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Challenges for general practice; complex multimorbidity patterns in patients aged 55 years and over.

Sinnige, J., Korevaar, J.C., Westert, G.P., Spreeuwenberg, P., Schellevis, F.G., Braspenning, J.C. Challenges for general practice; complex multimorbidity patterns in patients aged 55 years and over. Abstract. In: Abstractbook 21st WONCA Europe Conference. 15-18 juni 2016, Kopenhagen. OP38.4
Background
Due to the ageing of the population, the general practitioner (GP) increasingly manages older patients with multimorbidity. To support the management of these patients, more insight is needed into commonly occurring disease combinations (i.e. disease patterns).

Aim
The aim of this study is to identify highly prevalent or distinctive disease patterns in older patients with heart failure, migraine, diabetes mellitus or dementia.

Method
Clinical data of patients (≥55 years) were extracted from 158 Dutch general practices between 2002 and 2011. Prevalence rates of multimorbidity were analyzed using multilevel regression analyses; differentiated between patients 55-69 years and ≥70 years. To investigate multimorbidity patterns, prevalence ratios (prevalence rate index-disease group divided by that in the non-index-disease-group) were calculated for patients with heart failure, migraine, diabetes mellitus or dementia.

Results
The overall adjusted multimorbidity rate was 86% in patients with ≥1 chronic condition, varying from 70%(migraine) to 98%(heart failure). Numerous significant prevalence ratios were found for disease patterns in heart failure patients, ranging from 1.2 to 7.7. in patients with heart failure the combination 'chronic obstructive pulmonary disease and cardiac dysrhythmia' was almost 8 times more common than in patients without heart failure. for diabetes mellitus, dementia or migraine patients, highest ratios were for 'heart failure-visual disorder' (ratio 2.1), 'heart failure-depression' (ratio 3.9), and 'depression-back/neck disorder' (ratio 2.1), respectively (all P-values <0.001).

Conclusions
Multimorbidity is far more complicated than merely the presence of two co-occurring diseases within a person. Multimorbidity management in general practice can be reinforced by knowledge on the clinical implications of the presence of the comprehensive disease patterns among the elderly, and those between 55 and 69 years. As a consequence of the complexity of multimorbidity, it is even more important to focus on what matters to a patient with multimorbidity in general practice.