Multimorbidity of chronic diseases and health care utilization in general practice

Sandra H Van Oostrom, H Susan J Picavet, Simone R De Bruin, Irina Stirbu, Joke C Korevaar, Francois G Schellevis, C.A. Baan

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background
Multimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years and older.

Methods
Data on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008 (N = 32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses adjusted for age, gender, and clustering of patients in general practices were used to assess the association between multimorbidity and service utilization in 2008.

Results
Patients diagnosed with multiple chronic diseases had on average 18.3 contacts (95% CI 16.8 19.9) per year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any (6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions, and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were lower than what would be expected on the basis of contact rates of the separate diseases.

Conclusion
Multimorbidity is associated with increased health care utilization in general practice, yet the increase declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more extensive health resources are required.
Original languageEnglish
Article number61
JournalBMC Family Practice
Volume15
Issue number1
DOIs
Publication statusPublished - 2014

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General Practice
Comorbidity
House Calls
Information Services
Health Resources
Netherlands
Health Services
Cluster Analysis

Cite this

Van Oostrom, S. H., Picavet, H. S. J., De Bruin, S. R., Stirbu, I., Korevaar, J. C., Schellevis, F. G., & Baan, C. A. (2014). Multimorbidity of chronic diseases and health care utilization in general practice. BMC Family Practice, 15(1), [61]. https://doi.org/10.1186/1471-2296-15-61
Van Oostrom, Sandra H ; Picavet, H Susan J ; De Bruin, Simone R ; Stirbu, Irina ; Korevaar, Joke C ; Schellevis, Francois G ; Baan, C.A. / Multimorbidity of chronic diseases and health care utilization in general practice. In: BMC Family Practice. 2014 ; Vol. 15, No. 1.
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abstract = "BackgroundMultimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years and older.MethodsData on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008 (N = 32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses adjusted for age, gender, and clustering of patients in general practices were used to assess the association between multimorbidity and service utilization in 2008.ResultsPatients diagnosed with multiple chronic diseases had on average 18.3 contacts (95{\%} CI 16.8 19.9) per year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any (6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions, and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were lower than what would be expected on the basis of contact rates of the separate diseases.ConclusionMultimorbidity is associated with increased health care utilization in general practice, yet the increase declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more extensive health resources are required.",
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Van Oostrom, SH, Picavet, HSJ, De Bruin, SR, Stirbu, I, Korevaar, JC, Schellevis, FG & Baan, CA 2014, 'Multimorbidity of chronic diseases and health care utilization in general practice', BMC Family Practice, vol. 15, no. 1, 61. https://doi.org/10.1186/1471-2296-15-61

Multimorbidity of chronic diseases and health care utilization in general practice. / Van Oostrom, Sandra H; Picavet, H Susan J; De Bruin, Simone R; Stirbu, Irina; Korevaar, Joke C; Schellevis, Francois G; Baan, C.A.

In: BMC Family Practice, Vol. 15, No. 1, 61, 2014.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Multimorbidity of chronic diseases and health care utilization in general practice

AU - Van Oostrom, Sandra H

AU - Picavet, H Susan J

AU - De Bruin, Simone R

AU - Stirbu, Irina

AU - Korevaar, Joke C

AU - Schellevis, Francois G

AU - Baan, C.A.

PY - 2014

Y1 - 2014

N2 - BackgroundMultimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years and older.MethodsData on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008 (N = 32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses adjusted for age, gender, and clustering of patients in general practices were used to assess the association between multimorbidity and service utilization in 2008.ResultsPatients diagnosed with multiple chronic diseases had on average 18.3 contacts (95% CI 16.8 19.9) per year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any (6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions, and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were lower than what would be expected on the basis of contact rates of the separate diseases.ConclusionMultimorbidity is associated with increased health care utilization in general practice, yet the increase declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more extensive health resources are required.

AB - BackgroundMultimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years and older.MethodsData on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008 (N = 32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses adjusted for age, gender, and clustering of patients in general practices were used to assess the association between multimorbidity and service utilization in 2008.ResultsPatients diagnosed with multiple chronic diseases had on average 18.3 contacts (95% CI 16.8 19.9) per year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any (6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions, and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were lower than what would be expected on the basis of contact rates of the separate diseases.ConclusionMultimorbidity is associated with increased health care utilization in general practice, yet the increase declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more extensive health resources are required.

U2 - 10.1186/1471-2296-15-61

DO - 10.1186/1471-2296-15-61

M3 - Article

VL - 15

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

IS - 1

M1 - 61

ER -

Van Oostrom SH, Picavet HSJ, De Bruin SR, Stirbu I, Korevaar JC, Schellevis FG et al. Multimorbidity of chronic diseases and health care utilization in general practice. BMC Family Practice. 2014;15(1). 61. https://doi.org/10.1186/1471-2296-15-61