[Adjusted morbidity groups: Characteristics and comorbidities in patients with chronic conditions according to their risk level in Primary Care]

[How the individual characteristics and area of residence influence the request for virtual consultations?]

INTRODUCTION

The foundation of virtual consultation is to improve the cooperation and the coordination between Primary Care and other specialties. However, in its use inequities related to socioeconomic determinants have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource.

MATERIAL AND METHODS

Descriptive study of virtual and non-virtual consultations requested by Primary Care doctors from other specialists doctors in Aragon between 1 January 2020 and 31 December 2022. Characteristics of the interconsultations and variables specific to the patient treated were recorded and analyzed; and the request rate for virtual consultations by specialty and the standardized rates by age by Basic Health Zone and stratified by sex were calculated.

RESULTS

Progressive increase in the number of virtual consultations for the study period, being Traumatology, Neurology, Urology, General Surgery and Dermatology the specialties that received the most. The standardized rates by age and stratified by sex were higher in women and the Health Areas of Huesca, Calatayud and Alcañiz. The request was higher in 2022 and the specialized referral was the main type of response. Regarding variables of the patients treated, virtual consultations were requested more in urban and less dispersed areas, women, patients with lower adjusted morbidity and with free pharmacy, pensioners and active users with income less than €18,000/year.

CONCLUSIONS

Despite the rise of telemedicine and its potential advantages, it is necessary to adapt it to the needs of the local population, to mitigate inequalities in access, and to integrate it with face-to-face care.

Comorbidities and use of health services in people with diabetes mellitus according to risk levels by adjusted morbidity groups

BACKGROUND

People with diabetes mellitus frequently have other comorbidities and involve greater use of primary and hospital care services. The aim of this study was to describe the comorbidities and use of primary and hospital care services of people with diabetes according to their risk level by adjusted morbidity groups (AMG) and to analyse the factors associated with the utilisation of these services.

METHODS

Cross-sectional study. People with diabetes were identified within the population of patients with chronic conditions of an urban health care centre by the AMG stratification tool integrated into the primary health care electronic clinical record of the Community of Madrid. Sociodemographic, functional, clinical characteristics and annual health care services utilisation variables were collected. Univariate, bivariate and Poisson regression analyses were performed.

RESULTS

A total of 1,063 people with diabetes were identified, representing 10.8% of patients with chronic conditions within the health centre. A total of 51.4% were female, the mean age was 70 years, 94.4% had multimorbidity. According to their risk level, 17.8% were high-risk, 40.6% were medium-risk and 41.6% were low-risk. The most prevalent comorbidities were hypertension (70%), dyslipidaemia (67%) and obesity (32.4%). Almost 50% were polymedicated. Regarding health services utilisation, 94% were users of primary care, and 59.3% were users of hospital care. Among the main factors associated with the utilisation of both primary and hospital care services were AMG risk level and complexity index. In primary care, utilisation was also associated with the need for primary caregivers, palliative care and comorbidities such as chronic heart failure and polymedication, while in hospital care, utilisation was also associated with comorbidities such as cancer, chronic obstructive pulmonary disease or depression.

CONCLUSIONS

People with diabetes were older, with important needs for care, many associated comorbidities and polypharmacy that increased in parallel with the patient's risk level and complexity. The utilisation of primary and hospital care services was very high, being more frequent in primary care. Health services utilization were principally associated with functional factors related to the need of care and with clinical factors such as AMG medium and high-risk level, more complexity index, some serious comorbidities and polymedication.

