چکیده (انگلیسی):

Background:Multimorbidity is common among ageing populations and it affects the demand for health services.
The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases
and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years
and older.
Methods:Data on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and
home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands
Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008
(N = 32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses
adjusted for age, gender, and clustering of patients in general practices were used to assess the association
between multimorbidity and service utilization in 2008.
Results:Patients diagnosed with multiple chronic diseases had on average 18.3 contacts (95% CI 16.8 19.9) per
year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any
(6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions,
and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing
number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or
more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were
lower than what would be expected on the basis of contact rates of the separate diseases.
Conclusion:Multimorbidity is associated with increased health care utilization in general practice, yet the increase
declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more
extensive health resources are required.