Abstract
BackgroundMultimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings.MethodsWe undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits.ResultThe overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1–1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1–2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1–2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0–2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6–4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1–3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13–2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01–3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals.ConclusionOur findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers.
Highlights
Multimorbidity in primary care is a challenge for developing countries and for low and medium income countries (LMIC)
Our findings suggest that, multimorbidity is being more reported in public primary care facilities
Our recent systematic review on multimorbidity indicated the research on this topic to be in its infancy in India with most of the studies restricted to the elderly population and no reports available from primary care settings [18]
Summary
Multimorbidity in primary care is a challenge for developing countries and for low and medium income countries (LMIC). Several studies in high income countries have demonstrated the magnitude of multimorbidity to be emerging; with the prevalence varying from 25 to 60% in health care and community settings [10,11,12,13]. Our recent systematic review on multimorbidity indicated the research on this topic to be in its infancy in India with most of the studies restricted to the elderly population and no reports available from primary care settings [18]. This is a critical knowledge gap, since primary care is the first and most frequently consulted health care facility and constitutes the scaffold of health care delivery. Evidence demonstrates that prevention and control of chronic diseases by primary care interventions focusing on those at high risk and those with established diseases are more cost-effective when compared to secondary and tertiary care interventions [24]
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