Identifying multimorbidity clusters with the highest primary care use: 15 years of evidence from a multi-ethnic metropolitan population.
Identifying multimorbidity clusters with the highest primary care use: 15 years of evidence from a multi-ethnic metropolitan population.
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DOI：
10.3399/bjgp.2021.0325
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发表时间：
2022-03
期刊：
影响因子：
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通讯作者：
Fox-Rushby J
中科院分区：
文献类型：
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作者：
Soley-Bori M;Bisquera A;Ashworth M;Wang Y;Durbaba S;Dodhia H;Fox-Rushby J
患有多发性硬化症的人有复杂的医疗保健需求。一些共发疾病相互作用的程度比其他疾病更大，可能对初级保健的使用产生不同的影响。评估随着时间的推移，多发病集群和初级保健咨询之间的关联。采用回顾性纵向（面板）研究设计。数据包括2005年至2020年期间在伦敦种族多元化的城市环境中在全科医生诊所注册的826166名患者的电子初级保健健康记录。初级保健咨询率采用广义估计方程建模。关键控制包括长期疾病的总数，五个多因素集群，及其相互作用效应，种族群体和多药（疾病严重程度的代理）。模型还按咨询类型和族裔群体进行了校准。患有多发性硬化症的人使用的初级保健服务是没有多发性硬化症的人的两到三倍（发病率比2.30，95%置信区间= 2.29至2.32）。酒精依赖、物质依赖和艾滋病毒集群（依赖+）中的患者随着额外长期条件的积累，初级保健咨询的增加率最高，其次是精神健康集群（焦虑和抑郁）。观察到种族群体的差异，对黑人或亚洲种族个体的慢性肝病和病毒性肝炎集群的影响最大。这项研究确定了随着时间的推移，随着额外的长期条件的发展，随着时间的推移，初级保健需求最高的多发病集群，按咨询类型和种族区分。有针对性的临床实践，以防止这些群体的多发性硬化症的进展可能会减少未来的压力，通过改善健康结果的初级保健需求。
People with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may have a different impact on primary care use. To assess the association between multimorbidity clusters and primary care consultations over time. A retrospective longitudinal (panel) study design was used. Data comprised electronic primary care health records of 826 166 patients registered at GP practices in an ethnically diverse, urban setting in London between 2005 and 2020. Primary care consultation rates were modelled using generalised estimating equations. Key controls included the total number of long-term conditions, five multimorbidity clusters, and their interaction effects, ethnic group, and polypharmacy (proxy for disease severity). Models were also calibrated by consultation type and ethnic group. Individuals with multimorbidity used two to three times more primary care services than those without multimorbidity (incidence rate ratio 2.30, 95% confidence interval = 2.29 to 2.32). Patients in the alcohol dependence, substance dependence, and HIV cluster (Dependence+) had the highest rate of increase in primary care consultations as additional long-term conditions accumulated, followed by the mental health cluster (anxiety and depression). Differences by ethnic group were observed, with the largest impact in the chronic liver disease and viral hepatitis cluster for individuals of Black or Asian ethnicity. This study identified multimorbidity clusters with the highest primary care demand over time as additional long-term conditions developed, differentiating by consultation type and ethnicity. Targeting clinical practice to prevent multimorbidity progression for these groups may lessen future pressures on primary care demand by improving health outcomes.