310 Übersicht Multimorbidität in der Allgemeinpraxis Teil I: Pragmatische De?nition, Epidemiologie und Versorgungsprämissen Multimorbidity in General...
310 Übersicht Multimorbidität in der Allgemeinpraxis Teil I: Pragmatische De?nition, Epidemiologie und Versorgungsprämissen Multimorbidity in General...
A Study Based on Statutory Health Insurance DataBackground: The authors report the results of cross-sectional studies on the prevalence of multimorbidity in Germany, the underlying disease combinations and the utilization patterns of ambulatory medical care in the elderly German statutory insured population.Methods: The study is based on the claims data of all policy holders aged 65 and older of a statutory health insurance company in 2004 (n = 123,224). Adjustment for age and gender was performed for the German population of December 31, 2004. A person was defined as multimorbid if she/he had at least three diagnoses out of a list of 46 chronic conditions based on ICD 10 diagnoses in three or more quarters within the one-year observation period.Results: 62 % of the sample was multimorbid. Out of the possible 15,180 combinations of three chronic conditions, 15,024 (99 %) were found in the database. Triads of the six most prevalent individual chronic conditions (hypertension, dyslipidemia, chronic low back pain, diabetes mellitus, osteoarthritis and ischemic heart disease) span the disease spectrum of 42 % of the multimorbid sample. Gender differences were minor.Conclusion: The above list of dominating chronic conditions and their combinations could present a pragmatic start for the development of needed guidelines related to multimorbidity.
Background: Cardiovascular disease is the leading cause of death in Germany. However, the lethality of acute myocardial infarction is decreasing. Hence, there is a growing number of people whose life expectancy and quality of life is affected by the long-term consequences of a heart infarction. Thus, continuous primary care for patients who survived a myocardial infarction is an important task. The aim of this study was to investigate the utilization of ambulatory health care by patients who survived a myocardial infarction in Germany.Methods: We analyzed representative data of the German population aged between 40 and 79 from the first wave of the German Health Interview and Examination Survey for Adults (DEGS1). We compared patients with and without a history of myocardial infarction regarding their health care utilization of family practitioners, internists and other doctors in ambulatory care.Results: The prevalence of a history of myocardial infarction is 4,7 % among the German population aged between 40 and 79. Men above the age of 60 show an especially high prevalence. Persons with a history of myocardial infarction in Germany consult a family practitioner on average 5,8 times a year (95%-CI 4,1–7,4), which is twice as often as participants without such a history (3,4 times [95%-CI 3,2–3,6]). In total, people with a history of myocardial infarction reported on average 14,8 visits to doctors in ambulatory care in the past twelve months (95%-CI 11,1–18,6) compared to people in the reference group who reported on average only 8,3 visits. These differences are significant (p 0,01). However, the difference decreases with older age and increasing comorbidities.Conclusions: Persons with a history of myocardial infarction usually see their family practitioner regularly and can thus be treated according to the national guidelines. With elderly and multimorbid patients, a history of myocardial infarction itself is of minor relevance to the extent of health care utilization.
