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. 2019 Jan 4;9(1):e023919.
doi: 10.1136/bmjopen-2018-023919.

Predicting poorer health outcomes in older community-dwelling patients with multimorbidity: prospective cohort study assessing the accuracy of different multimorbidity definitions

Maxime Sasseville  1   2 , Susan M Smith  3 , Lisa Freyne  3 , Ronald McDowell  3   4 , Fiona Boland  3   5 , Martin Fortin  6 , Emma Wallace  3
Affiliations

Predicting poorer health outcomes in older community-dwelling patients with multimorbidity: prospective cohort study assessing the accuracy of different multimorbidity definitions

Maxime Sasseville et al. BMJ Open. .

Abstract

Purpose: Multimorbidity is commonly defined and measured using condition counts. The UK National Institute for Health Care Excellence Guidelines for Multimorbidity suggest that a medication-orientated approach could be used to identify those in need of a multimorbidity approach to management.

Objectives: To compare the accuracy of medication-based and diagnosis-based multimorbidity measures at higher cut-points to identify older community-dwelling patients who are at risk of poorer health outcomes.

Design: A secondary analysis of a prospective cohort study with a 2-year follow-up (2010-2012).

Setting: 15 general practices in Ireland.

Participants: 904 older community-dwelling patients.

Exposure: Baseline multimorbidity measurements based on both medication classes count (MCC) and chronic disease count (CDC).

Outcomes: Mortality, self-reported health related quality of life, mental health and physical functioning at follow-up.

Analysis: Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) adjusting for clustering by practice for each outcome using both definitions.

Results: Of the 904 baseline participants, 53 died during follow-up and 673 patients completed the follow-up questionnaire. At baseline, 223 patients had 3 or more chronic conditions and 89 patients were prescribed 10 or more medication classes. Sensitivity was low for both MCC and CDC measures for all outcomes. For specificity, MCC was better for all outcomes with estimates varying from 88.8% (95% CI 85.2% to 91.6%) for physical functioning to 90.9% (95% CI 86.2% to 94.1%) for self-reported health-related quality of life. There were no differences between MCC and CDC in terms of PPV and NPV for any outcomes.

Conclusions: Neither measure demonstrated high sensitivity. However, MCC using a definition of 10 or more regular medication classes to define multimorbidity had higher specificity for predicting poorer health outcomes. While having limitations, this definition could be used for proactive identification of patients who may benefit from targeted clinical care.

Keywords: chronic diseases; medications; multimorbidity; polypharmacy; risk prediction.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Fortin M, Bravo G, Hudon C, et al. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005;3:223–8. 10.1370/afm.272 - DOI - PMC - PubMed
    1. Fortin M, Bravo G, Hudon C, et al. Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res 2006;15:83–91. 10.1007/s11136-005-8661-z - DOI - PubMed
    1. Brettschneider C, Leicht H, Bickel H, et al. Relative impact of multimorbid chronic conditions on health-related quality of life--results from the MultiCare Cohort Study. PLoS One 2013;8:e66742 10.1371/journal.pone.0066742 - DOI - PMC - PubMed
    1. Gunn JM, Ayton DR, Densley K, et al. The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Soc Psychiatry Psychiatr Epidemiol 2012;47:175–84. 10.1007/s00127-010-0330-z - DOI - PubMed
    1. Fortin M, Bravo G, Hudon C, et al. Psychological distress and multimorbidity in primary care. Ann Fam Med 2006;4:417–22. 10.1370/afm.528 - DOI - PMC - PubMed

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