Identifying subgroups of persons with multimorbidity based on their needs for care and support

Mieke Rijken,Iris Van Der Heide

doi:10.1186/s12875-019-1069-6

Abstract

BackgroundThere is broad consensus that countries need to develop and implement person-centred integrated care to better meet the needs of their growing populations with multimorbidity. To develop appropriate care, it is essential to know the needs for care and support among these populations. For this purpose, we examined whether subgroups of people with multimorbidity could be distinguished based on their needs, and profiled these subgroups according to medical complexity and the availability of personal resources.MethodsPersons diagnosed with two or more somatic chronic diseases (N = 613) were selected from 38 general practices throughout the Netherlands. We conducted a cluster analysis of their scores on the RAND-36 questionnaire of health-related quality of life (QoL), to gain insight in their needs for care and support. Differences in demographics, medical characteristics and personal resources between the identified clusters were tested using analysis of variance and chi-square tests.ResultsThe cluster analysis revealed three subgroups: 1. a group with a relatively good QoL (48% of the sample), 2. a group with a poor physical QoL (28%), and 3. a group with a poor QoL in all domains assessed by the RAND-36 (24%). The group with a relatively good QoL had more favourable medical characteristics than the other groups, i.e., less chronic diseases, shorter illness duration, more stable course of illness, better controllable conditions, less polypharmacy. The group with a poor QoL in all domains could rely on less personal resources (education, income, social support, health literacy, self-management capabilities) than the other groups.ConclusionsDifferent subgroups of people with multimorbidity can be distinguished based on their needs for care and support. These needs are not only determined by demographic and medical characteristics, but also by the personal resources people have available to manage their health and care. Patient profiles combining medical complexity and personal resources could guide the development of integrated care for specific target groups of persons with multimorbidity.

Highlights

There is broad consensus that countries need to develop and implement person-centred integrated care to better meet the needs of their growing populations with multimorbidity
Multimorbidity asks for new models of organizing care, as many people with multimorbidity need care from multiple care providers from different disciplines [4, 5], who need to work as a solid team overcoming professional and organizational boundaries [6]
With this study we aim to fill this gap, by 1) exploring which subgroups of people with multimorbidity could be distinguished based on their needs for care and support, and, 2) describing the demographic and medical characteristics and personal resources of the people belonging to these subgroups

Summary

Introduction

There is broad consensus that countries need to develop and implement person-centred integrated care to better meet the needs of their growing populations with multimorbidity. It is essential to know the needs for care and support among these populations. For this purpose, we examined whether subgroups of people with multimorbidity could be distinguished based on their needs, and profiled these subgroups according to medical complexity and the availability of personal resources. Some people with multimorbidity may have highly complex medical needs, which require close collaborations between different medical disciplines in primary care and hospitals. Rijken and Heide BMC Family Practice (2019) 20:179 disability and participation problems in daily life. In such cases, social care may be necessary, in addition to (primary) healthcare. Discipline- and sector-encompassing needs cannot be adequately met without good coordination and collaboration at the clinical level, supported by organizational structures, financing methods and legislation that facilitate care integration [7]

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