Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India

Abstract

Background: Multimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings. Methods: We undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits. Result: The overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1-1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1-2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1-2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0-2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6-4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1-3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13-2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01-3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals.

Chronic conditions, multimorbidity, and quality of life among patients attending monk healers and primary care clinics in Thailand

“…This is the first study assessing chronic conditions, multimorbidity, and QoL in patients attending two different treatment settings in Asia. The study found a high prevalence of multimorbidity (40.6%) (42.4% in the monk healer and 38.9% in the primary care setting), which was higher than in primary care in India (28.3% Odisha state, 16.2% in Kerala) [ 2 , 3 ]. The prevalence of multimorbidity was higher in monk healers than primary care attendees.…”

“…Patients with coexisting physical and mental disorders have higher functional disabilities and poor quality of life compared to those with physical conditions only, and are therefore more likely to attend monk healers than primary care to improve their functional status, which was not successfully treated in primary care [ 8 ]. The lower prevalence of multimorbidity in primary care may be related to lower availability of specialists and supporting services [ 2 ], primary care health centres in Thailand provide preventive and basic acute care, mainly provided by professional nurses. Patients with higher education seem to more likely consult monk healers and secondary care (district hospitals) directly.…”

“…Multimorbidity (coexistence of two or more chronic conditions) has been found in Southeast Asian countries [ 1 ]. In Odisha state of India, 28.3% of patients (≥ 18 years) in primary care (30.7% in public care and 24.6% in private care) had multimorbidity [ 2 ], and in rural primary care in Kerala, India, the prevalence of multimorbidity was 16.2% (≥ 18 years) [ 3 ]. In a study among chronic disease primary care patients in four Greater Mekong countries, the majority (72.6%) had multimorbidity [ 1 ].…”

“…In comparing the morbidity pattern of patients of traditional Chinese medicine practitioners with Chinese medical practitioners in Hong Kong population, showing that for chronic illnesses TCM was the preferred treatment [ 9 ]. Multimorbidity has been identified as a major challenge for health care systems, which are based on single disease-specific management [ 2 ]. Therefore, an understanding of the prevalence of multimorbidity in both a TCM and conventional primary health setting are vital in designing more effective primary care [ 2 ].…”

“…Multimorbidity has been identified as a major challenge for health care systems, which are based on single disease-specific management [ 2 ]. Therefore, an understanding of the prevalence of multimorbidity in both a TCM and conventional primary health setting are vital in designing more effective primary care [ 2 ]. There is, to our knowledge, no information on multimorbidity in a traditional health practitioner (THP) setting.…”