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Chronic Diseases and Multimorbidity in Primary Care

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2017) | Viewed by 77372

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Dr. Harry H. X. Wang

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Guest Editor

School of Public Health, Sun Yat-Sen University, Guangzhou 510275, China
Interests: primary health care; multimorbidity; hypertension and CVDS; health services and epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on the chronic diseases and multimorbidity in primary care. The venue is an ISI-indexed, peer-reviewed scientific journal in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

As a result of the environmental, demographic, and economic transitions, non-communicable chronic diseases have become the number one health threat in many countries. The prevalence of coexistent multiple chronic conditions (multimorbidity) increases steadily at all ages, and this may be associated with a number of underlying healthcare and lifestyle factors.

The rates of awareness, treatment, and control of chronic diseases differ widely across countries. Patients with multimorbidity have greater health care needs, with consequent additional primary care visits, hospital re-admissions, and inevitably escalating healthcare costs. Environmentally sustainable designs and cost-effective strategies are needed to ultimately improve clinical outcomes.

The contributions of primary care have been demonstrated globally. Strong primary care is associated with more appropriate, more effective, and less costly care. In face of the emerging public health problems stemming from chronic diseases and multimorbidity, primary care-based multi-disciplinary health care models will need to be implemented. Research studies with complex and innovative designs may carry new perspectives.

We invite international researchers to contribute a variety of papers, including original research articles, essays, and review articles, that could add to the current knowledge on any subject area related to chronic diseases and multimorbidity in primary care. The listed keywords suggest just a few of the many possibilities.

Dr. Harry H.X. Wang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

chronic diseases
multimorbidity
primary care
healthcare reform
patients’ experiences
health system and service model
environmental risk factors
clinical trials
disease management
prevention, control, and treatment
health care quality

Published Papers (12 papers)

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11 pages, 494 KiB

Open AccessFeature PaperArticle

Primary Care Comprehensiveness Can Reduce Emergency Department Visits and Hospitalization in People with Hypertension in South Korea

by Nak-Jin Sung, Yong-Jun Choi and Jae-Ho Lee

Int. J. Environ. Res. Public Health 2018, 15(2), 272; https://doi.org/10.3390/ijerph15020272 - 05 Feb 2018

Cited by 20 | Viewed by 4673

Abstract

Hypertension has been the leading risk factor contributing to cardiovascular morbidity and mortality, which needs comprehensive measures to manage and can be controlled effectively in primary care. In the health care context of South Korea, where specialists can see patients directly at their own community clinics and there has been no consensus on the definition of primary care, the authors used the nationally representative 2013 Korea Health Panel data, categorized adults (≥18 years) with hypertension by types of usual source of care (USC), and analyzed the association of having a comprehensive community clinic (i.e., primary care) physician as a USC with experience of emergency department (ED) visits and hospitalization within a year. After adjusting for cofounding variables including Charlson comorbidity index scores, those having a primary care physician as a USC remained associated with a decrease in an experience of ED visits (OR: 0.61, 95% CI: 0.40–0.93) and hospitalization (OR: 0.69, 95% CI: 0.49–0.96), compared to those not having a usual physician. Health policies that promote having a primary care physician as a USC could decrease unnecessary experience of ED visits and hospitalization by adults with hypertension. This can partly reduce ED overcrowding and avoidable hospitalization in Korea. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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367 KiB

Open AccessArticle

Risk Factors for Chronic Diseases and Multimorbidity in a Primary Care Context of Central Argentina: A Web-Based Interactive and Cross-Sectional Study

by David E. V. Olivares, Frank R. V. Chambi, Evelyn M. M. Chañi, Winston J. Craig, Sandaly O. S. Pacheco and Fabio J. Pacheco

Int. J. Environ. Res. Public Health 2017, 14(3), 251; https://doi.org/10.3390/ijerph14030251 - 02 Mar 2017

