Multimorbidity in Patients Attending 2 Australian Primary Care Practices

Abstract

PURPOSE Multiple chronic conditions in a single patient can be a challenging health burden. We aimed to examine patterns and prevalence of multimorbidity among patients attending 2 large Australian primary care practices and to estimate disease severity burden using the Cumulative Illness Rating Scale (CIRS). METHODSUsing published CIRS guidelines and a disease severity index calculated for each individual, we extracted data from the medical records of all 7,247 patients (58.5% female) seen over 6 months in 2008 who were rated for chronic conditions across 14 anatomical domains. CONCLUSIONS Multimorbidity is a significant problem in men and women across all age-groups, and the moderate severity index increases with age. The musculoskeletal domain was most commonly affected. Mild and moderate severity index categories may underrepresent disease burden. Severity burden assessment in the primary care setting needs to take into account the severity index, as well as levels of domain severity within the index categories. RESULTS

Risk factors for potentially inappropriate prescribing to older patients in primary care

“…A possible reason for this lies in the fact that study participants were not affected by serious multimorbidity (median of total CIRS-G score was between 8 and 10), which could potentially raise the risk for inappropriate prescribing. The findings pointing out to an important protective role of CIRS-G severity index and a number of categories assigned the highest severity level according to CIRS-G scale in the occurrence of PIM and POM, respectively, are especially interesting, given that these two parameters present a more reliable description of the multimorbidity burden [32,45]. Despite the fact that mild to moderate severity index, as it was obtained in the present study, may underestimate the severity of multimorbidity [32], we believe that physicians' awareness about the influence of coexisting diseases on overall health status and the risk of further complications, particularly if more body systems were affected by serious disorders, significantly contributed to prescription of the appropriate, clinically indicated medication.…”

“…For the purpose of this study, the judgment about disease severity was made on the basis on the available patients' medical data, following strictly the scoring instructions given by Miller et al [29], and as needed, the specialists at the higher level of health care system who cared for a specific patient were also consulted. In order to reduce the possibility of underestimation of multiple disease severity burden (i.e., "risk of severity index dilution") due to preponderance of individual domain scores of 1 and 2 among our participants (reflecting actual mild and moderate health problems, respectively), the number of organ systems assigned a high severity level of 3 and 4 was also observed for each patient along with the total CIRS-G score (i.e., sum of severity scores of all organ domains) and severity index calculated (the ratio of total score to number of body systems affected by the chronic disease with a given level of severity of at least 1) [32]. 2.…”

Multimorbidity in a marginalised, street-health Australian population: a retrospective cohort study

“…Like our earlier mainstream practices study,24 we include an estimation of disease severity to enhance the overall picture of multimorbidity burden in this population.…”

In This Issue: Working in Community and Improving Health Care Quality

“…A new conceptualization and measure of the impact of information from electronic knowledge resources is articulated and evaluated by Pluye et al as the "number needed to benefit from information"-the number of patients for whom clinical information is retrieved for one patient to benefit. 10 The burden of multiple chronic conditions among patients see in primary care practice is shown in an article by Brett et al 11 We welcome your reflections at www.AnnFamMed. org.…”