Prevalence of Steinert's Myotonic Dystrophy and Utilization of Healthcare Services: A Population-Based Cross-Sectional Study

Myotonic dystrophy type I (MDI) is the most common muscular dystrophy in adults. The main objectives of this study were to determine the prevalence of MDI in the Community of Madrid (CM) (Spain) and to analyze the use of public healthcare services; a population-based cross-sectional descriptive study was carried out on patients with MDI in CM and data were obtained from a population-based registry (2010-2017). A total of 1101 patients were studied (49.1% women) with average age of 47.8 years; the prevalence of MDI was 14.4/100,000 inhabitants. In the women lineal regression model for hospital admissions, being in the fourth quartile of the deprivation index, was a risk factor (regression coef (rc): 0.80; 95%CI 0.25-1.37). In the overall multiple lineal regression model for primary health care (PHC) attendance, being a woman increased the probability of having a higher number of consultations (rc: 3.99; 95%CI: 3.95-5.04), as did being in the fourth quartile of the deprivation index (rc: 2.10; 95%CI: 0.58-3.63); having received influenza vaccines was a protective factor (rc: -0.46; 95%CI: -0.66-(-0.25)). The prevalence of MDI in the CM is high compared to other settings. Moreover, having any level of risk stratification of becoming ill (high, medium or low) has a positive association with increased PHC consultations and hospital admissions.

Situation of the Elderly Living Alone: Morbidity and Services Provided from the Field of Primary Health Care of Gran Canaria

The elderly suffer a greater number of health problems and have greater need for assistance and care. (1) Background: to determine the profile of the elderly who live alone, identified according to the Primary Care Health Record of Gran Canaria, and to analyze the sociodemographic data of the target population and determine the characteristics related to morbidity. (2) Methods: descriptive, prospective, cross-sectional study carried out in the Primary Health Care Management of Gran Canaria. The study population was all adults over 65 years of age living alone. The instrument used was the Drago-Electronic Health Record. Data analysis was carried out using RStudio version 1.1.447 software, and descriptive analysis and inferential analysis were carried out using the Chi-square values, T-test for independent samples, and ANOVA. (3) Results: The sample amounted to 8679 subjects, predominantly female sex (86.14%) and with a mean age of 79.4 years. Of the sample, 6.4% lived alone. Based on the classification by Adjusted Morbidity Groups (AMG), subjects with “moderate complications” predominated at 45.5%. (4) Conclusions: It is necessary to implement this type of stratification tool, which allows interventions to be carried out in elderly people at risk.

Use of primary and hospital care health services by chronic patients according to risk level by adjusted morbidity groups

Background

Patients with chronic diseases have increased needs for assistance and care. The objective of this study was to describe the characteristics and use of primary care (PC) and hospital care (HC) health services by chronic patients according to risk level based on adjusted morbidity groups (AMG) and to analyze the associated factors.

Methods

Cross-sectional descriptive observational study. Patients from a basic health area classified as chronically ill by the AMG classification system of the Madrid PC electronic medical record were included. Sociodemographic, clinical-care characteristics (classified as predisposing factors or need factors) and service utilization variables were collected. Univariate, bivariate and simple linear regression analyses were performed.

Results

The sample consisted of 9866 chronic patients and 8332 (84.4%) used health services. Of these service users, 63% were women, mean age was 55.7 (SD = 20.8), 439 (5.3%) were high risk, 1746 (21.2%) were medium risk, and 6041(73.4%) were low risk. A total of 8226 (98.7%) were PC users, and 4284 (51.4%) were HC users. The average number of annual contacts with PC was 13.9 (SD = 15); the average number of contacts with HC was 4.8 (SD = 6.2). Predisposing factors associated with services utilization at both care levels were: age (B coefficient [BC] = 0.03 and 0.018, 95% CI = 0.017–0.052 and 0.008–0.028, respectively, for PC and HC) and Spanish origin (BC = 0.962 and 3.396, 95% CI = 0.198–1.726 and 2.722–4.070); need factors included: palliative care (BC = 10,492 and 5047; 95% CI = 6457–14,526 and 3098-6995), high risk (BC = 4631 and 2730, 95% CI = 3022–6241 and 1.949–3.512), number of chronic diseases (BC = 1.291 and 0.222, 95% CI = 1.068–1.51 and 0.103–0.341) and neoplasms (BC = 2.989 and 4.309, 95% CI = 1.659–4.319 and 3.629–4.989).

Conclusions

The characteristics and PC and HC service utilization of chronic patients were different and varied according to their AMG risk level. There was greater use of PC services than HC services, although utilization of both levels of care was high. Service use was related to predisposing factors such as age and country of origin and, above all, to need factors such as immobility, high risk, and number and type of chronic diseases that require follow-up and palliative care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07020-z.

