scholarly journals Prevalence of multimorbidity in general practice: a cross-sectional study within the Swiss Sentinel Surveillance System (Sentinella)

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019616 ◽  
Author(s):  
Sophie Excoffier ◽  
Lilli Herzig ◽  
Alexandra A N’Goran ◽  
Anouk Déruaz-Luyet ◽  
Dagmar M Haller
Keyword(s):  
Primary Care ◽  
Health System ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
Sentinel Surveillance ◽  
Psychological Disorder ◽  
Secondary Outcome ◽  
Endocrine Disorders ◽  
Surveillance Network ◽  
Cross Sectional

ObjectivesTo estimate the prevalence of multimorbidity using a list of 75 chronic conditions derived from the International Classification for Primary Care, Second edition and developed specifically to assess multimorbidity in primary care. Our aim was also to provide prevalence data for multimorbidity in primary care in a country in which general practitioners (GPs) do not play a gatekeeping role in the health system.SettingA representative sample of GPs within the Swiss Sentinel Surveillance Network.Participants118 GPs completed a paper-based questionnaire about 25 consecutive patients of all ages between September and November 2015. There were no patient exclusion criteria. Recorded data included date of birth, gender and the patients’ chronic conditions.Primary and secondary outcome measuresWe estimated the prevalence of multimorbidity, defined as ≥2, and ≥3 chronic conditions stratified by gender and age group, and adjusted for clustering by GPs. We also computed the prevalence of each chronic condition individually and grouped by system.ResultsData from 2904 patients were included (mean age (SD)=56.5 (20.5) years; male=43.7%). Prevalence was 52.1% (95% CI 48.6% to 55.5%) for ≥2 and 35.0% (95% CI 31.6% to 38.5%) for ≥3 chronic conditions, with no significant gender differences. Prevalence of two or more chronic conditions was low (6.2%, 95% CI 2.8% to 13.0%) in those below 20 but affected more than 85% (85.8%, 95% CI 79.6% to 90.3%) of those above the age of 80. The most prevalent conditions were cardiovascular (42.7%, 95% CI 39.7% to 45.7%), psychological (28.5%, 95% CI 26.1% to 31.1%) and metabolic or endocrine disorders (24.1%, 95% CI 21.6% to 26.7%). Elevated blood pressure was the most prevalent cardiovascular condition and depression the most common psychological disorder.ConclusionIn a country in which GPs do not play a gatekeeping role within the health system, the prevalence of multimorbidity, as assessed using a list of chronic conditions specifically relevant to primary care, is high and increases with age.

scholarly journals Prevalence and coprevalence of chronic comorbid conditions in patients with type 2 diabetes in Catalonia: a population-based cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031281 ◽  
Author(s):  
Manel Mata-Cases ◽  
Josep Franch-Nadal ◽  
Jordi Real ◽  
Marta Cedenilla ◽  
Didac Mauricio
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Cross Sectional

ObjectivesTo evaluate the prevalence and coprevalence of several chronic conditions in patients with type 2 diabetes in a Mediterranean region.DesignA cross-sectional study.SettingTwo hundred and eighty-six primary care teams of the Catalonian Health Institute (Catalonia, Spain).ParticipantsWe included patients aged ≥18 years with a diagnosis of type 2 diabetes by 31 December, 2016, who were registered in the Information System for the Development of Research in primary care (SIDIAP) database. We excluded patients with a diagnosis of type 1 diabetes, gestational diabetes mellitus and any other type of diabetes.Primary and secondary outcome measuresWe collected data on diabetes-related comorbidities (ie, chronic complications, associated cardiovascular risk factors and treatment complications). Diagnoses were based on the International Classification of Diseases, 10thRevision codes recorded in the database or, for some entities, on the cut-off points for a particular test result or a specific treatment indicated for that entity. The presence and stage of chronic kidney disease (CKD) were based on the glomerular filtration rate, the CKD Epidemiology Collaboration creatinine equation and the urine albumin-to-creatinine ratio.ResultsA total of 373 185 patients were analysed. 82% of patients exhibited ≥2 comorbidities and 31% exhibited ≥4 comorbidities. The most frequent comorbidities were hypertension (72%), hyperlipidaemia (60%), obesity (45%), CKD (33%), chronic renal failure (CRF)(28%) and cardiovascular disease (23%). The most frequently coprevalent pairs of chronic conditions were the combination of hypertension with hyperlipidaemia (45%), obesity (35%), CKD (28%), CRF (25%) or cardiovascular disease (19%), as well as the combination of hyperlipidaemia with obesity (28%), CKD (21%), CRF (18%) or cardiovascular disease (15%); other common pairs of comorbidities were obesity/CKD, obesity/CRF, hypertension/retinopathy, hypertension/albuminuria, hypertension/urinary tract infection, CVD/CRF and CVD/CKD, which were each present in more than 10% of patients.ConclusionPatients with type 2 diabetes have a high frequency of coprevalence of metabolic risk factors, cardiovascular disease and CKD and thus require an integrated management approach.

