Systematic Age-Related Differences in Chronic Disease Management in a Population-Based Cohort Study: A New Paradigm of Primary Care Is Required

Abstract

BackgroundOur interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group.MethodsThis population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level.ResultsThe quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16–44 year-olds), adults (45–64), and oldest old (+85) than for patients aged 65–74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16–44 y), adults (45–64 y), the very old (75–84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65–74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old.ConclusionOur study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.

Prevalence of Heart Failure and Adherence to Process Indicators: Which Socio-Demographic Determinants are Involved?

“…Creative solutions are needed to address the escalating health care burden of chronic diseases. Adopting evidence-based approaches for the management of chronic conditions such as CHF can make health care systems more coherent and efficient, and provide a way to improve quality of care across a range of chronic health problems, as well as ensuring that primary care really is a service that comes as close as possible to where people live and work, with a level of care that guarantees fewer health disparities across population subgroups [ 3 ]. More action is still needed to promote a proactive, integrated approach to chronic care capable of actively involving chronically ill patients in all seasons of their life.…”

“…It is also essential to analyze the determinants of adherence in order to identify population groups likely to be scarcely compliant with disease management programs. Adherence to appropriate chronic disease management programs is a multifaceted issue influenced by how health care is delivered and by patient-related factors (called antecedents ) that may have an impact on an individual’s propensity to follow medical recommendations; some sociodemographic factors are among these antecedents [ 3 ]. Several studies have shown that age, ethnicity and formal education have an important influence on adherence to health professionals’ advice [ 4 , 5 ], for instance.…”

Effect of statins in preventing hospitalizations for infections: A population study

“…The regional dataset of this population contains information about gender, age, and chosen general practitioners (GP) at January 1 st , 2011. This dataset also informs about the participation of patients' GPs to the regional chronic care model project (CCM), launched by Tuscany Region during year 2010, and concerning the commitment for a more proactive behavior by family physicians regarding current care policy of major chronic diseases …”

“…GPs to the regional chronic care model project (CCM), launched by Tuscany Region during year 2010, and concerning the commitment for a more proactive behavior by family physicians regarding current care policy of major chronic diseases. 22 From a different database we identified as diabetic each individual who had at least 1 hospitalization with main or concomitant diagnosis of diabetes (ICD9-CM 250*), or who had an active exemption for diabetes, or had at least 2 prescriptions of antidiabetic drugs in a year, before January 1 st 2011. 23 In order to avoid possible selection biases, those with a new diagnosis of diabetes satisfying at least one of these conditions after January 1 st , 2011, along with those who had chosen a GP joining the CCM program after year 2011, were dropped from the cohort.…”

Data Extraction And Management In Networks Of Observational Health Care Databases For Scientific Research: A Comparison Among EU-ADR, OMOP, Mini-Sentinel And MATRICE Strategies

“…Currently, it covers a population of about 9 million subjects living in some of the Local Health Authorities in 9 of the 21 regional health care systems in the country. Studies completed so far using data from this network were aimed at evaluating the quality and equity of primary care, the impact of policies in this field [Visca2013, 44 , 45 , 46 , 47 and methodological challenges of such studies [Gini2014]. 48 , 49 The network currently participates in several studies funded by the Italian Ministry of Health.…”