Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Br J Gen Pract. 2013 Apr;63(609):e274-82. doi: 10.3399/bjgp13X665242.
Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear.
To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each.
Retrospective observational study using data on 86 100 patients in the General Practice Research Database.
Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately.
Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, particularly when co-occurring with other cardiovascular conditions.
Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.
共病在基层医疗中越来越常见。其对患者护理和预算管理的成本影响尚不清楚。
调查与分别治疗每位患者的单一病症相比，治疗特定疾病组合的患者是否会增加或降低基层医疗成本。
使用一般实践研究数据库中 86100 名患者的数据进行回顾性观察研究。
为每位患者估算了年度基层医疗成本，包括咨询、药物和检查。共病患者被定义为在质量和结果框架中当前患有一种以上慢性疾病的患者。多元回归模型用于确定在三个年龄组中，与单独治疗每种疾病相比，哪些疾病组合会增加（成本增加）或减少（成本限制）成本。
20%的患者至少患有两种慢性疾病。除痴呆症外，所有疾病与其他疾病同时发生时，均被发现既会增加成本又会限制成本，痴呆症仅会限制成本。当与一系列疾病同时发生时，抑郁症是最重要的成本增加疾病。高血压是成本限制因素，特别是当与其他心血管疾病同时发生时。
出现了三类共病，分别是：成本增加，主要是由于抑郁症与身体共病的结合所致；由于治疗重叠而成本限制；以及由于护理不足或其他原因而成本限制。这些结果有助于在基层医疗中有效管理慢性病。