Cited by 32 | Viewed by 7341

Abstract

Global health agencies estimate an increase of chronic diseases in South America. Nevertheless, few studies have investigated chronic diseases and their risk factors in the perspective of multimorbidity. This research aimed to identify these aspects in a primary health care setting of central Argentina. The Pan America version of the STEP wise approach surveillance (STEPS) instrument of the World Health Organization was applied to 1044 participants, 365 men and 679 women, with a mean age of 43 years. High prevalence of overweight (33.5%), obesity (35.2%), central obesity (54%), dyslipidemia (43.5%), metabolic syndrome (21.1%), low intake of fruit and vegetables (91.8%), low levels of physical activity (71.5%), risky alcohol consumption (28%), and smoking (22.5%) were detected. Hypertension and diabetes were the most prevalent chronic conditions and the total prevalence of multimorbidity was 33.1%, with 2, 3, 4, 5 and 6 chronic conditions found in 19.9%, 9.1%, 2.6%, 1.1% and 0.4% of the population, respectively. Multimorbidity affected 6.4% of the young, 31.7% of the adults, and 60.6% of the elderly, and was more prevalent among women, and in participants with lower levels of education. Having multimorbidity was significantly associated with obesity, central obesity, and higher concentrations of total blood cholesterol, low-density lipoprotein cholesterol, triglycerides, and glucose. A website was made available to the participants in order to share the experimental results and health-promoting information. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

494 KiB

Open AccessArticle

What Contributes to the Regularity of Patients with Hypertension or Diabetes Seeking Health Services? A Pilot Follow-Up, Observational Study in Two Sites in Hubei Province, China

by Da Feng, Ray Serrano, Ting Ye, Shangfeng Tang, Lei Duan, Yuan Xu, Jian Yang, Yuan Liang, Shanquan Chen, Zhanchun Feng and Liang Zhang

Int. J. Environ. Res. Public Health 2016, 13(12), 1268; https://doi.org/10.3390/ijerph13121268 - 21 Dec 2016

Cited by 11 | Viewed by 8936

Abstract

Regular maintenance of non-communicable chronic diseases can constrain disease progression in diabetic and hypertensive patients. To identify the individual and social factors that are associated with positive health-seeking behaviors and regular maintenance of chronic diseases, we have conducted a follow up study in 2015 on diabetic and hypertensive patients in Hubei Province. We used binary logistic regression models to determine specific factors associated with diabetic and hypertensive patients that sought healthcare services for their conditions in accordance with current Chinese Centers for Disease Prevention and Control (CDC) guidelines. Our findings show that 42.16% of 510 people living with chronic conditions (PLCDs) sought health services in line with existing guidelines. Findings also show a higher probability (8.418 times) for PLCDs seeking healthcare services at higher-tiered hospitals (secondary and tertiary hospitals) than for PLCDs seeking care at primary hospitals (odds ratio (OR) = 8.418, 95% confidence interval (CI) = 4.82, 14.27, p < 0.001). These analyses underscore the importance of having patient advocates who can provide support, where necessary, and encourage positive health-seeking behavior. The study also shows a negative impact on regular maintenance for PLCDs in households with high financial constraints. In contrast, the study shows positive impacts for increased household income, age, and residency in rural locations. In sum, this study underscores the importance of primary hospitals as key points of care and critical players in care coordination for PLCDs. The study provides more evidence for Chinese policymakers seeking to contain costs and improve population health. The findings also underscore the need for community-based interventions, specifically interventions that link local primary hospitals, friends/family members, and PLCDs. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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Open AccessArticle

The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions

by Filipe Prazeres and Luiz Santiago

Int. J. Environ. Res. Public Health 2016, 13(11), 1097; https://doi.org/10.3390/ijerph13111097 - 08 Nov 2016

Cited by 11 | Viewed by 5303

Abstract

Multimorbidity’s high prevalence and negative impact has made it a subject of worldwide interest. The main aim of this study was to access the Portuguese knowledge, awareness, and practices of general practitioners (GPs) regarding multimorbidity and its management, in order to aid in the development of interventions for improving outcomes in multimorbid patients in primary care. A web-based qualitative descriptive study was carried out in the first trimester of 2016 with primary care physicians working in two districts of the Centre region of Portugal. Open-ended questions were analysed via inductive thematic content analysis. GPs pointed out several difficulties and challenges while managing multimorbidity. Extrinsic factors were associated with the healthcare system logistics’ management (consultation time, organization of care teams, clinical information) and society (media pressure, social/family support). Intrinsic factors related to the GP, patient, and physician-patient relationship were also stated. The most significant conclusion to emerge from this study is that although GPs perceived difficulties and challenges towards multimorbidity, they also have the tools to deal with them: the fundamental characteristics of family medicine. Also, the complex care required by multimorbid patients needs adequate consultation time, multidisciplinary teamwork, and more education/training. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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1933 KiB

