[Size and type of frequent use of ambulatory medical care among the elderly population in Germany: a study based on statutory health insurance data]

Prevalence and pattern of acute and chronic multimorbidity across all body systems and age groups in primary health care

Multimorbidity is more than just the addition of individual illnesses, and its diagnosis and treatment poses special problems. General practitioners play an important role in looking after multimorbid patients. The aim of this study is to assess the prevalence and pattern of acute and chronic multimorbidity in primary care patients, regardless of body system and age group. A convenience sample of 2099 patients treated by 40 general practitioners was assessed using the Burvill scale. This measure of multimorbidity differentiates according to organ system and covers both acute and chronic illnesses. It also allows severity ratings to be assessed for both acute and chronic conditions, and thus patients’ actual need for general practice care. Patients reported an average of 3.5 (SD = 2.0) acute and/or chronically affected body systems. Overall, 12.7% of patients reported only one health problem, 83.0% at least two, 65.8% at least three, 46.1% at least four, and 29.7% five or more. The most frequent problems were musculoskeletal (62.5%) and psychological (56.6%). Some morbidities were interrelated, while others co-occurred despite being medically independent. In primary care, multimorbidity is the rule rather than the exception. Acute and chronic morbidity both contribute to the burden of illness. Body systems reflect treatment needs. Instead of specialist treatment for individual illnesses, an integrative treatment approach is needed. This is the specialty of general practitioners.

Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study

Background

Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors.

Methods

The study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency.

Results

Prevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient.

Conclusions

Multimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-015-0698-2) contains supplementary material, which is available to authorized users.

[Which chronic diseases are associated with frequent attending of ambulatory medical care in the elderly population in Germany? - A study based on statutory health insurance data]

BACKGROUND

Frequent attenders utilise a high proportion of medical services and therefore produce relatively high costs. Questions of utility and adequacy and, also, about the reasons for high use arise. The authors report the results of a study on the association between morbidity of the elderly and various forms of frequent attendance in ambulatory medical care in Germany.

METHODS

The study is based on claims data of all policyholders aged 65 and over of a statutory health insurance company operating nationwide in Germany in 2004 (n = 123,224). Utilisation was analysed by the number of contacts with practices of physicians working in the ambulatory medical care sector and by the number of different practices contacted. Criteria for frequent attendance were ≥ 50 contacts with practices or contacts with ≥ 10 individual practices or ≥ 3 practices of the same discipline per year. We analysed prevalences and relative risks for frequent attendance for 46 chronic diseases.

RESULTS

Frequent attendance in ambulatory medical care among the elderly is related to both severe somatic and psychic diagnoses. Five chronic diseases showed the highest relative risks for all types of frequent attendance in general: urinary incontinence, anaemia, neuropathies, renal insufficiency, and cancer. Psychic syndromes mainly led to the utilisation of many different physicians.

CONCLUSION

Frequent attendance in ambulatory medical care among the elderly is related to a large number of diseases, both somatic and psychic. Frequent attendance is a complex phenomenon which cannot be addressed by mono-dimensional approaches.