چکیده (انگلیسی):

Background:Multimorbidity is a common phenomenon in primary care. Until now, no clinical guidelines for
multimorbidity exist. For the development of these guidelines, it is necessary to know whether or not patients are
aware of their diseases and to what extent they agree with their doctor. The objectives of this paper are to analyze
the agreement of self-reported and general practitioner-reported chronic conditions among multimorbid patients
in primary care, and to discover which patient characteristics are associated with positive agreement.
Methods:The MultiCare Cohort Study is a multicenter, prospective, observational cohort study of 3,189 multimorbid
patients, ages 65 to 85. Data was collected in personal interviews with patients and GPs. The prevalence proportions
for 32 diagnosis groups, kappa coefficients and proportions of specific agreement were calculated in order to examine
the agreement of patient self-reported and general practitioner-reported chronic conditions. Logistic regression models
were calculated to analyze which patient characteristics can be associated with positive agreement.
Results:We identified four chronic conditions with good agreement (e.g. diabetes mellitusκ= 0.80;PA = 0,87), seven
with moderate agreement (e.g. cerebral ischemia/chronic strokeκ= 0.55;PA = 0.60), seventeen with fair agreement (e.g.
cardiac insufficiencyκ= 0.24;PA = 0.36) and four with poor agreement (e.g. gynecological problemsκ= 0.05;PA = 0.10).
Factors associated with positive agreement concerning different chronic diseases were sex, age, education, income,
disease count, depression, EQ VAS score and nursing care dependency. For example: Women had higher odds ratios
for positive agreement with their GP regarding osteoporosis (OR = 7.16). The odds ratios for positive agreement
increase with increasing multimorbidity in almost all of the observed chronic conditions (OR = 1.22-2.41).
Conclusions:For multimorbidity research, the knowledge of diseases with high disagreement levels between the
patients’ perceived illnesses and their physicians’ reports is important. The analysis shows that different patient
characteristics have an impact on the agreement. Findings from this study should be included in the development of
clinical guidelines for multimorbidity aiming to optimize health care. Further research is needed to identify more
reasons for disagreement and their consequences in health care.
Trial registration:ISRCTN89818205