The epidemiology of multimorbidity in primary care: a retrospective cohort study

Abstract

BackgroundMultimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available.AimTo describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation.Design and settingRetrospective cohort study, undertaken in England.MethodThe study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified.ResultsIn total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions.ConclusionMultimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

The challenge of ageing populations and patient frailty: can primary care adapt?

“…Regardless, implementing different schemes and guidelines for each group is unduly complex and inefficient, especially as they share several core management elements (medicines review, personalised assessment, care planning). In addition, more than 25% of adults have two or more chronic conditions,18 hence the multimorbidity guidelines require additional factors to be present such as frailty, risk for unplanned care, or management complexity,17 further blurring distinctions between the groups. Although frailty is the more complex concept, it has a strong theoretical basis related to its origins in geriatric medicine 19…”

Seven days in medicine: 7-13 March 2018

“…The study, published in the British Journal of General Practice ,1 found that over a third of people with multimorbidities also had a mental health condition. Helen Stokes-Lampard, college chair, said that the research was “further evidence of the increasing complexity of cases that GPs are dealing with, and the inadequacy of the standard 10 minute consultation.”…”

Multimorbidity within households and health and social care utilisation and cost: retrospective cohort study using administrative data

“…Recent UK data shows that 23-27% of people have two or more conditions and their care needs account for over 50% of primary and secondary care costs and a substantial portion of community and social care costs. [1] [2] [3] Trials of initiatives to improve outcomes and reduce emergency secondary care use of those with multimorbidity have not shown immediate success. [4] [5] Therefore, more is needed to understand the drivers of care use and costs for those living with multimorbidity, and identify ways their care could be improved.…”

“…This list was adapted from[1]. A list of Read codes and Gemscript codes is available at http://www.phpc.cam.ac.uk/pcu/cprd_cam/codelists/Supplementary Table 4.…”