Challenges for clinical practice and research in family medicine in reducing the risk of chronic diseases. Notes on the EGPRN Spring Conference 2017 in Riga

Silina, Vija; Kalda, Ruth

doi:10.1080/13814788.2018.1429594

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…26 Family physicians in Estonia lack clear evidence-based standards for the management of patients with multiple chronic diseases, and the applicability of a single evidence-based guideline to MM is limited and can be problematic. 27 A definitive, population-based assessment of MM prevalence by age and between males and females is needed to inform the continued restructuring of the healthcare system to accommodate the growing proportion of these patients.…”

Section: Open Accessmentioning

confidence: 99%

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Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study

et al. 2021

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ObjectivesPrevalence estimates for specific chronic conditions and multimorbidity (MM) in eastern Europe are scarce. This national study estimates the prevalence of MM by age group and sex in Estonia.DesignA population-based cross-sectional study, using administrative data.SettingData were collected on 55 chronic conditions from the Estonian Health Insurance Fund from 2015 to 2017. MM was defined as the coexistence of two or more conditions.ParticipantsThe Estonian Health Insurance Fund includes data for approximately 95% of the Estonian population receiving public health insurance.Primary and secondary outcome measuresPrevalence and 95% CIs for MM stratified by age group and sex.ResultsNearly half (49.1%) of the individuals (95% CI 49.0 to 49.3) had at least 1 chronic condition, and 30.1% (95% CI 30.0 to 30.2) had MM (2 or more chronic conditions). The number of conditions and the prevalence of MM increased with age, ranging from an MM prevalence of 3.5% (3.5%–3.6%) in the youngest (0–24 years) to as high as 80.4% (79.4%–81.3%) in the oldest (≥85 years) age group. Half of all individuals had MM by 60 years of age, and 75% of the population had MM by 75 years of age. Women had a higher prevalence of MM (34.9%, 95% CI 34.7 to 35.0) than men (24.4%, 95% CI 24.3 to 24.5). Hypertension was the most frequent chronic condition (24.5%), followed by chronic pain (12.4%) and arthritis (7.7%).ConclusionsHypertension is an important chronic condition amenable to treatment with lifestyle and therapeutic interventions. Given the established correlation between uncontrolled hypertension and exacerbation of other cardiovascular conditions as well as acute illnesses, this most common condition within the context of MM may be suitable for targeted public health interventions.

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Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study

et al. 2021

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“…The data obtained in the present study point to an increase in their age, the prominence of chronic neurological diseases, and a higher vulnerability and 12-month mortality. This tendency could be the result of the improvement in socioeconomic conditions, and the generalized preventive measures implemented in last 20-30 years, which may have delayed the onset of the most common chronic diseases (cardiovascular, pulmonary, neurological...) [34][35][36]. Thus, it is probable, that the impact of chronic diseases is now being intertwined with the impact of ageing processes such as frailty, sarcopenia, and other geriatric conditions in most polypathological patients.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population

M¹,

L²,

J³

et al. 2022

J Biomed Res Environ Sci

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Background: To analyze the prevalence and main epidemiological, clinical and outcome features of in-Patients with Complex Chronic conditions (PCC) in internal medicine areas, using a pragmatic working definition. Methods: Prospective study in 17 centers from Spain, with 97 in-hospital, monthly prevalence cuts. A PCC was considered when criteria of polypathological patient (two or more major chronic diseases) were met, or when a patient suffered one major chronic disease plus one or more of nine predefined complexity criteria like socio-familial risk, alcoholism or malnutrition among others (PCC without polypathology). A complete set of baseline features as well as 12-months survival were collected. Then, we compared clinical, outcome variables, and PROFUND index accuracy between polypathological patients and PCC without polypathology. Results: The global prevalence of PCC was 61% (40% of them were polypathological patients, and 21% PCC withouth polypathology) out of the 2178 evaluated patients. Their median age was 82 (59.5% men), suffered 2.3 ± 1.1 major diseases (heart diseases (70.5%), neurologic (41.5%), renal (36%), and lung diseases (26%)), 5.5 ± 2.5 other chronic conditions, met 2.5 ± 1.5 complexity criteria, and presented functional decline (Barthel index 55 (25-90)). Compared to polypathological patients, the subgroup of PCC without polypathology were younger, with a different pattern of major diseases and comorbidities, a better functional status, and lower 12-months mortality rates ((36.2% vs 46.8%; p = .003; OR 0.7(0.48-0.86). The PROFUND index obtained adequate calibration and discrimination power (AUC-ROC 0.67 (0.63-0.69)) in predicting 12-month mortality of PCC. Conclusion: Patients with complex chronic conditions are highly prevalent in internal medicine areas; their clinical pattern has changed in parallel to socio-epidemiological modifications, but their death-risk is still adequately predicted by PROFUND index.

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“…In theory, the better management of chronic conditions through primary care is critical, not only to improve the quality of life of patients but also to reduce preventable hospital admissions ( 28 ). GPs are best positioned to manage chronic conditions as they can establish a long-term continuing relationship with their patients and they understand the multiple needs of their patients best ( 34 ). Interestingly, less than half the respondents in our study could name their contracting doctors.…”

Section: Discussionmentioning

confidence: 99%

Policy Goals of Contract Arrangements in Primary Care in Jeopardy: A Cross-Sectional Consumer Satisfaction Survey of Community Residents in Hangzhou, China

Ren

Liu

et al. 2022

Front. Public Health

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ObjectiveChina is attempting to establish a voluntary contracting system in primary care. This study aimed to determine the degree of consumer satisfaction with the entitlements of contract arrangements and its associated factors.MethodsA stratified cluster sampling strategy was adopted to recruit study participants from three administrative districts of Hangzhou municipality, each containing six residential communities. In each community, 50 households were recruited. A questionnaire was administered through face-to-face interviews with members of the households who signed a contract with community health centers, to collect data regarding their sociodemographic characteristics, health conditions, and knowledge of and attitudes toward the contract entitlements. Consumer satisfaction was measured using six items rated on a five-point Likert scale ranging from “1=very dissatisfied” to “5=very satisfied” and a summed score was calculated. A mixed linear regression model was established to identify individual predictors of consumer satisfaction after adjustment of the random (intercept) effect of household clusters.ResultsOverall, the respondents reported low levels of awareness and understanding of the contract entitlements, with an average knowledge score of 8.21 (SD = 3.74) out of a maximum possible of 19. The respondents had relatively lower levels of satisfaction (satisfied or very satisfied) with their prioritized entitlements (51.5%) and hospitals at home and telemedicine services (31.3%), compared with the contract and insurance policies (85.5%) and medical services provided (87.0%). Female gender, older age, chronic conditions, and perceived better health were associated with higher levels of satisfaction, while poor awareness and knowledge were associated with lower levels of satisfaction.ConclusionThe study participants perceived limited benefits from the contract arrangements in primary care, which may jeopardize the policy purpose of the arrangements to encourage patients to use primary care as the first contact point in accessing health care services. It is evident that consumer satisfaction with the contract entitlements varies by healthcare needs. Lower levels of satisfaction are associated with poor awareness and knowledge of the entitlements.

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Challenges for clinical practice and research in family medicine in reducing the risk of chronic diseases. Notes on the EGPRN Spring Conference 2017 in Riga

Cited by 5 publications

References 15 publications

Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study

Prevalence of chronic conditions and multimorbidity in Estonia: a population-based cross-sectional study

Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population

Policy Goals of Contract Arrangements in Primary Care in Jeopardy: A Cross-Sectional Consumer Satisfaction Survey of Community Residents in Hangzhou, China

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