BackgroundChronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors.MethodsThe study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency.ResultsPrevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient.ConclusionsMultimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0698-2) contains supplementary material, which is available to authorized users.

BackgroundQuantifying population health is important for public health policy. Since national disease registers recording clinical diagnoses are often not available, pharmacy data were frequently used to identify chronic conditions (CCs) in populations. However, most approaches mapping prescribed drugs to CCs are outdated and unambiguous. The aim of this study was to provide an improved and updated mapping approach to the classification of medications. Furthermore, we aimed to give an overview of the proportions of patients with CCs in Switzerland using this new mapping approach.MethodsThe database included medical and pharmacy claims data (2011) from patients aged 18 years or older. Based on prescription drug data and using the Anatomical Therapeutic Chemical (ATC) classification system, patients with CCs were identified by a medical expert review. Proportions of patients with CCs were calculated by sex and age groups. We constructed multiple logistic regression models to assess the association between patient characteristics and having a CC, as well as between risk factors (diabetes, hyperlipidemia) for cardiovascular diseases (CVD) and CVD as one of the most prevalent CCs.ResultsA total of 22 CCs were identified. In 2011, 62% of the 932′612 subjects enrolled have been prescribed a drug for the treatment of at least one CC. Rheumatologic conditions, CVD and pain were the most frequent CCs. 29% of the persons had CVD, 10% both CVD and hyperlipidemia, 4% CVD and diabetes, and 2% suffered from all of the three conditions. The regression model showed that diabetes and hyperlipidemia were strongly associated with CVD.ConclusionsUsing pharmacy claims data, we developed an updated and improved approach for a feasible and efficient measure of patients’ chronic disease status. Pharmacy drug data may be a valuable source for measuring population’s burden of disease, when clinical data are missing. This approach may contribute to health policy debates about health services sources and risk adjustment modelling.

BackgroundIn previous years, out- of-hours primary care has been organised in large-scale organisations in many countries. This may have lowered the threshold for many patients to present health problems at nights and during the weekend. Comparisons of out-of-hours care between countries require internationally comparable figures on symptoms and diagnoses, which were not available. This study aimed to describe the symptoms and diagnoses in out-of-hours primary care services in regions in eight European countries.MethodsWe conducted a retrospective observational study based on medical records from out-of-hours primary care services in Belgium, Denmark, Germany, the Netherlands, Norway, Slovenia, Spain, and Switzerland. We aimed to include data on 1000 initial contacts from up to three organisations per country. Excluded were contacts with an administrative reason. The International Classification for Primary Care (ICPC) was used to categorise symptoms and diagnoses. In two countries (Slovenia and Spain) ICD10 codes were translated into ICPC codes.ResultsThe age distribution of patients showed a high consistency across countries, while the percentage of males varied from 33.7% to 48.3%. The ICPC categories that were used most frequently concerned: chapter A 'general and unspecified symptoms' (mean 13.2%), chapter R 'respiratory' (mean 20.4%), chapter L 'musculoskeletal' (mean 15.0%), chapter S 'skin' (mean 12.5%), and chapter D 'digestive' (mean 11.6%). So, relatively high numbers of patients presenting with infectious diseases or acute pain related syndromes. This was largely consistent across age groups, but in some age groups chapter H ('ear problems'), chapter L ('musculoskeletal') and chapter K ('cardiovascular') were frequently used. Acute life-threatening problems had a low incidence.ConclusionsThis international study suggested a highly similar diagnostic scope in out-of-hours primary care services. The incidence rates of acute life-threatening health problems were low in all countries.

ObjectivesEpidemiological research has confirmed the association between socioeconomic status (SES) and health, but only a few studies considered working conditions in this relationship. This study examined the contribution of physical and psychosocial working conditions in explaining the social gradient in self-rated health. MethodsA representative sample of 10 101 employees, 5003 women and 5098 men, from the Swiss national health survey 2002 was used. SES was assessed according to the EGP-scheme.Working conditions included exposure to physical disturbances, physical strain, job insecurity, monotonous work and handling simultaneous tasks. For data analysis logistic regression analyses were performed. ResultsData show a social gradient for self-rated health (SRH) as well as for physical and psychosocial working conditions. Logistic regression analysis controlling for age, gender and level of employment showed both physical and psychosocial working conditions to be significant predictors of SRH. Physical and psychosocial working conditions such as physical disturbances from work environment, physical strains in doing the job, monotony at work, job insecurity etc. could explain most of the social gradient of SRH in men and women. ConclusionThe study confirmed the relevance of modifiable physical and psychosocial working conditions for reducing social inequality in health. Gender differences need to be considered in epidemiological and intervention studies.3