In aging populations, multimorbidity (two or more chronic diseases in the same person [1, 2] is very common [3-5]. Patients with multimorbidity have complex health and social needs, are at risk of being admitted to the hospital or residential care home and require a wide range of interventions [6]. To satisfy the needs of these patients and their families, new innovative integrated care models are needed. To be effective, they should have primary care as the cornerstone of care [7]; effective integration between care levels [8, 9]; empowered patient´ and carers/families' [8]; and it should be patient-centered. The use of information and communication technology (ICT) platforms could

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BackgroundThe aim of this study was to investigate the quality of life in Croatian homeland war veterans who suffer from post-traumatic stress disorder and chronic low back pain (LBP).MethodsA total of 369 participants were included, classified in four study groups: those with post-traumatic stress disorder (PTSD; N = 59), those with both PTSD and lower back pain (PTSD+LBP; N = 80), those with isolated LBP (N = 95) and controls (N = 135). WHOQOL-BREF survey was used in the estimation of quality of life. The data were analysed using statistical methods and hierarchical clustering.ResultsThe results indicated a general pattern of lowering quality of life in participants with both psychological (PTSD) and physical (LBP) burden. The average overall quality of life was 2.82 ± 1.14 for the PTSD+LBP group, 3.29 ± 1.28 for the PTSD group, 4.04 ± 1.25 for the LBP group and 4.48 ± 0.80 for the controls (notably, all the pair-wise comparisons were significantly different at the level of P < 0.001, except for the pair LBP-controls, which was insignificant). This result indicated that quality of life was reduced for 9.9% in patients with LBP, 26.6% in patients with PTSD and 37.1% in PTSD+LBP, suggesting strong synergistic effect of PTSD and LBP. The analysis also identified several clusters of participants with different pattern of quality of life related outcomes, reflecting the complex nature of this indicator.ConclusionsThe results of this study reiterate strong impact of PTSD on quality of life, which is additionally reduced if the patient also suffers from LBP. PTSD remains a substantial problem in Croatia, nearly two decades after the beginning of the 1991-1996 Homeland war.

Association (ADA) guidelines were simulated. Cost of treatment and complications were based on officially published sources for medicines prices (www.mh.government.bg), for hospital charges (www.nhif.bg) and verified by expert opinion survey (1 BGN ϭ 0.51 EUR). Future costs were discounted with 5%. RESULTS: Treatment to targets postpones minor complications by up to 4 years, delays major complications by 3 to 4 years and extends life expectancy from diagnosis by 3 years compared with the baseline scenario. Total discounted cost savings over remaining life expectancy from the diagnosis were from 2483 BGN to 2908 BGN per person. CONCLUSIONS: Enhanced treatment leads to avoidance or delay of the complications of diabetes. This significantly reduces the impact diabetes can have on patients' quality of life, life expectancy and cost of diabetes treatment in Bulgarian health care system settings.