Open AccessArticle

Type and Proximity of Green Spaces Are Important for Preventing Cardiovascular Morbidity and Diabetes—A Cross-Sectional Study for Quebec, Canada

by Roland Ngom, Pierre Gosselin, Claudia Blais and Louis Rochette

Int. J. Environ. Res. Public Health 2016, 13(4), 423; https://doi.org/10.3390/ijerph13040423 - 14 Apr 2016

Cited by 52 | Viewed by 8465

Abstract

This study aimed at determining the role of proximity to specific types of green spaces (GSes) as well as their spatial location in the relationship with the most morbid cardiovascular diseases (CVD) and diabetes. We measured the accessibility to various types of GS and used a cross-sectional approach at census Dissemination Area (DA) levels in the Montreal and Quebec City metropolitan zones for the period 2006–2011. Poisson and negative binomial regression models were fitted to quantify the relationship between distances to specific types of GS and CVD morbidity as well as some risk factors (diabetes and hypertension) while controlling for several social and environmental confounders. GSes that have sports facilities showed a significant relationship to cerebrovascular diseases: the most distant population had an 11% higher prevalence rate ratio (PRR) compared to the nearest, as well as higher diabetes risk (PRR 9%) than the nearest. However, the overall model performance and the understanding of the role of GSes with sport facilities may be substantially achieved with lifestyle factors. Significantly higher prevalence of diabetes and cerebrovascular diseases as well as lower access to GSes equipped with sports facilities were found in suburban areas. GSes can advantageously be used to prevent some CVDs and their risk factors, but there may be a need to reconsider their types and location. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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267 KiB

Open AccessArticle

The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study

by Oyun Chimeddamba, Darshini Ayton, Nansalmaa Bazarragchaa, Bayarsaikhan Dorjsuren, Anna Peeters and Catherine Joyce

Int. J. Environ. Res. Public Health 2016, 13(4), 407; https://doi.org/10.3390/ijerph13040407 - 07 Apr 2016

Cited by 2 | Viewed by 4329

Abstract

(1) Background: In 2011, new chronic disease guidelines were introduced across Mongolia. No formal advice was provided regarding role delineation. This study aimed to analyse the roles that different primary care providers adopted, and the variations in these, in the implementation of the guidelines in urban Mongolia; (2) Methods: Ten group interviews with nurses and ten individual interviews each with practice doctors and practice directors were conducted. Data was analysed using a thematic approach based on the identified themes relevant to role delineation; (3) Results: There was some variability and flexibility in role delineation. Factors involving teamwork, task rotation and practice flexibility facilitated well the guideline implementation. However, factors including expectations and decision making, nursing shortage, and training gaps adversely influenced in the roles and responsibilities. Some role confusion and dissatisfaction was identified, often associated with a lack of training or staff turnover; (4) Conclusions: Findings suggest that adequate ongoing training is required to maximize the range of roles particular provider types, especially primary care nurses, are competent to perform. Ensuring that role delineation is specified in guidelines could remove confusion and enhance implementation of such guidelines. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

419 KiB

Open AccessArticle

How Does Sex Influence Multimorbidity? Secondary Analysis of a Large Nationally Representative Dataset

by Karolina Agur, Gary McLean, Kate Hunt, Bruce Guthrie and Stewart W. Mercer

Int. J. Environ. Res. Public Health 2016, 13(4), 391; https://doi.org/10.3390/ijerph13040391 - 31 Mar 2016

