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

Cortés, Juan José Baztán; Fernández, Carmen Suárez; Oliveira, Mariana Bandeira de; Lagos, Cristina Muñoz; Beca-Martínez, María Teresa; Hernández, Cristina Lozano; González, Isabel del Cura

doi:10.1016/j.anpede.2019.12.006

Cited by 20 publications

(10 citation statements)

References 26 publications

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“…The prevalence of patients with chronic conditions in our study coincided with the results of the 2020 European Health Survey in Spain [26], which revealed a prevalence of patients with chronic conditions in Spain of 54.3%. Studies on the distribution of patients with chronic conditions according to AMG show similar figures to those observed in the present study [12,13,[20][21][22].…”

Section: Comparison With Other Studiessupporting

confidence: 90%

“…Since the complexity index is a continuous variable, putting this index into percentiles allows the stratification of each individual of the population, allocating them into four risk groups following the model of the Kaiser-Permanente pyramid [18] (high-risk patients with chronic conditions above the 95th percentile, medium-risk patients with chronic conditions between the 85th and 95th percentiles, patients with chronic conditions in the low risk level between the 50th and 85th percentiles and patients without relevant chronic conditions below the 50th percentile). These AMGs have been elaborated and subsequently analysed with data from the general population [12,13,[15][16][17]19] and specifically checked on different types of populations [20][21][22].…”

Section: Methodsmentioning

confidence: 99%

“…Last, our study did not collect data on acute associated conditions and their interaction with chronic conditions. However, rigorous research has been carried out with these data sources, and there is validation of the diagnoses in the clinical history [20,21]. Likewise, it should be noted that the use of secondary clinical-administrative sources for epidemiological studies makes it possible to work with almost all individuals and not with partial samples or volunteers, minimizing selection and memory biases.…”

Section: Limitationsmentioning

confidence: 99%

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Adjusted morbidity groups and survival: a retrospective cohort study of primary care patients with chronic conditions

et al. 2023

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Background Chronic conditions are one of the main determinants of frailty, functional disability, loss of quality of life and the number one cause of death worldwide. This study aimed to describe the survival of patients with chronic conditions who were followed up in primary care according to the level of risk by adjusted morbidity groups and to analyse the effects of sex, age, clinician and care factors on survival. Methods This was a longitudinal observational study of a retrospective cohort of patients with chronic conditions identified by the adjusted morbidity group stratifier of the electronic medical records in a primary health centre of the Region of Madrid, which has an assigned population of 18,107 inhabitants. The follow-up period was from June 2015 to June 2018. A description of survival according to the Kaplan–Meier method and Cox proportional hazards multivariate regression model was used to analyse the effects of sex, age, clinician and care factors. Results A total of 9,866 patients with chronic conditions were identified; 77.4% (7,638) had a low risk, 18.1% (1,784) had a medium risk, and 4.5% (444) had a high risk according to the adjusted morbidity groups. A total of 477 patients with chronic conditions died (4.8%). The median survival was 36 months. The factors associated with lower survival were age over 65 years (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1–1.6), receiving palliative care (HR = 3.4; 95% CI = 2.6–4.5), high versus low risk level (HR = 2.4; 95% CI = 1.60–3.7), five chronic conditions or more (HR = 1.5; 95% CI = 1.2-2), complexity index (HR = 1.01; 95% CI = 1.02–1.04) and polymedication (HR = 2.6; 95% CI = 2.0-3.3). Conclusions There was a gradual and significant decrease in the survival of patients with chronic conditions according to their level of risk as defined by adjusted morbidity groups. Other factors, such as older age, receiving palliative care, high number of chronic conditions, complexity, and polymedication, had a negative effect on survival. The adjusted morbidity groups are useful in explaining survival outcomes and may be valuable for clinical practice, resource planning and public health research.

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Section: Comparison With Other Studiessupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

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Adjusted morbidity groups and survival: a retrospective cohort study of primary care patients with chronic conditions

et al. 2023

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“…They are considered to be responsible for 74% of the deaths in the world ( 1 ) and, according to the Global Burden of Disease and Injury in 2019, account for more than 80% of disability-adjusted life years in Europe ( 2 ). Moreover, analyses carried out in Spain have postulated that the use of primary care increases in people with chronic diseases ( 3 – 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…The presence of multimorbidity is increasingly present worldwide ( 7 ). It has been observed in studies with Spanish patients that those who use primary care the most are multimorbid people ( 3 , 4 ). This supposes significant challenges for health systems ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program

et al. 2022

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Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.

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Febrile children with comorbidities at the emergency department — a multicentre observational study

et al. 2022

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We aimed to describe characteristics and management of children with comorbidities attending European emergency departments (EDs) with fever. MOFICHE (Management and Outcome of Fever in children in Europe) is a prospective multicentre study (12 European EDs, 8 countries). Febrile children with comorbidities were compared to those without in terms of patient characteristics, markers of disease severity, management, and diagnosis. Comorbidity was defined as a chronic underlying condition that is expected to last > 1 year. We performed multivariable logistic regression analysis, displaying adjusted odds ratios (aOR), adjusting for patient characteristics. We included 38,110 patients, of whom 5906 (16%) had comorbidities. Most common comorbidities were pulmonary, neurologic, or prematurity. Patients with comorbidities more often were ill appearing (20 versus 16%, p < 0.001), had an ED-Paediatric Early Warning Score of > 15 (22 versus 12%, p < 0.001), or a C-reactive protein > 60 mg/l (aOR 1.4 (95%CI 1.3–1.6)). They more often required life-saving interventions (aOR 2.7, 95% CI 2.2–3.3), were treated with intravenous antibiotics (aOR 2.3, 95%CI 2.1–2.5), and were admitted to the ward (aOR 2.2, 95%CI 2.1–2.4) or paediatric intensive care unit (PICU) (aOR 5.5, 95% CI 3.8–7.9). They were more often diagnosed with serious bacterial infections (aOR 1.8, 95%CI 1.7–2.0), including sepsis/meningitis (aOR 4.6, 95%CI 3.2–6.7). Children most at risk for sepsis/meningitis were children with malignancy/immunodeficiency (aOR 14.5, 8.5–24.8), while children with psychomotor delay/neurological disease were most at risk for life-saving interventions (aOR 5.3, 4.1–6.9) or PICU admission (aOR 9.7, 6.1–15.5).Conclusions: Our data show how children with comorbidities are a population at risk, as they more often are diagnosed with bacterial infections and more often require PICU admission and life-saving interventions. What is Known:• While children with comorbidity constitute a large part of ED frequent flyers, they are often excluded from studies. What is New:• Children with comorbidities in general are more ill upon presentation than children without comorbidities.• Children with comorbidities form a heterogeneous group; specific subgroups have an increased risk for invasive bacterial infections, while others have an increased risk of invasive interventions such as PICU admission, regardless of the cause of the fever.

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

Cited by 20 publications

References 26 publications

Adjusted morbidity groups and survival: a retrospective cohort study of primary care patients with chronic conditions

Adjusted morbidity groups and survival: a retrospective cohort study of primary care patients with chronic conditions

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program

Febrile children with comorbidities at the emergency department — a multicentre observational study

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