Chronic diseases in the geriatric population: morbidity and use of primary care services according to risk level

BACKGROUND

Geriatric patients have significant morbidity and greater needs for care and assistance. The objective of this study was to describe the characteristics, morbidity, and use of services in primary care (PC) of patients with chronic diseases older than 65 years according to their risk level assigned by the adjusted morbidity groups (AMG) and to analyse the factors associated with the use of PC services.

METHODS

This was a cross-sectional descriptive observational study. Patients older than 65 years from a healthcare service area, classified as chronically ill by the AMG classification system of the PC electronic medical record of the Community of Madrid, were included. Sociodemographic, clinical-care, and PC service utilization variables were collected. Univariate, bivariate and multivariate analyses were done.

RESULTS

A total of 3292 chronic patients older than 65 years were identified, of whom 1628 (49.5%) were low risk, 1293 (39.3%) were medium risk and 371 (11.3%) were high risk. Their mean age was 78.1 (SD = 8.1) years and 2167 (65.8%) were women. Their mean number of chronic diseases was 3.8 (SD = 2), 89.4% had multimorbidity and 1550 (47.1%) were polymedicated. The mean number of contacts/year with PC was 19.5 (SD = 18.2) [men: 19.4 (SD = 19.8); women: 19.5 (SD = 17.4)]. The mean number of contacts/year in people over 85 years was 25.2 (SD = 19.6); in people 76-85 years old, it was 22.1 (SD = 20.3); and in people 66-75 years old, it was 14.5 (SD = 13.9). The factors associated with greater use of services were age (B coefficient [BC] = 0.3; 95%CI = 0.2-0.4), high risk level (BC = 1.9; 95%CI =0.4-3.2), weight of complexity (BC = 0.7; 95%CI = 0.5-0.8), and ≥ 4 chronic diseases (BC = 0.7; 95%CI = 0.3-1.1).

CONCLUSIONS

In the geriatric population, we found a high number of patients with chronic diseases and there were three levels of risk by AMG with differences in characteristics, morbidity, and use of PC services. The greatest use of services was by patients with older age, high risk level, greater weight of complexity and ≥ 4 chronic diseases. Further research is needed to develop an intervention model more adapted to the reality of the geriatric population based on risk levels by AMG.

[Chronic diseases in the paediatric population: Comorbidities and use of primary care services]

INTRODUCTION

Adjusted morbidity groups (AMG) are being used in the stratification of chronic patients in Primary Care (PC). The aim of this study was to describe the characteristics, prevalence of comorbidities, and use of PC services by chronic paediatric patients as well as to analyse factors associated with the weight of complexity according to AMG.

PATIENTS AND METHODS

A cross-sectional study conducted on patients <18 years-old from a basic health area, classified as chronic according to the AMG of the Madrid Primary Care computerised clinical records. Sociodemographic and clinical-care variables were collected, as well as the use of services in PC. Univariate, bivariate and linear regression analysis were performed.

RESULTS

A total of 2,961 patients<18 years were included, of whom 423 (15.7%) were identified as chronic, and 408 (96.5%) were low risk patients. Their mean age was 9.5 (SD=4.7) years, and 54.1% were male. The mean of chronic diseases was 1.1 (SD=0.4) and 11.3% had multiple morbidity. The most prevalent diseases were asthma (6.1%), attention deficit hyperactivity disorder (ADHD) (1.8%), and obesity (1.4%). The mean number of visits to the paediatrician was 4.9 (SD=6.3). Age<5 years-old (Coefficient B [CB]=2.6, 95% CI=2.1, 3.1), number of chronic diseases (CB=1.6, 95% CI=1.1; 2.1), and annual contacts with PC (CB=0.1, 95% CI=0.06; 0.11) were associated with greater complexity weight.

CONCLUSIONS

A significant number of patients with chronic diseases were found in the paediatric population. The most prevalent diseases were asthma, ADHD, and obesity. The use of PC services was high. The greatest complexity corresponded to nursing and pre-school age, multiple morbidity, and higher number of contacts with PC.