Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain.
Primary Care Investigation Unit, Gerencia Asistencial de Atención Primaria, Madrid, Spain.
BMC Endocr Disord. 2024 Jul 16;24(1):115. doi: 10.1186/s12902-024-01634-0.
People with diabetes mellitus frequently have other comorbidities and involve greater use of primary and hospital care services. The aim of this study was to describe the comorbidities and use of primary and hospital care services of people with diabetes according to their risk level by adjusted morbidity groups (AMG) and to analyse the factors associated with the utilisation of these services.
Cross-sectional study. People with diabetes were identified within the population of patients with chronic conditions of an urban health care centre by the AMG stratification tool integrated into the primary health care electronic clinical record of the Community of Madrid. Sociodemographic, functional, clinical characteristics and annual health care services utilisation variables were collected. Univariate, bivariate and Poisson regression analyses were performed.
A total of 1,063 people with diabetes were identified, representing 10.8% of patients with chronic conditions within the health centre. A total of 51.4% were female, the mean age was 70 years, 94.4% had multimorbidity. According to their risk level, 17.8% were high-risk, 40.6% were medium-risk and 41.6% were low-risk. The most prevalent comorbidities were hypertension (70%), dyslipidaemia (67%) and obesity (32.4%). Almost 50% were polymedicated. Regarding health services utilisation, 94% were users of primary care, and 59.3% were users of hospital care. Among the main factors associated with the utilisation of both primary and hospital care services were AMG risk level and complexity index. In primary care, utilisation was also associated with the need for primary caregivers, palliative care and comorbidities such as chronic heart failure and polymedication, while in hospital care, utilisation was also associated with comorbidities such as cancer, chronic obstructive pulmonary disease or depression.
People with diabetes were older, with important needs for care, many associated comorbidities and polypharmacy that increased in parallel with the patient's risk level and complexity. The utilisation of primary and hospital care services was very high, being more frequent in primary care. Health services utilization were principally associated with functional factors related to the need of care and with clinical factors such as AMG medium and high-risk level, more complexity index, some serious comorbidities and polymedication.
糖尿病患者常伴有其他合并症，并更多地使用初级保健和医院服务。本研究的目的是根据调整后的发病风险组（AMG）描述糖尿病患者的合并症和使用初级保健和医院服务的情况，并分析与这些服务利用相关的因素。
这是一项横断面研究。通过马德里社区初级卫生保健电子临床记录中整合的 AMG 分层工具，在城市卫生保健中心的慢性病患者人群中确定糖尿病患者。收集社会人口统计学、功能、临床特征和年度卫生保健服务利用变量。进行单变量、双变量和泊松回归分析。
共确定了 1063 名糖尿病患者，占该卫生中心慢性病患者的 10.8%。其中 51.4%为女性，平均年龄为 70 岁，94.4%患有多种合并症。根据风险水平，17.8%为高风险，40.6%为中风险，41.6%为低风险。最常见的合并症是高血压（70%）、血脂异常（67%）和肥胖（32.4%）。近 50%的患者接受了多种药物治疗。在卫生服务利用方面，94%的患者使用初级保健，59.3%的患者使用医院保健。与初级保健和医院保健服务利用相关的主要因素是 AMG 风险水平和复杂性指数。在初级保健中，利用率还与初级保健提供者的需求、姑息治疗和慢性心力衰竭、多种药物治疗等合并症有关，而在医院保健中，利用率还与癌症、慢性阻塞性肺疾病或抑郁症等合并症有关。
糖尿病患者年龄较大，护理需求大，合并症多，且随着患者风险水平和复杂性的增加，药物治疗也随之增加。初级保健和医院服务的利用率非常高，在初级保健中更为常见。卫生服务的利用主要与与护理需求相关的功能因素以及 AMG 中高风险水平、更复杂的指数、一些严重的合并症和多种药物治疗等临床因素相关。
