Abstract
Multimorbidity is more than just the addition of individual illnesses, and its diagnosis and treatment poses special problems. General practitioners play an important role in looking after multimorbid patients. The aim of this study is to assess the prevalence and pattern of acute and chronic multimorbidity in primary care patients, regardless of body system and age group. A convenience sample of 2099 patients treated by 40 general practitioners was assessed using the Burvill scale. This measure of multimorbidity differentiates according to organ system and covers both acute and chronic illnesses. It also allows severity ratings to be assessed for both acute and chronic conditions, and thus patients’ actual need for general practice care. Patients reported an average of 3.5 (SD = 2.0) acute and/or chronically affected body systems. Overall, 12.7% of patients reported only one health problem, 83.0% at least two, 65.8% at least three, 46.1% at least four, and 29.7% five or more. The most frequent problems were musculoskeletal (62.5%) and psychological (56.6%). Some morbidities were interrelated, while others co-occurred despite being medically independent. In primary care, multimorbidity is the rule rather than the exception. Acute and chronic morbidity both contribute to the burden of illness. Body systems reflect treatment needs. Instead of specialist treatment for individual illnesses, an integrative treatment approach is needed. This is the specialty of general practitioners.
Highlights
Multimorbidity is more than just the addition of individual illnesses, and its diagnosis and treatment poses special problems
Multimorbidity is the rule rather than the exception in primary care patients, and the problem is becoming more serious as society a ges[1,2,16]
General practitioners must master the full range of medical specializations
Summary
Multimorbidity is more than just the addition of individual illnesses, and its diagnosis and treatment poses special problems. A convenience sample of 2099 patients treated by 40 general practitioners was assessed using the Burvill scale This measure of multimorbidity differentiates according to organ system and covers both acute and chronic illnesses. Primary care is responsible for the treatment of 40,000 to 60,000 different illnesses and health problems In view of this high number and the prevalence rates of illnesses, many patients inevitably suffer from several disorders simultaneously. Physicians treating multimorbid patients face the problem of how many medical disciplines to take into account, who should conduct the assessments, how intensively patients should be examined, whether self- or expert assessments should be used, which laboratory tests should be performed, whether only the courses of illnesses (e.g. diabetes) or their consequences (e.g. diabetic gangrene) should be taken into account, whether medically relevant problems (carcinoma) or those with a subjective burden (warts) should be considered, whether health care utilizers or epidemiological samples should be described, whether acute or chronic conditions should be included, and, last but not least, what thresholds (e.g. for initiating treatment for hypertension) should be used[16]. The aim of this study is to collect data on the role of multimorbidity in general practice for all body systems and age groups
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