Different definitions of multimorbidity and their effect on prevalence rates: a retrospective study in German general practices

Abstract

Background: Multimorbidity is common among general practice patients and increases a general practitioner’s (GP’s) workload. But the extent of multimorbidity may depend on its definition and whether a time delimiter is included in the definition or not. Aims: The aims of the study were (1) to compare practice prevalence rates yielded by different models of multimorbidity, (2) to determine how a time delimiter influences the prevalence rates and (3) to assess the effects of multimorbidity on the number of direct and indirect patient contacts as an indicator of doctors’ workload. Methods: This retrospective observational study used electronic medical records from 142 German general practices, covering 13 years from 1994 to 2007. The four models of multimorbidity ranged from a simple definition, requiring only two diseases, to an advanced definition requiring at least three chronic conditions. We also included a time delimiter for the definition of multimorbidity. Descriptive statistics, such as means and correlation coefficients, were applied. Findings: The annual percentage of multimorbid primary care patients ranged between 84% (simple model) and 16% (advanced model) and between 74% and 13% if a time delimiter was included. Multimorbid patients had about twice as many contacts annually than the remainder. The number of contacts were different for each model, but the ratio remained similar. The number of contacts correlated moderately with patient age (r = 0.35). The correlation between age and multimorbidity increased from model to model up to 0.28 while the correlations between contacts and multimorbidity varied around 0.2 in all four models. Conclusion: Multimorbidity seems to be less prevalent in primary care practices than usually estimated if advanced definitions of multimorbidity and a temporal delimiter are applied. Although multimorbidity increases in any model a doctor’s workload, it is especially the older person with multiple chronic diseases who is a challenge for the GP.

Age, sex, and socioeconomic differences in multimorbidity measured in four ways: UK primary care cross-sectional analysis

“…Similarly, Payne et al 13 performed a retrospective cohort study also in Scotland, and found that mental health morbidity was more prevalent in areas of deprivation and was independently associated with increased rates of unplanned hospital admission. Hauswaldt et al 27 examined prevalence of multimorbidity 2+ and multimorbidity 3+ from 3+ in German general practices. They found that women were more likely to be multimorbid than men and the gender ratio remained stable across both definitions, however they did not examine mental-physical multimorbidity which in the current study was more strongly associated with being a woman than the other definitions.…”

Non-communicable disease multimorbidity: Challenges and solutions

“…Multimorbidity represents a growing public health concern and poses a major challenge to healthcare systems [9]. Any person with more than two chronic health conditions suffers from multimorbidity [10]. The fast-developing multimorbidity is often a negative prognostic factor for disability, particularly among the elderly, and is associated with unfavorable intellectual, psychological, and social outcomes [11,12].…”

Asking the generalist – evaluation of a General Practice rounding and consult service

“…Multimorbidity is defined as the presence of two or more, generally chronic, illnesses in one person [ 1 , 2 ]. The prevalence of multimorbidity in General Practice- as well as in hospitalized patients is high and will most likely continue to increase over the next years [ 3 ].…”