Comparación entre tres métodos de medida de la multimorbilidad en función del uso de recursos sanitarios en atención primaria

Sicras‐Mainar, Antoni; Velasco-Velasco, Soledad; Navarro‐Artieda, Ruth; Tamayo, M. Blanca; Jodar, Alba Aguado; Torrejón, Amador Ruiz; Prados‐Torres, Alexandra; Violán, Concepción

doi:10.1016/j.aprim.2011.05.010

Cited by 4 publications

(5 citation statements)

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“…We observed that O’Halloran criteria have several misclassifications with respect to congenital diseases, benign tumours, and some cardiovascular disease risk factors (e.g., smoking) that are considered acute conditions [ 17 ]. In this sense, other authors have attempted to define a new classification system for chronicity according to the use of health resources [ 27 ] or the duration of acute and chronic care episodes [ 28 ]. Continued work is needed to establish a definition and measurement of chronicity that takes into account not only clinical criteria but also episode duration and the use of resources.…”

Section: Discussionmentioning

confidence: 99%

Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study

et al. 2014

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BackgroundThe burden of chronic conditions and multimorbidity is a growing health problem in developed countries. The study aimed to determine the estimated prevalence and patterns of multimorbidity in urban areas of Catalonia, stratified by sex and adult age groups, and to assess whether socioeconomic status and use of primary health care services were associated with multimorbidity.MethodsA cross-sectional study was conducted in Catalonia. Participants were adults (19+ years) living in urban areas, assigned to 251 primary care teams. Main outcome: multimorbidity (≥2 chronic conditions). Other variables: sex (male/female), age (19–24; 25–44; 45–64; 65–79; 80+ years), socioeconomic status (quintiles), number of health care visits during the study.ResultsWe included 1,356,761 patients; mean age, 47.4 years (SD: 17.8), 51.0% women. Multimorbidity was present in 47.6% (95% CI 47.5-47.7) of the sample, increasing with age in both sexes but significantly higher in women (53.3%) than in men (41.7%). Prevalence of multimorbidity in each quintile of the deprivation index was higher in women than in men (except oldest group). In women, multimorbidity prevalence increased with quintile of the deprivation index. Overall, the median (interquartile range) number of primary care visits was 8 (4–14) in multimorbidity vs 1 (0–4) in non-multimorbidity patients. The most prevalent multimorbidity pattern beyond 45 years of age was uncomplicated hypertension and lipid disorder. Compared with the least deprived group, women in other quintiles of the deprivation index were more likely to have multimorbidity than men until 65 years of age. The odds of multimorbidity increased with number of visits in all strata.ConclusionsWhen all chronic conditions were included in the analysis, almost 50% of the adult urban population had multimorbidity. The prevalence of multimorbidity differed by sex, age group and socioeconomic status. Multimorbidity patterns varied by life-stage and sex; however, circulatory-endocrine-metabolic patterns were the most prevalent multimorbidity pattern after 45 years of age. Women younger than 80 years had greater prevalence of multimorbidity than men, and women’s multimorbidity prevalence increased as socioeconomic status declined in all age groups. Identifying multimorbidity patterns associated with specific age-related life-stages allows health systems to prioritize and to adapt clinical management efforts by age group.

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Section: Discussionmentioning

confidence: 99%

Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study

et al. 2014

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“…Aunque al igual que en otros estudios previos 9 , el gasto farmacéutico ambulatorio de la población de los estados de salud CRG 5 y CRG 6 (el 24,5% del total) fue el 73% del gasto total, la media del gasto por paciente y año fue de 238 € por paciente y año, inferior a otros estudios de la CV en el mismo año (277 €) 31 , porque probablemente la estructura poblacional no sea igual en todas las ZBS. Corroborando que la multimorbilidad genera mayor gasto 34 , se obtuvo que la media del gasto en los estados de salud CRG 7 y CRG 6 fue 4,5 y 2,4 veces superior con relación al estado de salud CRG 5, lo cual confirma que el aumento del n. o de enfermedades crónicas incrementa el gasto farmacéutico ambulatorio, al igual que ocurre con el aumento de la gravedad dentro de cada estado de salud.…”

