Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study
Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study
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DOI：
10.3399/bjgp11x548929
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发表时间：
2011-01-01
影响因子：
5.9
通讯作者：
Montgomery, Alan A.
中科院分区：
文献类型：
--
作者：
Salisbury, Chris;Johnson, Leigh;Montgomery, Alan A.
背景在发达国家，初级卫生保健越来越多地涉及对患有多种慢性病的患者的护理，目的描述多发性骨髓瘤的流行病学和多发性骨髓瘤与初级保健咨询率和护理连续性之间的关系。研究设计回顾性队列研究。设置随机抽样99997名年龄18岁或以上的人，在182个全科诊所登记，英格兰贡献数据的一般实践研究database.MethodMultimorphism的定义使用两种方法：人与多种慢性疾病的质量和成果框架，并确定使用约翰霍普金斯大学调整的临床组（ACG（R））的情况下，组合系统的人。多morphies（年龄，性别，区域剥夺）的决定因素和与咨询率和连续性的护理关系进行了检查，使用回归models.Results16%的患者有一个以上的慢性疾病包括在质量和成果框架，但这些人占32%的所有咨询。使用更广泛的ACG条件列表，58%的人患有多发性硬化症，他们占咨询的78%。多发性硬化症与年龄和贫困密切相关。与multimorrhythm的人有较高的咨询率和更少的连续性的护理相比，没有multimorrhythm.ConclusionMultimorrhythm的人是常见的人口和大多数咨询在初级保健涉及的人与multimorrhythm.ConclusionMultimorrhythmis。这些人不太可能得到连续性的护理，尽管他们可能更有可能从中获益。
BackgroundIn developed countries, primary health care increasingly involves the care of patients with multiple chronic conditions, referred to as multimorbidity.AimTo describe the epidemiology of multimorbidity and relationships between multimorbidity and primary care consultation rates and continuity of care.Design of studyRetrospective cohort study.SettingRandom sample of 99 997 people aged 18 years or over registered with 182 general practices in England contributing data to the General Practice Research Database.MethodMultimorbidity was defined using two approaches: people with multiple chronic conditions included in the Quality and Outcomes Framework, and people identified using the Johns Hopkins University Adjusted Clinical Groups (ACG (R)) Case-Mix System. The determinants of multimorbidity (age, sex, area deprivation) and relationships with consultation rate and continuity of care were examined using regression models.ResultsSixteen per cent of patients had more than one chronic condition included in the Quality and Outcomes Framework, but these people accounted for 32% of all consultations. Using the wider ACG list of conditions, 58% of people had multimorbidity and they accounted for 78% of consultations. Multimorbidity was strongly related to age and deprivation. People with multimorbidity had higher consultation rates and less continuity of care compared with people without multimorbidity.ConclusionMultimorbidity is common in the population and most consultations in primary care involve people with multimorbidity. These people are less likely to receive continuity of care, although they may be more likely to gain from it.