physical findings, laboratory results, etc. are organized around patient’s problems. These medical records include a list of all the problems of the patient including both clearly established diagnoses and other problems relevant for patient management in primary care
Summary
Most evidence on chronic diseases has been collected for single diseases whereas in reality, patients often suffer from more than one condition. 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. Datasets based on automatized extraction of disease codes do not necessarily identify the problems that are relevant at the point of care [3]. They might lead to over- or underestimation of diseases. This study aims to identify the problems that influence clinical management at the patient level in primary care in order to identify combinations of problems that could be a relevant focus for trials or guidelines for patients with multimorbidity
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