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. 2014 Apr 7;15:61.
doi: 10.1186/1471-2296-15-61.

Multimorbidity of Chronic Diseases and Health Care Utilization in General Practice

Free PMC article

Multimorbidity of Chronic Diseases and Health Care Utilization in General Practice

Sandra H van Oostrom et al. BMC Fam Pract. .
Free PMC article


Background: Multimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years and older.

Methods: Data on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008 (N=32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses adjusted for age, gender, and clustering of patients in general practices were used to assess the association between multimorbidity and service utilization in 2008.

Results: Patients diagnosed with multiple chronic diseases had on average 18.3 contacts (95% CI 16.8 19.9) per year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any (6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions, and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were lower than what would be expected on the basis of contact rates of the separate diseases.

Conclusion: Multimorbidity is associated with increased health care utilization in general practice, yet the increase declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more extensive health resources are required.


Figure 1
Figure 1
Total number of contacts (and numbers of different types of contacts: face-to-face contacts, contacts for diagnostics and minor surgery, home visits, phone consultations, and contacts for prescribing medications) with general practice in 2008 for patients without a chronic disease and those with 1, 2, 3, 4 and 5 or more chronic diseases. Means and 95% confidence intervals are presented, adjusted for sex, age, and clustering of patients within general practices.
Figure 2
Figure 2
Total number of contacts with general practice per disease in 2008 for patients with ten prevalent chronic diseases according to the number of diseases, adjusted for sex, age, and clustering of patients within general practices. The grey solid line presents total number of contacts per disease, the black dotted line presents additional number of contacts per disease (minus the number of contacts for patients without chronic diseases).

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