Abstract

Multimorbidity is increasingly the primary concern of healthcare systems globally with substantial implications for patient outcomes and resource cost. A critical knowledge gap exists as to the magnitude of multimorbidity in primary care practice in low and middle income countries with available information limited to prevalence. In India, primary care forms the bulk of the health care delivery being provided through both public (community health center) and private general practice setting. We undertook a study to identify multimorbidity patterns and relate these patterns to severity among 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. Multimorbidity patterns (dyad and triad) were identified for 21 chronic conditions, functional limitation was assessed as a proxy measure of severity and the mean severity score for each pattern, was determined after adjusting for age. The leading dyads in younger age group i.e. 18–29 years were acid peptic disease with arthritis/ chronic back ache/tuberculosis /chronic lung disease, while older age groups had more frequent combinations of hypertension + arthritis/ chronic lung disease/vision difficulty, and arthritis + chronic back ache. The triad of acid peptic disease + arthritis + chronic backache was common in men in all age groups. Tuberculosis and lung diseases were associated with significantly higher age-adjusted mean severity score (poorer functional ability). Among men, arthritis, chronic backache, chronic lung disease and vision impairment were observed to have highest severity) whereas women reported higher severity for combinations of hypertension, chronic back ache and arthritis. Given the paucity of studies on multimorbidity patterns in low and middle income countries, future studies should seek to assess the reproducibility of our findings in other populations and settings. Another task is the potential implications of different multimorbidity clusters for designing care protocols, as currently the protocols are disease specific, hardly taking comorbidity into account.

Highlights

  • With increased life expectancy and better living conditions, the co-occurrence of multiple chronic conditions, commonly referred to as ‘multimorbidity’ is being increasingly observed among individuals globally [1]

  • With no gold standard available to measure multimorbidity in India, we developed and validated a structured tool—Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC)[20]

  • The mean number of chronic conditions and the prevalence of multimorbidity was more among women [32.5%] compared to men [25.1%] [X2 14.23, p = 0.047] whereas, the mean severity score was higher among men [3.22, 95% CI 3.05–3.39] compared to women [3.15, 95%CI 2.97–3.33]

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Summary

Introduction

With increased life expectancy and better living conditions, the co-occurrence of multiple chronic conditions, commonly referred to as ‘multimorbidity’ is being increasingly observed among individuals globally [1]. The consequences of multimorbidity are manifold—individuals with multiple morbidities experience an inferior quality of life, a poorer perception of their physical and mental health, experience higher in-hospital mortality, longer length of hospital stay, incur higher healthcare expenditure, and a lower functional capacity[3,4,5]. Evidence suggests that it is not the chronic conditions by themselves that increase the resource cost. Existing care models and the clinical guidelines for chronically ill patients are mostly focused on management of single conditions separately though diseases are rarely presented in isolation[10]

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