Age- and gender-related prevalence of multimorbidity in primary care: the swiss fire project

Abstract

BackgroundGeneral practitioners often care for patients with several concurrent chronic medical conditions (multimorbidity). Recent data suggest that multimorbidity might be observed more often than isolated diseases in primary care. We explored the age- and gender-related prevalence of multimorbidity and compared these estimates to the prevalence estimates of other common specific diseases found in Swiss primary care.MethodsWe analyzed data from the Swiss FIRE (Family Medicine ICPC Research using Electronic Medical Record) project database, representing a total of 509,656 primary care encounters in 98,152 adult patients between January 1, 2009 and July 31, 2011. For each encounter, medical problems were encoded using the second version of the International Classification of primary Care (ICPC-2). We defined chronic health conditions using 147 pre-specified ICPC-2 codes and defined multimorbidity as 1) two or more chronic health conditions from different ICPC-2 rubrics, 2) two or more chronic health conditions from different ICPC-2 chapters, and 3) two or more medical specialties involved in patient care. We compared the prevalence estimates of multimorbidity defined by the three methodologies with the prevalence estimates of common diseases encountered in primary care.ResultsOverall, the prevalence estimates of multimorbidity were similar for the three different definitions (15% [95%CI 11-18%], 13% [95%CI 10-16%], and 14% [95%CI 11-17%], respectively), and were higher than the prevalence estimates of any specific chronic health condition (hypertension, uncomplicated 9% [95%CI 7-11%], back syndrome with and without radiating pain 6% [95%CI 5-7%], non-insulin dependent diabetes mellitus 3% [95%CI 3-4%]), and degenerative joint disease 3% [95%CI 2%-4%]). The prevalence estimates of multimorbidity rose more than 20-fold with age, from 2% (95%CI 1-2%) in those aged 20–29 years, to 38% (95%CI 31-44%) in those aged 80 or more years. The prevalence estimates of multimorbidity were similar for men and women (15% vs. 14%, p=0.288).ConclusionsIn primary care, prevalence estimates of multimorbidity are higher than those of isolated diseases. Among the elderly, more than one out of three patients suffer from multimorbidity. Management of multimorbidity is a principal concern in this vulnerable patient population.

Polypharmacy and specific comorbidities in university primary care settings

“…With the increasing life expectancy worldwide, a higher proportion of individuals not only get older [1], but are also more likely to develop multiple chronic conditions [2][3][4]. Most chronic conditions (comorbidities) are covered by disease-specific clinical guidelines using a single disease framework; this leads physicians to recommend drug treatments for each condition separately, which may lead to polypharmacy and drug-drug and drug-disease interactions [5].…”

The CUPCIG (CAM-Use in Primary Care in Germany) Study:Part I-Pain. Study Protocol of a Pilot-trial to Assess Feasibility, Acceptability and Perceived Effectiveness of CAM in Pain Disorders in Primary Care

“…[19]. In all pain-associated cases in which patients consulted a German GP, nociceptive (musculoskeletal) pain dominates when compared with neuropathic pain -a fact that is quite analogous to other European data pooling: In Switzerland, chronic back pain with or without a radicular pain component is, aside from painful degenerative joint diseases, one of the most frequent reasons for consulting GPs [20]. According to a Swedish observational study [21], musculoskeletal pain disorders are found to be the most frequent reason to consult a doctor, with 21%, followed by respiratory diseases or hypertension.…”

Anticoagulation Control in Swiss Primary Care: Time in Therapeutic Range Percentages Exceed Benchmarks of Phase III Trials

“…This approach has previously been validated for the FIRE database [58,64]; All drugs prescribed for at least 6 months were considered to be long-term medication and counted as concomitant drugs; CHADS 2 -Score of stroke risk in patients with atrial fibrillation according to ICPC-2 coding was calculated according to Gage, et al [65]. We used the CHADS 2 -Score instead of the CHA 2 DS 2 -VASc-Score for comparison reasons, because the NOAC approval studies exclusively reported the CHADS 2 -Score.…”