Cited by 40 | Viewed by 7357

Abstract

Multimorbidity increases with age and is generally more common in women, but little is known about sex effects on the “typology” of multimorbidity. We have characterized multimorbidity in a large nationally representative primary care dataset in terms of sex in ten year age groups from 25 years to 75 years and over, in a cross-sectional analysis of multimorbidity type (physical-only, mental-only, mixed physical and mental; and commonest conditions) for 1,272,685 adults in Scotland. Our results show that women had more multimorbidity overall in every age group, which was most pronounced in the 45–54 years age group (women 26.5% vs. men 19.6%; difference 6.9 (95% CI 6.5 to 7.2). From the age of 45, physical-only multimorbidity was consistently more common in men, and physical-mental multimorbidity more common in women. The biggest difference in physical-mental multimorbidity was found in the 75 years and over group (women 30.9% vs. men 21.2%; difference 9.7 (95% CI 9.1 to 10.2). The commonest condition in women was depression until the age of 55 years, thereafter hypertension. In men, drugs misuse had the highest prevalence in those aged 25–34 years, depression for those aged 35–44 years, and hypertension for 45 years and over. Depression, pain, irritable bowel syndrome and thyroid disorders were more common in women than men across all age groups. We conclude that the higher overall prevalence of multimorbidity in women is mainly due to more mixed physical and mental health problems. The marked difference between the sexes over 75 years especially warrants further investigation. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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1417 KiB

Open AccessArticle

Age- and Sex-Specific Trends in Lung Cancer Mortality over 62 Years in a Nation with a Low Effort in Cancer Prevention

by Ulrich John and Monika Hanke

Int. J. Environ. Res. Public Health 2016, 13(4), 362; https://doi.org/10.3390/ijerph13040362 - 25 Mar 2016

Cited by 6 | Viewed by 7758

Abstract

Background: A decrease in lung cancer mortality among females below 50 years of age has been reported for countries with significant tobacco control efforts. The aim of this study was to describe the lung cancer deaths, including the mortality rates and proportions among total deaths, for females and males by age at death in a country with a high smoking prevalence (Germany) over a time period of 62 years. Methods: The vital statistics data were analyzed using a joinpoint regression analysis stratified by age and sex. An age-period-cohort analysis was used to estimate the potential effects of sex and school education on mortality. Results: After an increase, lung cancer mortality among women aged 35–44 years remained stable from 1989 to 2009 and decreased by 10.8% per year from 2009 to 2013. Conclusions: Lung cancer mortality among females aged 35–44 years has decreased. The potential reasons include an increase in the number of never smokers, following significant increases in school education since 1950, particularly among females. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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1295 KiB

Open AccessArticle

EQ-5D-5L in the General German Population: Comparison and Evaluation of Three Yearly Cross-Section Surveys

by Manuel B. Huber, Peter Reitmeir, Martin Vogelmann and Reiner Leidl

Int. J. Environ. Res. Public Health 2016, 13(3), 343; https://doi.org/10.3390/ijerph13030343 - 21 Mar 2016

Cited by 31 | Viewed by 6226

Abstract

Health-related quality of life (HRQoL) is a key measure for evaluating health status in populations. Using the recent EQ-5D-5L for measurement, this study analyzed quality of life results and their stability over consecutive population surveys. Three cross-section surveys for representative samples of the general German population from 2012, 2013, and 2014 were evaluated using the EQ-5D-5L descriptive system and valuation by the Visual Analog Scale (VAS). Aggregated sample size reached 6074. The dimension with the highest prevalence of problems was pain/discomfort (31.7%). Compared with 2012 (59.3%), the percentage of participants in the best health state increased slightly in 2013 (63.4%) and 2014 (62%). Over the 3-year period, diabetes and heart disease had the strongest negative influence on mean VAS result. The number of reported chronic diseases cumulatively reduced mean VAS. Extreme problems in one or more dimensions were stated by only 0.1%–0.2% of patients. Of the potential 247 health states with a problem score ≥20, only six were observed in the aggregated sample. HRQoL results were fairly stable over the 3 years, but the share of the population with no problems was not. Results from the aggregated sample may serve as updated reference values for the general German population. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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756 KiB

Open AccessArticle

Prevalence of Heart Failure and Adherence to Process Indicators: Which Socio-Demographic Determinants are Involved?

by Alessandra Buja, Giuliana Solinas, Modesta Visca, Bruno Federico, Rosa Gini, Vincenzo Baldo, Paolo Francesconi, Gino Sartor, Mariadonata Bellentani and Gianfranco Damiani

