استعرض مصدر Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice


Examining different measures
of multimorbidity, using a large
prospective cross-sectional study
in Australian general practice<ref>Harrison C, Britt H, Miller G, et al. Examining different measures of multimorbidity, using a large prospective crosssectional study in Australian general practice. BMJ Open 2014;4:e004694.</ref>

Christopher Harrison, Helena Britt, Graeme Miller, Joan Henderson

doi:10.1136/bmjopen-2013-
004694

==ABSTRACT==
Objectives: Prevalence estimates of multimorbidity vary
widely due to inconsistent definitions and measurement
methods. This study examines the independent effects
on prevalence estimates of how ‘disease entity’ is defined
—as a single chronic condition or chapters/domains in
the International Classification of Primary Care (V.2;
ICPC-2), International Classification of Disease (10th
revision; ICD-10) or the Cumulative Illness Rating Scale
(CIRS), the number of disease entities required for
multimorbidity, and the number of chronic conditions
studied.

Design: National prospective cross-sectional study.

Setting: Australian general practice.
Participants: 8707 random consenting deidentified
patient encounters with 290 randomly selected general
practitioners.

Main outcome measures: Prevalence estimates of
multimorbidity using different definitions.
Results: Data classified to ICPC-2 chapters, ICD-10
chapters or CIRS domains produce similar
multimorbidity prevalence estimates. When
multimorbidity was defined as two or more (2+) disease
entities: counting individual chronic conditions and
groups of chronic conditions produced similar estimates;
the 12 most prevalent chronic conditions identified about
80% of those identified using all chronic conditions.
When multimorbidity was defined as 3+ disease entities:
counting individual chronic conditions produced
significantly higher estimates than counting groups of
chronic conditions; the 12 most prevalent chronic
conditions identified only two-thirds of patients identified
using all chronic conditions.

Conclusions: Multimorbidity defined as 2+ disease
entities can be measured using different definitions of
disease entity with as few as 12 prevalent chronic
conditions, but lacks specificity to be useful, especially in
older people. Multimorbidity, defined as 3+, requires
more measurement conformity and inclusion of all
chronic conditions, but provides greater specificity than
the 2+ definition. The proposed concept of “complex
multimorbidity”, the co-occurrence of three or more
chronic conditions affecting three or more different body
systems within one person without defining an index
chronic condition, may be useful in identifying high-need
individuals.


==رابط==
*http://bmjopen.bmj.com/content/bmjopen/4/7/e004694.full.pdf

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