Abstract
BackgroundPeople with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may have a different impact on primary care use.AimTo assess the association between multimorbidity clusters and primary care consultations over time.Design and settingA retrospective longitudinal (panel) study design was used. Data comprised electronic primary care health records of 826 166 patients registered at GP practices in an ethnically diverse, urban setting in London between 2005 and 2020.MethodPrimary care consultation rates were modelled using generalised estimating equations. Key controls included the total number of long-term conditions, five multimorbidity clusters, and their interaction effects, ethnic group, and polypharmacy (proxy for disease severity). Models were also calibrated by consultation type and ethnic group.ResultsIndividuals with multimorbidity used two to three times more primary care services than those without multimorbidity (incidence rate ratio 2.30, 95% confidence interval = 2.29 to 2.32). Patients in the alcohol dependence, substance dependence, and HIV cluster (Dependence+) had the highest rate of increase in primary care consultations as additional long-term conditions accumulated, followed by the mental health cluster (anxiety and depression). Differences by ethnic group were observed, with the largest impact in the chronic liver disease and viral hepatitis cluster for individuals of Black or Asian ethnicity.ConclusionThis study identified multimorbidity clusters with the highest primary care demand over time as additional long-term conditions developed, differentiating by consultation type and ethnicity. Targeting clinical practice to prevent multimorbidity progression for these groups may lessen future pressures on primary care demand by improving health outcomes.
Highlights
Preventing and managing multimorbidity — the co-occurrence of ≥2 conditions — is challenging for patients, healthcare providers, and policymakers.[1,2,3,4] Multimorbidity increases with, but is not confined to, old age,[5,6] with a prevalence of 33% among middle- to older-aged adults (37–73 years) in the UK.[7]
This study identified multimorbidity clusters with the highest primary care demand over time as additional long-term conditions developed, differentiating by consultation type and ethnicity
This study identified the clustering of alcohol dependence, substance dependence, HIV, and mental health conditions as groups associated with the highest increases in primary care demand as additional longterm conditions developed over time
Summary
Preventing and managing multimorbidity — the co-occurrence of ≥2 conditions — is challenging for patients, healthcare providers, and policymakers.[1,2,3,4] Multimorbidity increases with, but is not confined to, old age,[5,6] with a prevalence of 33% among middle- to older-aged adults (37–73 years) in the UK.[7]. Research directed at understanding the clustering and sequencing of diseases, and the health and economic impact of multimorbidity, with a view to determining key drivers and efficient interventions is needed.[2,4]. People with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may have a different impact on primary care use
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