Back
 Health  Vol.8 No.12 , September 2016
Thoughts about Person-Centered Care for the Adult Population with Multimorbidity
Abstract: Patients with multimorbidity are becoming the norm rather than the exception. The management of patients with several chronic diseases is now the most important challenge facing health care systems in developed countries. Based on the actual medical records of ambulatory care visits, this study investigated the prevalence and patterns of multimorbidity in 55 and older population. Among a cohort comprised of 300,000 beneficiaries selected randomly from the National Health Insurance Research Database of Taiwan in 2001, 42,441 were eligible. These were followed longitudinally 10 years. The prevalence of chronic disease rose from 62.3% to 79.8% and multimorbidity rose from 57.4% to 75.7%. Multimorbidity patterns were found fell in-to four clusters: metabolic diseases, cardiac diseases, mental joints and gastrointestinal tract disorders. Hypertension and diabetes mellitus, as well as hyperplasia of the prostate in men, were the most common chronic diseases. The prevalence of chronic disease increased with age, especially high at age 75 - 79. Thought about the health care system for an ageing society is necessary. Applying the concept of customer experience and strengthening people-centered management in an integrated model of health care, enhancing knowledge and skills in the long-term management of chronic disease, revising clinical guidelines and training professionals in caring for the elderly, reinforcing preventive health services, especially in men’s health, modifying the materials for health education, and planning for health manpower resources will provide a better model to ensure the health care for people with multimorbidity.
Cite this paper: Wang, M. and Lo, Y. (2016) Thoughts about Person-Centered Care for the Adult Population with Multimorbidity. Health, 8, 1275-1287. doi: 10.4236/health.2016.812130.
References

[1]   WHO (2015) Ageing and Health.
http://www.who.int/mediacentre/factsheets/fs404/en/

[2]   National Development Council. Population Projections for Taiwan: 2016-2060.
http://www.ndc.gov.tw/en/cp.aspx?n=2E5DCB04C64512CC

[3]   Garin, N., Olaya, B., Perales, J., Monetal, M.V., Miret, M., Ayuso-Mateos, J.L., et al. (2014) Multimorbidity Patterns in a National Representative Sample of the Spanish Adult Population. PLoS One, 9, e84794.
http://dx.doi.org/10.1371/journal.pone.0084794

[4]   Fortin, M., Bravo, G., Hudon, C., Vanasse, A. and Lapointe, L. (2005) Prevalence of Multimorbidity among Adults Seen in Family Practice. The Annals of Family Medicine, 3, 223- 228.
http://dx.doi.org/10.1370/afm.272

[5]   Salisbury, C., Johnson, L., Purdy, S., Valderas, J.M. and Montgomery, A.A. (2011) Epidemiology and Impact of Multimorbidity in Primary Care: A Retrospective Cohort Study. The British Journal of General Practice, 61, e12-e21.
http://dx.doi.org/10.3399/bjgp11X548929

[6]   Ose, D., Miksch, A., Urban, E., Natanzon, I., Szecsenyi, J., et al. (2011) Health Related Quality of Life and Comorbidity. A Descriptive Analysis Comparing EQ-5D Dimensions of Patients in the German Disease Management Program for Type 2 Diabetes and Patients in Routine Care. BMC Health Services Research, 11, 179.
http://dx.doi.org/10.1186/1472-6963-11-179

[7]   Lee, T.A., Shields, A.E., Vogeli, C., Gibson, T.B., Woong-Sohn, M., et al. (2007) Mortality Rate in Veterans with Multiple Chronic Conditions. Journal of General Internal Medicine, 3, 403-407.
http://dx.doi.org/10.1007/s11606-007-0277-2

[8]   Dy, S.M., Pfoh, E.R., Salive, M.E. and Boyd, C.M. (2013) Health-Related Quality of Life and Functional Status Quality Indicators for Older Persons with Multiple Chronic Conditions. Journal of the American Geriatrics Society, 61, 2120-2127.
http://dx.doi.org/10.1111/jgs.12555

[9]   Marengoni, A., von Strauss, E., Rizzuto, D., Winblad, B. and Fratiglioni, L. (2009) The Impact of Chronic Multimorbidity and Disability on Functional Decline and Survival in Elderly Persons. A Community-Based, Longitudinal Study. Journal of Internal Medicine, 265, 288-295.
http://dx.doi.org/10.1111/j.1365-2796.2008.02017.x

[10]   Steiner, C.A. and Friedman, B. (2013) Hospital Utilization, Costs, and Mortality for Adults with Multiple Chronic Conditions, Nationwide Inpatient Sample, 2009. Preventing Chronic Disease, 10, 28.
http://dx.doi.org/10.5888/pcd10.120292

