Multimorbidity in primary care: a systematic review of prospective cohort studies
- 1 April 2012
- journal article
- review article
- Published by Royal College of General Practitioners in British Journal of General Practice
- Vol. 62 (597), e297-e307
- https://doi.org/10.3399/bjgp12x636146
Abstract
Primary care increasingly deals with patients with multimorbidity, but relevant evidence-based interventions are scarce. Knowledge about multimorbidity over time is required to inform the development of effective interventions. This review identifies prospective cohort studies of multimorbidity in primary care to determine: their nature, scope and key findings; the methodologies used; and gaps in knowledge. Systematic review. Studies were identified by searching electronic databases, reviewing citations, and writing to authors. Searches were limited to adult populations with no restrictions on publication date or language. In total, 996 articles were identified and screened. Of the 996 articles, six detailing five completed prospective cohort studies were selected as appropriate. Three of the studies were undertaken in the US and two in The Netherlands; none was nationally representative. The main focus of the studies was: healthcare utilisation and/or costs (n = 3); patients' physical functioning (n = 1); and risk factors for developing multimorbidity (n = 1). The conditions that were included varied widely. The findings of these studies showed that multimorbidity increased healthcare costs (n = 2), inpatient admission (n = 1), death rates (n = 1), and service use (n = 3), and reduced physical functioning (n = 1). One study identified psychosocial risk factors for multimorbidity. No study used random sampling, sample sizes were relatively small (414-3745 patients at baseline), and study duration was relatively short (1-4 years). No study focused on prevalence, treatment use, patient safety, service models, cultural or socioeconomic factors, and patient experience, and no study collected qualitative data. Few longitudinal studies based in primary care have investigated multimorbidity. Further large, long-term prospective studies are required to inform healthcare commissioning, planning, and delivery.Keywords
This publication has 29 references indexed in Scilit:
- Impact of comorbidity on the individual's choice of primary health care providerScandinavian Journal of Primary Health Care, 2011
- Epidemiology and impact of multimorbidity in primary care: a retrospective cohort studyBritish Journal of General Practice, 2011
- At the interface of community and healthcare systems: a longitudinal cohort study on evolving health and the impact of primary healthcare from the patient's perspectivBMC Health Services Research, 2010
- The German MultiCare-study: Patterns of multimorbidity in primary health care – protocol of a prospective cohort studyBMC Health Services Research, 2009
- Defining Comorbidity: Implications for Understanding Health and Health ServicesAnnals of Family Medicine, 2009
- Multimorbidity in younger deprived patients: An exploratory study of research and service implications in general practiceBMC Family Practice, 2008
- The SMILE study: a study of medical information and lifestyles in Eindhoven, the rationale and contents of a large prospective dynamic cohort studyBMC Public Health, 2008
- The Inverse Care Law: Clinical Primary Care Encounters in Deprived and Affluent Areas of ScotlandAnnals of Family Medicine, 2007
- Projections of Global Mortality and Burden of Disease from 2002 to 2030PLoS Medicine, 2006
- Prevalence of Multimorbidity Among Adults Seen in Family PracticeAnnals of Family Medicine, 2005