Westert G P, Satariano W A, Schellevis F G, van den Bos G A
National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
Eur J Public Health. 2001 Dec;11(4):365-72. doi: 10.1093/eurpub/11.4.365.
The study objective was to examine the relation between combinations of chronic conditions in the same person and the volume and variety of health care utilization.
Analysis of continuous Netherlands Health Interview Survey data (1990-1997). The study population consisted of adults (16 years and older) reporting at least one chronic condition from the following six disease clusters: musculoskeletal diseases, lung diseases, neurological disorders, heart diseases, diabetes, and cancer (n = 13,806). Health care utilization is categorized in terms of contacts in the preceding year with a general practitioner (GP), medical specialist, physiotherapist, home help and/or home nursing, and hospital admission. Utilization was adjusted for age, gender and year of interview. Statistical methods used are contingency table analysis and (logistic) multiple regression.
Almost one-fifth of the study population reported more than one chronic condition. Musculoskeletal disease, in addition to being the most common single condition, was found to be the condition most likely to occur with one of the remaining five disease clusters. Seven per cent reported not having used any services at all. Two-thirds of the study population used at least two different services in the previous year. In contrast, 26% of the study population reported comprehensive utilization patterns (GP and/or home care and/or physiotherapist and/or medical specialist and/or hospitalization: minimum of three types). Persons with more than one chronic condition reported having used more services, in terms of volume and variety, than those with only one condition.
There is a strong association between comorbidity and the volume and variety of health care services that are used. Since many people have comorbid conditions, their use of health services is more complex than would be suggested by a one-disease approach. New disease management systems need to be developed to reflect the multiplicity of health care needs of the growing number patients with more than one chronic condition.
本研究的目的是探讨同一个人身上慢性病组合与医疗保健利用的数量和种类之间的关系。
对荷兰健康访谈调查的连续数据（1990 - 1997年）进行分析。研究人群包括报告患有以下六个疾病组中至少一种慢性病的成年人（16岁及以上）：肌肉骨骼疾病、肺部疾病、神经系统疾病、心脏病、糖尿病和癌症（n = 13,806）。医疗保健利用情况根据前一年与全科医生（GP）、专科医生、物理治疗师、家庭帮助和/或家庭护理以及住院治疗的接触情况进行分类。利用情况根据年龄、性别和访谈年份进行了调整。所使用的统计方法是列联表分析和（逻辑）多元回归。
近五分之一的研究人群报告患有不止一种慢性病。肌肉骨骼疾病除了是最常见的单一疾病外，还被发现是最有可能与其余五个疾病组中的一种同时出现的疾病。7%的人报告根本没有使用任何服务。三分之二的研究人群在前一年使用了至少两种不同的服务。相比之下，26%的研究人群报告了综合利用模式（全科医生和/或家庭护理和/或物理治疗师和/或专科医生和/或住院治疗：至少三种类型）。患有不止一种慢性病的人在使用服务的数量和种类方面都比仅患有一种疾病的人更多。
共病与所使用的医疗保健服务的数量和种类之间存在密切关联。由于许多人患有共病，他们对医疗服务的使用比单一疾病方法所表明的更为复杂。需要开发新的疾病管理系统，以反映越来越多患有不止一种慢性病的患者的多种医疗保健需求。
