NIVEL, Utrecht, The Netherlands.
NIVEL, Utrecht, The Netherlands; Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
Eur J Intern Med. 2016 Nov;35:44-50. doi: 10.1016/j.ejim.2016.08.025. Epub 2016 Sep 15.
To examine health care utilization of people with multiple chronic diseases in The Netherlands compared to people with a single chronic disease, and to identify subgroups of multimorbid patients according to health care utilization.
All patients diagnosed with one or more chronic diseases in 2008-2009 (N=54,051) were selected from the nationwide NIVEL Primary Care Database, and data on their GP contacts and medication in 2010 were retrieved. Data on hospital admissions, household size and income were added. Chi-square-tests and multivariate regression analyses were performed to analyze differences between multimorbid patients and patients with a single chronic disease, and between subgroups of multimorbid patients derived from cluster analysis.
Multimorbid patients (37% of all patients) had more GP contacts, prescribed medications, and hospital admissions (all p<.0001) than patients with a single chronic disease. The largest cluster of multimorbid patients (57%) had a relatively low level of health care utilization, a smaller cluster (36%) had higher levels of health care utilization, and 7.6% of patients were heavy health care users (p<.0001 for all variables). The latter were older, more often female, had a lower income, lived in a smaller household, had more chronic diseases, and more often had specific chronic diseases such as COPD, diabetes and heart failure.
The majority of multimorbid patients have only slightly higher health care utilization than patients with a single chronic disease. Extensive health care utilization among multimorbid patients seems to be related to patient characteristics as well as chronic disease numbers and patterns.
考察荷兰患有多种慢性疾病的人群与患有单一慢性疾病的人群相比的医疗保健利用情况，并根据医疗保健利用情况确定多种疾病患者的亚组。
从全国范围内的 NIVEL 初级保健数据库中选择 2008-2009 年诊断出一种或多种慢性疾病的所有患者（N=54051），并检索其 2010 年的全科医生就诊记录和药物使用情况。还添加了住院、家庭规模和收入的数据。采用卡方检验和多变量回归分析比较了多种疾病患者和患有单一慢性疾病患者之间的差异，以及聚类分析得出的多种疾病患者亚组之间的差异。
多种疾病患者（所有患者的 37%）的全科医生就诊次数、开处药物和住院次数均多于患有单一慢性疾病的患者（均 P<.0001）。多种疾病患者中最大的亚组（57%）的医疗保健利用率相对较低，较小的亚组（36%）的医疗保健利用率较高，7.6%的患者是重度医疗保健使用者（所有变量均 P<.0001）。后者年龄较大，女性居多，收入较低，居住在较小的家庭中，患有更多的慢性疾病，并且更常见患有特定的慢性疾病，如 COPD、糖尿病和心力衰竭。
大多数多种疾病患者的医疗保健利用率仅略高于患有单一慢性疾病的患者。多种疾病患者广泛的医疗保健利用似乎与患者特征以及慢性疾病的数量和模式有关。
