Healthcare use in patients with multimorbidity.

BACKGROUND: The existence of multiple chronic conditions in the same patient is a public health problem increasingly recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which imply a heavy burden in healthcare use. It is estimated that between 70% and 80% of the total health expenditure is used with chronic conditions. Patients with multimorbidity are responsible for up to 75% of primary care appointments. These patients are also high hospital users, with up to 14.6 times more risk of hospitalization. METHODS: This study analyses the association between healthcare use and multimorbidity in the Portuguese population aged 25-74 years old. The association between socioeconomic variables and healthcare use was studied, based on data from the first Portuguese Health Examination Survey using a logistic regression model, stratified by sex and adjusted for socioeconomic confounding variables. RESULTS: In patients with multimorbidity, there was a greater use of primary healthcare consultations, medical or surgical specialist consultations and hospitalizations. An association was established between female, older age groups and lower educational levels, and increased healthcare use. When adjusted to socioeconomic variables, the likelihood of using healthcare services can be as high as 3.5 times, when compared to patients without chronic conditions. CONCLUSION: Our results show a greater healthcare use in multimorbidity patients, both in primary and hospital care. The availability of scientific evidence regarding the use of healthcare services by multimorbidity patients may support health policy changes, which could allow a more efficient management of these patients.

Effect of lifestyle on blood pressure in patients under antihypertensive medication: An analysis from the Portuguese Health Examination Survey.

INTRODUCTION AND OBJECTIVES: Hypertension is one of the main risk factors for disability and death from cardiovascular disease. Current guidelines include initiatives to control blood pressure in hypertensive patients that focus on lifestyle changes. The main objective of this study was to analyze the association between lifestyle and blood pressure in patients under antihypertensive medication. METHODS: Data collected in the Portuguese National Health Examination Survey (INSEF) were analyzed. Individuals who met INSEF inclusion criteria and reported being under antihypertensive medication in the two weeks prior to the questionnaire were studied. Lifestyle variables (alcohol consumption, smoking, added salt intake, fruit and vegetable consumption, and physical activity) were assessed by questionnaire, and systolic and diastolic blood pressure were measured by physical examination. Associations between lifestyle factors and blood pressure, stratified by gender and adjusted for sociodemographic variables and obesity, were estimated through a multiple linear regression model. RESULTS: Alcohol consumption (beta=6.31, p=0.007) and smoking (beta=4.72, p=0.018) were positively associated with systolic blood pressure in men. Added salt intake, fruit and vegetable consumption, and physical activity were not associated with blood pressure in men. In women, no association was observed for any behavioral variable. CONCLUSIONS: These conclusions highlight the need in the population under antihypertensive medication, particularly in men, to focus on the fight against high systolic blood pressure in the two modifiable and preventable behaviors of smoking and alcohol consumption.

[Multimorbidity in Portugal: Results from The First National Health Examination Survey]. / Multimorbilidade em Portugal: Dados do Primeiro Inquérito Nacional de Saúde com Exame Físico.

INTRODUCTION: The simultaneous presence of multiple chronic diseases in the same individual is recognized as an important public health problem. Patients with multimorbidity have greater healthcare needs, which represents a higher burden on health services. Although there is no consensual definition of this concept, multimorbidity is usually defined as the presence of two or more chronic diseases in the same patient. The existence of evidence regarding multimorbidity will lead to more efficient management and treatment of these patients. MATERIAL AND METHODS: In order to estimate the prevalence of multimorbidity and to identify the associated factors, a cross-sectional epidemiological study was developed based on data from the INSEF, a population-based survey conducted on a representative probability sample of the Portuguese population (n = 4911). The prevalence of multimorbidity was estimated for the total population and separately for men and women, stratified by age group, region, education and income. The magnitudes of the associations were measured by the adjusted prevalence ratios calculated by the Poisson regression model. RESULTS: Prevalence of multimorbidity was 38.3% (95% CI: 35.4% to 41.3%), with higher frequency in women, older people, Lisbon and Tagus Valley; Northern Portugal; Algarve and Alentejo regions and in those with lower academic qualifications. No association was found between multimorbidity and income. DISCUSSION: Multimorbidity affects more than one third of the Portuguese population. Epidemiological data about multimorbidity in Portugal allows the identification of population groups with higher multimorbidity prevalence. CONCLUSION: Our results, which highlight the greater risk of multimorbidity among older and less instructed people, are in line with the literature. These results show the relevance of multimorbidity patients and are especially important in the way how healthcare is organized and provided.

Introdução: A presença de múltiplas doenças crónicas, em simultâneo, no mesmo indivíduo é um problema de saúde reconhecido. Os doentes com multimorbilidade têm necessidades de saúde acrescidas, o que representa um ónus elevado para os cuidados de saúde. Embora não exista uma definição consensual do conceito, a multimorbilidade é definida habitualmente pela presença de duas ou mais doenças crónicas. A existência de evidência, para a realidade nacional, quanto à multimorbilidade poderá contribuir para a gestão e tratamento destes doentes de forma mais eficiente. Material e Métodos: Com o objetivo de estimar a prevalência de multimorbilidade e identificar os fatores associados foi realizado um estudo epidemiológico transversal com base nos dados do INSEF, um inquérito de base populacional desenvolvido com uma amostra probabilística representativa da população portuguesa (n = 4911). A prevalência de multimorbilidade foi estimada para o total da população e para cada um dos sexos, estratificada por grupo etário, região de saúde, educação e rendimento. As magnitudes das associações foram medidas pelas razões de prevalências ajustadas calculadas pelo modelo de regressão de Poisson. Resultados: A prevalência de multimorbilidade foi de 38,3% (IC 95%: 35,4% a 41,3%), com maior frequência nas mulheres, nos indivíduos mais velhos, nas regiões de Lisboa e Vale do Tejo, Norte, Algarve e Alentejo e em níveis educacionais mais baixos. Não foi observada associação estatisticamente significativa entre a multimorbilidade e o rendimento. Discussão: A multimorbilidade é um problema que afeta mais de um terço da população portuguesa. O conhecimento epidemiológico sobre a multimorbilidade em Portugal permite identificar os grupos populacionais onde esta realidade é mais prevalente. Conclusão: Os valores observados apontam para maior risco de multimorbilidade entre os indivíduos mais velhos e menos diferenciados e está em consonância com os resultados da literatura. Estes dados demonstram a relevância dos doentes com multimorbilidade e têm especial importância na forma com os cuidados de saúde são organizados e prestados.