[11]   Van den Bussche, H., Schon, G., Kolonko, T., Hansen, H., Wegscheider, K., Glaeske, G., et al. (2011) Patterns of Ambulatory Medical Care Utilization in Elderly Patients with Special Reference to Chronic Diseases and Multimorbidity: Results from a Claims Data Based Observational Study in Germany. BMC Geriatrics, 11, 54.
http://dx.doi.org/10.1186/1471-2318-11-54

[12]   Tinetti, M.E., Fried, T.R. and Boyd, C.M. (2012) Designing Health Care for the Most Common Chronic Condition—Multimorbidity. JAMA, 307, 2493-2494.
http://dx.doi.org/10.1001/jama.2012.5265

[13]   Norris, S.L., High, K., Gill, T.M., Hennessy, S., Kutner, J.S., Reuben, D.B., Unützer, J. and Landefeld, C.S. (2008) Health Care for Older Americans with Multiple Chronic Conditions: A Research Agenda. JAGS, 56, 149-159.
http://dx.doi.org/10.1111/j.1532-5415.2007.01530.x

[14]   Boyd, C.M., Darer, J., Boult, C., Fried, L.P., Boult, L. and Wu, A.W. (2005) Clinical Practice Guidelines and Quality of Care for Older Patients with Multiple Comorbid Diseases: Implications for Pay for Performance. JAMA, 294, 716-724.
http://dx.doi.org/10.1001/jama.294.6.716

[15]   Fortin, M., Dionne, J., Pinho, G., Gignac, J., Almirall, J. and Lapointe, L. (2006) Randomized Controlled Trials: Do They Have External Validity for Patients with Multiple Comorbidities? The Annals of Family Medicine, 4, 104-108.
http://dx.doi.org/10.1370/afm.516

[16]   Salisbury, C. (2012) Multimorbidity: Redesigning Health Care for People Who Use It. Lancet, 380, 7-9.
http://dx.doi.org/10.1016/S0140-6736(12)60482-6

[17]   Paez, K.A., Zhao, L. and Hwang, W. (2009) Rising Out-of-Pocket Spending or Chronic Conditions: A Ten-Year Trend. Health Affairs, 28, 15-26.
http://dx.doi.org/10.1377/hlthaff.28.1.15

[18]   Fortin, M., Stewart, M., Poitras, M.E., Almirall, J. and Maddocks, H. (2012) A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology. Annals of Family Medicine, 10, 142-151.
http://dx.doi.org/10.1370/afm.1337

[19]   National Health Research Institutes (2014) National Health Insurance Research Database.
http://nhird.nhri.org.tw/en/index.html

[20]   Wang, M.J., Yang, H.Y., Yang, C.C. and Lo, Y.T. (2014) Strategies for Transformational Change in the Health Care System: Challenges Facing an Aging Population. Journal of Health Science, 4, 79-88.

[21]   Marengoni, A., et al. (2011) Aging with Multimorbidity: A Systematic Review of the Literature. Ageing Research Reviews, 10, 430-439.
http://dx.doi.org/10.1016/j.arr.2011.03.003

[22]   Prados-Torres, A., Calderón-Larranaga, A., Hancco-Saavedra, J., Poblador-Plou, B. and van den Akker, M. (2014) Multimorbidity Patterns: A Systematic Review. Journal of Clinical Epidemiology, 67, 254-266.
http://dx.doi.org/10.1016/j.jclinepi.2013.09.021

[23]   Schram, M.T., Frijters, D., van de Lisdonk, E.H., et al. (2008) Setting and Registry Characteristics Affect the Prevalence and Nature of Multimorbidity in the Elderly. Journal of Clinical Epidemiology, 61, 1104-1112.
http://dx.doi.org/10.1016/j.jclinepi.2007.11.021

[24]   Fu, S., Huang, N. and Chou, Y. (2014) Trends in the Prevalence of Multiple Chronic Conditions in Taiwan from 2000 to 2010: A Population-Based Study. Patterns of Chronic Conditions, 11, Article ID: 140205.

[25]   Chi, M.-J., Lee, C.-Y. and Wu, S.-C. (2011) The Prevalence of Chronic Conditions and Medical Expenditures of The elderly by Chronic Condition Indicator (CCI). Archives of Gerontology and Geriatrics, 52, 284-289.
http://dx.doi.org/10.1016/j.archger.2010.04.017

[26]   Schellevis, F.G. (2013) Epidemiology of Multiple Chronic Conditions: An International Perspective. Journal of Comorbidity, 3, 36-40.
http://dx.doi.org/10.15256/joc.2013.3.25

[27]   Garin, N., Koyanagi, A., Chatterji, S., et al. (2016) Global Multimorbidity Patterns: A Cross-Sectional, Population-Based, Multi-Country Study. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 71, 205-214.
http://dx.doi.org/10.1093/gerona/glv128

[28]   Violán, C., et al. (2014) Burden of Multimorbidity, Socioeconomic Status and Use of Health Services across Stages of Life in Urban Areas: A Cross-Sectional Study. BMC Public Health, 14, 530.
http://dx.doi.org/10.1186/1471-2458-14-530