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Impacto de los factores de riesgo cardiovascular en el consumo de recursos en Atención Primaria según los Grupos de Riesgo Clínico

2019

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The study of CVRF in a stratified population using the CRG system identifies and predicts where the greatest impact on morbidity and consumption of healthcare resources is generated. It allows us to know the groups of patients where to develop prevention and chronicity strategies. At the level of clinical practice, a new concept of multimorbidity is provided, defined from the state of health CRG 4 and above.

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“…This means that as multi-morbidity increases, the health problems vary more widely from the average and therefore there is no homogeneity with respect to the development of the episodes of certain specific diseases. Further studies are required to better explain and interpret these correlations and variations between PHCs and BCTs, including more information about type of PHC (rural/urban) and the professional characteristics of general practices [ 15 - 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Analysis of each indicator by PHC and BCT showed that not all physicians within the same PHC act in the same way, and that the differences are related more to the physician than to the PHC. Nonetheless, it is well known that physician behaviour depends to a great extent on the complexity and morbidity of the patient population, which affects variations in the pattern of health care services provided [ 17 , 21 - 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…In health care terms, effectiveness is the capacity to achieve a desired or expected effect; efficiency is the capacity to achieve that effect with the minimum viable use of possible resources. Measures of effectiveness in clinical practice derive from a group of indicators defined by evidence-based medicine and/or the various clinical practice guidelines [ 15 - 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Relationship between efficiency and clinical effectiveness indicators in an adjusted model of resource consumption: a cross-sectional study

Violán

Plana‐Ripoll

Foguet-Boreu

et al. 2013

BMC Health Serv Res

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BackgroundAdjusted clinical groups (ACG®) have been widely used to adjust resource distribution; however, the relationship with effectiveness has been questioned. The purpose of the study was to measure the relationship between efficiency assessed by ACG® and a clinical effectiveness indicator in adults attended in Primary Health Care Centres (PHCs).MethodsResearch design: cross-sectional study. Subjects: 196, 593 patients aged >14 years in 13 PHCs in Catalonia (Spain). Measures: Age, sex, PHC, basic care team (BCT), visits, episodes (diagnoses), and total direct costs of PHC care and co-morbidity as measured by ACG® indicators: Efficiency indices for costs, visits, and episodes (costs EI, visits EI, episodes EI); a complexity or risk index (RI); and effectiveness measured by a general synthetic index (SI). The relationship between EI, RI, and SI in each PHC and BCT was measured by multiple correlation coefficients (r).ResultsIn total, 56 of the 106 defined ACG® were present in the study population, with five corresponding to 44.5% of the patients, 11 to 68.0% of patients, and 30 present in less than 0.5% of the sample. The RI in each PHC ranged from 0.9 to 1.1. Costs, visits, and episodes had similar trends for efficiency in six PHCs. There was moderate correlation between costs EI and visits EI (r = 0.59). SI correlation with episodes EI and costs EI was moderate (r = 0.48 and r = −0.34, respectively) and was r = −0.14 for visits EI. Correlation between RI and SI was r = 0.29.ConclusionsThe Efficiency and Effectiveness ACG® indicators permit a comparison of primary care processes between PHCs. Acceptable correlation exists between effectiveness and indicators of efficiency in episodes and costs.

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Comparación entre tres métodos de medida de la multimorbilidad en función del uso de recursos sanitarios en atención primaria

Abstract: The CCI may be a simple method of predicting PHC costs in routine clinical practice. If confirmed, these results will allow improvements in the comparison of the case-mix.

Cited by 4 publications

References 33 publications

Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study

Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study

Impacto de los factores de riesgo cardiovascular en el consumo de recursos en Atención Primaria según los Grupos de Riesgo Clínico

Relationship between efficiency and clinical effectiveness indicators in an adjusted model of resource consumption: a cross-sectional study

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