scholarly journals Representativeness of patients and providers in the Canadian Primary Care Sentinel Surveillance Network: a cross-sectional study

CMAJ Open ◽  
2016 ◽  
Vol 4 (1) ◽  
pp. E28-E32 ◽  
Author(s):  
J. A. Queenan ◽  
T. Williamson ◽  
S. Khan ◽  
N. Drummond ◽  
S. Garies ◽  
...  
Keyword(s):  
Primary Care ◽  
Cross Sectional Study ◽  
Sentinel Surveillance ◽  
Sectional Study ◽  
Surveillance Network ◽  
Cross Sectional

scholarly journals Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029340 ◽  
Author(s):  
Usnish B Majumdar ◽  
Christophe Hunt ◽  
Patrick Doupe ◽  
Aaron J Baum ◽  
David J Heller ◽  
...  
Keyword(s):  
New York ◽  
Health System ◽  
Urban Health ◽  
Low Income ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
Multiple Chronic Conditions ◽  
Cross Sectional ◽  
Study Population ◽  
Mount Sinai

ObjectiveTo (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs.DesignRetrospective cross-sectional study.SettingMount Sinai Health System, set in all five boroughs of New York City, USA.Participants192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014.MethodsWe classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected.Results61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%.ConclusionsIn this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.

scholarly journals Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Cesar I. Fernandez-Lazaro ◽  
Juan M. García-González ◽  
David P. Adams ◽  
Diego Fernandez-Lazaro ◽  
Juan Mielgo-Ayuso ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
World Health ◽  
Healthcare Team ◽  
Sectional Study ◽  
Adherence To Treatment ◽  
Related Factors ◽  
Cross Sectional ◽  
Factors Associated

Abstract Background Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs.

scholarly journals Multimorbidity and patterns of chronic conditions in a primary care population in Switzerland: a cross-sectional study

BMJ Open ◽  
2017 ◽  
Vol 7 (6) ◽  
pp. e013664 ◽  
Author(s):  
Anouk Déruaz-Luyet ◽  
A Alexandra N'Goran ◽  
Nicolas Senn ◽  
Patrick Bodenmann ◽  
Jérôme Pasquier ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Primary Care Population

scholarly journals Diagnostic routes and time intervals for patients with colorectal cancer in 10 international jurisdictions; findings from a cross-sectional study from the International Cancer Benchmarking Partnership (ICBP)

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023870 ◽  
Author(s):  
David Weller ◽  
Usha Menon ◽  
Alina Zalounina Falborg ◽  
Henry Jensen ◽  
Andriana Barisic ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Cancer Registries ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Time Intervals ◽  
Cross Sectional ◽  
Treatment Data ◽  
The Uk

ObjectiveInternational differences in colorectal cancer (CRC) survival and stage at diagnosis have been reported previously. They may be linked to differences in time intervals and routes to diagnosis. The International Cancer Benchmarking Partnership Module 4 (ICBP M4) reports the first international comparison of routes to diagnosis for patients with CRC and the time intervals from symptom onset until the start of treatment. Data came from patients in 10 jurisdictions across six countries (Canada, the UK, Norway, Sweden, Denmark and Australia).DesignPatients with CRC were identified via cancer registries. Data on symptomatic and screened patients were collected; questionnaire data from patients’ primary care physicians and specialists, as well as information from treatment records or databases, supplemented patient data from the questionnaires. Routes to diagnosis and the key time intervals were described, as were between-jurisdiction differences in time intervals, using quantile regression.ParticipantsA total of 14 664 eligible patients with CRC diagnosed between 2013 and 2015 were identified, of which 2866 were included in the analyses.Primary and secondary outcome measuresInterval lengths in days (primary), reported patient symptoms (secondary).ResultsThe main route to diagnosis for patients was symptomatic presentation and the most commonly reported symptom was ‘bleeding/blood in stool’. The median intervals between jurisdictions ranged from: 21 to 49 days (patient); 0 to 12 days (primary care); 27 to 76 days (diagnostic); and 77 to 168 days (total, from first symptom to treatment start). Including screen-detected cases did not significantly alter the overall results.ConclusionICBP M4 demonstrates important differences in time intervals between 10 jurisdictions internationally. The differences may justify efforts to reduce intervals in some jurisdictions.

scholarly journals Patterns of patients with multiple chronic conditions in primary care: A cross-sectional study

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0238353
Author(s):  
Xiao Wei Tan ◽  
Ying Xie ◽  
Jeremy Kaiwei Lew ◽  
Poay Sian Sabrina Lee ◽  
Eng Sing Lee
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
Multiple Chronic Conditions ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Chronic conditions and multimorbidity in a primary care population: a study in the Swiss Sentinel Surveillance Network (Sentinella)

2018 ◽  
Vol 63 (9) ◽  
pp. 1017-1026 ◽  
Author(s):  
Markus Gnädinger ◽  
Lilli Herzig ◽  
Alessandro Ceschi ◽  
Dieter Conen ◽  
Alfred Staehelin ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Sentinel Surveillance ◽  
Surveillance Network ◽  
Primary Care Population
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