[29]   Schafer, I., et al. (2010) Multimorbidity Patterns in the Elderly: A New Approach of Disease Clustering Identifies Complex Interrelations between Chronic Conditions. PLoS ONE, 5, e15941.
http://dx.doi.org/10.1371/journal.pone.0015941

[30]   Park, J.M. (2014) Health Status and Health Services Utilization in Elderly Koreans. International Journal for Equity in Health, 13, 73.
http://dx.doi.org/10.1186/s12939-014-0073-7

[31]   Diederichs, C.P., Wellmann, J., Bartels, D.B., Ellert, U., Hoffmann, W. and Berger, K. (2012) How to Weight Chronic Diseases in Multimorbidity Indices? Development of a New Method on the Basis of Individual Data from Five Population-Based Studies. Journal of Clinical Epidemiology, 65, 679-685.
http://dx.doi.org/10.1016/j.jclinepi.2011.11.006

[32]   Shao, H., Chen, L.-Q. and Xu, J. (2011) Treatment of Dyslipidemia in the Elderly. Journal of Geriatric Cardiology, 8, 55-64.
http://dx.doi.org/10.3724/SP.J.1263.2011.00055

[33]   Epidemiology.
http://emedicine.medscape.com/article/330487-overview#a6

[34]   (2016) Risk Factors.
http://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/dxc-20198250Risk

[35]   Rushton, C.A., Green, J., Jaarsma, T., Walsh, P., Stromberg, A. and Kadam, U.T. (2015) The Challenge of Multimorbidity in Nurse Education: An International Perspective. Nurse Education Today, 35, 288-292.
http://dx.doi.org/10.1016/j.nedt.2014.05.006

[36]   Barnett, K., Mercer, S.W., Norbury, M., Watt, G., Wyke, S. and Guthrie, B. (2012) Epidemiology of Multimorbidity and Implications for Health Care, Research, and Medical Education: A Cross-Sectional Study. Lancet, 380, 37-43.
http://dx.doi.org/10.1016/S0140-6736(12)60240-2

[37]   Walter-Ginzburg, A., Chetrit, A., Medina, C., Blumstein, T., Gindin, J. and Modan, B. (2001) Physician Visits, Emergency Room Utilization, and Overnight Hospitalization in the Old-Old in Israel: The Cross sectional and Longitudinal Aging Study (CALAS). Journal of the American Geriatrics Society, 49, 549-556.
http://dx.doi.org/10.1046/j.1532-5415.2001.49112.x

[38]   Vegda, K., Nie, J.X., Wang, L., Tracy, C.S., Moineddin, R. and Upshur, R.E.G. (2009) Trends in Health Services Utilization, Medication Use, and Health Conditions among Older Adults: A 2-Year Retrospective Chart Review in a Primary Care Practice. BMC Health Services Research, 9, 217.
http://dx.doi.org/10.1186/1472-6963-9-217

[39]   Nie, J.X., Wang, L., Tracy, C.S., Moineddin, R. and Upshur, R.E. (2010) A Population- Based Cohort Study of Ambulatory Care Service Utilization among Older Adults. Journal of Evaluation in Clinical Practice, 16, 825-831.
http://dx.doi.org/10.1111/j.1365-2753.2009.01218.x

[40]   Woo, J., Goggins, W., Zhang, X., Griffiths, S. and Wong, V. (2010) Aging and Utilization of Hospital Services in Hong Kong: Retrospective Cohort Study. International Journal of Public Health, 55, 201-207.
http://dx.doi.org/10.1007/s00038-009-0068-0

[41]   Vadla, D., et al. (2011) Differences in Healthcare Service Utilisation in Elderly, Registered in Eight Districts of Five European Countries. Scandinavian Journal of Public Health, 39, 272-279.
http://dx.doi.org/10.1177/1403494811401476

[42]   Juel, K. and Christensen, K. (2008) Are Men Seeking Medical Advice Too Late? Contacts to General Practitioners and Hospital Admissions in Denmark 2005. Public Health, 30, 111- 113.
http://dx.doi.org/10.1093/pubmed/fdm072

[43]   Galdas, P.M., Cheater, F. and Marshall, P. (2005) Men and Health Help-Seeking Behaviour: Literature Review. Journal of Advanced Nursing, 49, 616-623.
http://dx.doi.org/10.1111/j.1365-2648.2004.03331.x

[44]   Harvard Medical School (2010) Mars vs. Venus: The Gender Gap in Health. Harvard Men’s Health Watch, 14, 1-6.

[45]   Rocca, W.A., Boyd, C.M., Grossardt, B., et al. (2014) Prevalence of Multimorbidity in a Geographically Defined American Population: Patterns by Age, Sex, and Race/Ethnicity. Mayo Clinic Proceedings, 89, 1336-1349.
http://dx.doi.org/10.1016/j.mayocp.2014.07.010

 
 
Top