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Observational Study
. 2020 Feb;52(2):86-95.
doi: 10.1016/j.aprim.2018.12.007. Epub 2019 May 29.

[Adjusted morbidity groups: Characteristics and comorbidities in patients with chronic conditions according to their risk level in Primary Care]

[Article in Spanish]
Jaime Barrio-Cortes  1 , Isabel Del Cura-González  2 , Miguel Martínez-Martín  3 , Carmen López-Rodríguez  4 , María Ángeles Jaime-Sisó  4 , Carmen Suárez-Fernández  5
Affiliations
Observational Study

[Adjusted morbidity groups: Characteristics and comorbidities in patients with chronic conditions according to their risk level in Primary Care]

[Article in Spanish]
Jaime Barrio-Cortes et al. Aten Primaria. 2020 Feb.

Abstract
in English, Spanish

Aims: To describe the characteristics of patients with chronic conditions according to their risk levels assigned by the adjusted morbidity groups (AMG). To analyse the factors associated with a high risk level and to study their effect.

Design: Observational cross-sectional study with an analytical focus.

Location: Primary care (PC), Madrid Health Service.

Participants: Population of 18,107 patients stratified by their risk levels with the AMG in the computerised clinical records of Madrid PC.

Main measurements: The variables studied were: socio-demographic, clinical-nursing care and use of services. Univariate, bivariate, and multivariate analysis were performed.

Results: Of the 18,107 patients, 9,866(54.4%) were identified as chronic patients, with 444 (4.5%) stratified as high risk, 1784 (18,1%) as medium risk, and 7,638 (77.4%) as low risk. The high risk patients, compared with medium and low risk, had an older mean age [77.8 (SD=12.9), 72.1 (SD=12.9), 50.6 (SD=19.4)], lower percentage of women (52.3%, 65%, 61.1%), a higher number of chronic diseases [6.7 (SD=2.4), 4.3 (SD=1.5), 1.9 (SD=1.1)], polymedication (79.1%, 43.3%, 6.2%), and contact with PC [33.9 (28), 21.4 (17.3), 7.9 (9.9)] (P<.01). In the multivariate analysis, the high risk level was independently related to age>65 [1.43 (1.03-1.99), male gender (OR=3.46, 95% CI=2.64-4.52), immobility (OR=6.33, 95% CI=4.40-9.11), number of chronic conditions (OR=2.60, 95% CI=2.41-2.81), and PC contact>7 times (OR=1.95, 95% CI=1.36-2.80)] (P<.01).

Conclusions: More than half of the population is classified by the AMG as a chronic, and it is stratified into 3 risk levels that show differences in gender, age, functional impairment, need for care, morbidity, complexity, and use of Primary Care services. Age>65, male gender, immobility, number of chronic conditions, and contact with PC>7 times were the factors associated with high risk.

Objetivos: Describir las características de los pacientes crónicos según el nivel de riesgo asignado por los grupos de morbilidad ajustados (GMA). Analizar los factores asociados al nivel de riesgo alto y estudiar el efecto de cada uno de ellos.

Diseño: Estudio observacional descriptivo transversal con enfoque analítico.

Emplazamiento: Atención Primaria (AP). Servicio Madrileño de Salud.

Participantes: Población de 18.107 pacientes estratificados por los GMA integrados en la historia clínica electrónica de AP de la Comunidad de Madrid.

Mediciones principales: Variables sociodemográficas, clínico-asistenciales y de uso de servicios. Se realizó análisis univariado, bivariado y multivariante.

Resultados: De los 18.107 pacientes se identificaron 9.866 (54,4%) pacientes crónicos, 444 (4,5%) estratificados como de alto riesgo, 1.784 (18,1%) como de medio riesgo y 7.638 (77,4%) como de bajo riesgo. Los de alto riesgo, comparados con medio y bajo riesgo, tenían una edad media mayor (77,8 [12,9]; 72,1 [12,9]; 50,6 [19,4]), menor porcentaje de mujeres (52,3%, 65%, 61,1%), mayor número de enfermedades crónicas (6,7 [2,4]; 4,3 [1,5]; 1,9 [1,1]), polimedicación (79,1%, 43,3%, 6,2%) y contactos con AP (33,9 [28]; 21,4 [17,3]; 7,9 [9,9]) (p < 0,01). En el multivariante el nivel de riesgo alto se relacionó de manera independiente con la edad > 65 (OR = 1,43; IC 95% = 1,03-1,99), sexo masculino (OR = 3,46; IC 95% = 2,64-4,52), inmovilidad (OR = 6,33; IC 95% = 4,40-9,11), número de enfermedades crónicas (OR = 2,60; IC 95% = 2,41-2,81) (p < 0,01) y número de contactos con AP > 7 (OR = 1,95; IC 95% = 1,36-2,80).

Conclusiones: Más de la mitad de la población fue clasificada por los GMA como crónica, y se estratificó en 3 niveles de riesgo que presentaban diferencias en sexo, edad, deterioro funcional, necesidad de cuidados, morbilidad, complejidad, polifarmacia y contactos con AP. La edad > 65, el sexo masculino, la inmovilidad, el número de enfermedades crónicas y los contactos con AP > 7 fueron los factores asociados al alto riesgo.

Keywords: Agrupador de morbilidad; Atención primaria; Chronic diseases; Enfermedades crónicas; Morbidity grouper; Multimorbidity; Multimorbilidad; Niveles de riesgo; Primary care; Risk groups.

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Figures

Figura 1
Figura 1
Distribución de las enfermedades crónicas más importantes según sexo y edad en los diferentes niveles de riesgo.
See this image and copyright information in PMC

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