The prevalence of multimorbidity among adults aged 40 years and above in primary care setting: a cross-sectional study

Abstract

Objective: Coordination function of primary care (PC) enables continuous, efficient, and cost-effective health care provided to patients with chronic disease and multimorbidity (MM). The aim of this study was to identify the most common chronic diseases and to determine the prevalence of MM in PC registries. Methods: Our study is a cross-sectional study. All the individuals aged 40 and over who were registered to the primary care units (PCUs) of the Uskudar district of Istanbul have formed the population of the study. A systematic cluster sampling was used. The patient list of each family physician in Uskudar district was accepted as a cluster and an equal number of patients from each cluster were enrolled. Only the information on the patients’ MM data was requested from the primary care physicians. Results: The 108 physicians of the Uskudar district (response rate: 73.4%) gave consent to participate in the study. The 1187 (40.3%) of registered patients of all PCUs were 40 years old and over. The multimorbid patients were found as 330 (27.8%). Conclusion: Approximately, one of four patients have multimorbidity. So, the policy of primary care services should be redesigned for the management of MM patients including the ‘goal-oriented care’ approach.

Keywords

• multimorbidity
• physicians
• primary care

Birinci basamakta 40 yaş ve üzeri yetişkinlerde multimorbidite prevalansı: kesitsel bir çalışma

Abstract

Amaç: Birinci basamağın (BB) koordinasyon işlevi, kronik hastalığı ve multimorbiditesi (MM) olan hastalara sağlanan sağlık hizmetlerinde sürekli, verimli ve uygun maliyetli sağlık bakımını sağlar. Bu çalışmanın amacı BB kayıtlarında en sık görülen kronik hastalıkları ve MM prevalansını belirlemektir. Gereç ve Yöntem: Çalışmamız kesitsel bir çalışmadır. İstanbul'un Üsküdar ilçesine bağlı Aile Sağlığı Merkez’lerine (ASM) kayıtlı 40 yaş ve üzerindeki tüm bireyler çalışmanın evrenini oluşturmuştur. Örneklemin seçiminde sistematik küme örneklemesi metodu kullanılmıştır. Üsküdar ilçesindeki her aile hekiminin hasta listesi küme olarak kabul edilmiş ve her kümeden eşit sayıda hasta kaydedilmiştir. Birinci basamak hekimlerinden sadece hastaların MM verileri ile ilgili bilgiler istenmiştir. Bulgular: Üsküdar ilçesinin 108 hekimi (yanıt oranı:% 73,4) çalışmaya katılmayı kabul etmiştir. Tüm PKB'lerde kayıtlı hastaların 1187'si (% 40,3) 40 yaş ve üzerindeydi. Multimorbid hastalar 330 (% 27,8) olarak bulunmuştur. Sonuç: Yaklaşık olarak dört hastadan biri multimorbiditeye sahiptir. Bu nedenle, BB sağlık hizmetleri politikası, MM hastalarının yönetimi için "hedefe yönelik bakım" yaklaşımı dahil olmak üzere yeniden tasarlanmalıdır.

Keywords

• Multimorbidite
• Birinci basamak
• Hekim
• Sağlık politikası
• Prevalans

References

1. 1. World Health Organization (WHO). Multimorbidity: Technical Series on Safer Primary Care. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO, 2016. p. 3.
2. 2. Le Reste J, Nabbe P, Manceau B, et al. The European General Practice Research Network Presents a Comprehensive Definition of Multimorbidity in Family Medicine and Long Term Care, Following a Systematic Review of Relevant Literature. J Am Med Dir Assoc. 2013;14(5):319-325.
3. 3. World Health Organization (WHO). Innovative Care for Chronic Conditions: Building Blocks for Action: Global Report. Geneva, Switzerland, 2002. p. 12.
4. 4. O’ Halloran J. , Miller G., Britt H. Defining Chronic Conditions for Primary Care with ICPC-2. Fam Pract. 2004;21(4):381-386.
5. 5. Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey Tom, Smith SM. Managing patients with multimorbidity in primary care. BMJ. 2015;350:h176.
6. 6. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380(9836): 37-43.
7. 7. Rizza A, Kaplan V, Senn O, Rosemann T, Bhend H, Tandjung R. Age and gender-related prevalence of multimorbidity in primary care: the Swiss FIRE Project. BMC Fam Pract. 2012;24(13):113.
8. 8. Van den Akker M, Buntinx E, Knottnerus JA. Comorbidity or multimorbidity: what’s in a name? A review of literature. Eur J Gen Pract. 1996;2: 65-70.

9. 9. Public Health Agency of Turkey. The prevalence study of chronic diseases and risk factors in Turkey. 2013. Presidency of Refik Saydam Health Center. Directorate of Hıfzıssıha Institution.
10. 10. Satman I, Omer B, Tutuncu Y, et al. TURDEP-II Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28(2):169-180.
11. 11. Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H. A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology. Ann Fam Med. 2012;10(2):142-151.
12. 12. Urbaniak GC, Plous S. Research Randomizer (Version 4.0) 2013. [Computer software]. Retrieved on June 22, 2013. Available from: http://www.randomizer.org/
13. 13. Smith MS, Soubhi H, Fortin M, Hudon C, O’Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012; 345.
14. 14. Hwang W, Weller W, Ireys H, Anderson G. Out-of-pocket medical spending for care of chronic conditions. Health Aff (Millwood). 2001;20 (6): 267-278.
15. 15. Cassell A, Edwards D, Harshfield A, et al. The epidemiology of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2018;68(669):e245-e251.
16. 16. Glynn LG, Valderas JM, Healy P, et al. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011;28(5); 516–523.
17. 17. Brett T, Popescu A, Arnold-Reed DE, et al. Multimorbidity in patients attending 2 Australian primary care practices. Ann Fam Med. 2013; 11(6): 535–542.
18. 18. Déruaz-Luyet A, N'Goran AA, Senn N, et al. Multimorbidity and patterns of chronic conditions in a primary care population in Switzerland: a cross-sectional study. BMJ Open 2017;7:e013664.
19. 19. Gülbayrak C, Açık Y, Oğuzöncül F, Deveci E, Ozan T. Yenimahalle Eğitim Araştırma Sağlık Ocağına Başvuran Yaşlılardaki Kronik Hastalıkların Sıklığı ve Maliyeti. Eurasian J Med,2003;35: 7-12.
20. 20. Republic of Turkey Ministry of Health. News Bulletin of 2013 for Annual Health Statistics. 2014. [cited 2020 Feb 5]. Available from: https://dosyasb.saglik.gov.tr/Eklenti/2774,siy2013haberbultenipdf.pdf?0
21. 21. Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition-multimorbidity. JAMA. 2012;307(23):2493-2494.
22. 22. Billings J, Zeitel L, Lukomnik J, Carey TS, Blank AE, Newman L. Impact of socio-economic status on hospital use in New York City. Health Aff (Millwood). 1993;12(1):162-173.
23. 23. Salisbury C. Multimorbidity: redesigning health care for people who use it. Lancet. 2012;380(9836):7-9.
24. 24. Mold JW, Blake GH, Becker LA. Goal-oriented Medical Care. Family Medicine. 1991;23:46-51.
25. 25. Lenzen SA, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. Setting goals in chronic care: Shared decision making as self-management support by the family physician. Eur J Gen Pract. 2015;21(2):138-144