Int. J. Environ. Res. Public Health 2016, 13(2), 238; https://doi.org/10.3390/ijerph13020238 - 19 Feb 2016

Cited by 21 | Viewed by 5901

Abstract

Interest in chronic conditions reflects their role as the first cause of death and disability in developed countries; improving the management of these conditions is a priority for health care services. The aim of this study was to establish which sociodemographic factors influence adherence to standards of care for chronic heart failure (CHF). A generalized multilevel structural equation model was developed and applied to a sample of patients with CHF obtained from administrative data flows in six Italian regions to ascertain any associations between adherence to standards of care for CHF and sociodemographic variables. Indicators of compliance were adherence to beta-blocker therapy (BB-A) and Angiotensin Convertin Enzime inhibitor/Angiotensin Receptor Blocker therapy (ACE-A), and creatinine and electrolyte testing (CNK-T). All indicators were computed over a one-year follow-up. Among a cohort of 24,997 patients, the BB-A rate was 40.4%, the ACE-A rate 61.1%, and the CNK-T rate 57.0%. Factors found associated with adherence were gender, age, and citizenship. Our study shows an inadequate adherence to standards of care for CHF, particularly associated with certain sociodemographic characteristics. This suggests the need to improve the role of primary care in managing this chronic condition. The measures considered only apply to patients with a reduced Left Ventricular Ejection Fraction, hence a limitation of this analysis is the lack of information on left ventricular ejection. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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199 KiB

Open AccessArticle

Physical Comorbidities in Depression Co-Occurring with Anxiety: A Cross Sectional Study in the Czech Primary Care System

by Petr Winkler, Jiří Horáček, Aneta Weissová, Martin Šustr and Martin Brunovský

Int. J. Environ. Res. Public Health 2015, 12(12), 15728-15738; https://doi.org/10.3390/ijerph121215015 - 10 Dec 2015

Cited by 20 | Viewed by 5250

Abstract

Comorbidities associated with depression have been researched in a number of contexts. However, the epidemiological situation in clinical practice is understudied, especially in the post-Communist Central and Eastern Europe region. The aim of this study was to assess physical comorbidities in depression, and to identify whether there are increased odds of physical comorbidities associated with co-occurring depressive and anxiety disorders. Data on 4264 patients aged 18–98 were collected among medical doctors in the Czech Republic between 2010 and 2011. Descriptive statistics were calculated and multiple logistic regressions were performed to assess comorbidities among patients with depressive disorder. There were 51.29% of those who have a physical comorbidity, and 45.5% of those who have a comorbid anxiety disorders among patients treated with depression in Czech primary care. Results of logistic regressions show that odds of having pain, hypertension or diabetes mellitus are particularly elevated at those who have co-occurring depressive and anxiety disorder. Our findings demonstrate that comorbidities associated with depressive disorders are highly prevalent in primary health care practice, and that physical comorbidities are particularly frequent among those with co-occurring depressive and anxiety disorders. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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Open AccessCommentary

Economies through Application of Nonmedical Primary-Preventative Health: Lessons from the Healthy Country Healthy People Experience of Australia’s Aboriginal People

by David Campbell

Int. J. Environ. Res. Public Health 2016, 13(4), 400; https://doi.org/10.3390/ijerph13040400 - 01 Apr 2016

Cited by 4 | Viewed by 4815

Abstract

The World Health Organization reports noncommunicable disease as a global pandemic. While national and international health research/policy bodies, such as the World Health Organization and the Australian Institute of Health and Welfare, emphasize the importance of preventative health, there is a continuing distortion in the allocation of resources to curative health as a result of government failure. Government failure is, in part, the result of a political response to individual preference for certainty in receiving treatment for specific health conditions, rather than the uncertainty of population-based preventative intervention. This has led to a failure to engage with those primary causative factors affecting chronic disease, namely the psychosocial stressors, in which the socioeconomic determinants are an important component. Such causal factors are open to manipulation through government policies and joint government-government, government-private cooperation through application of nonmedical primary-preventative health policies. The health benefits of Aboriginal people in traditional land management, or caring-for-country, in remote to very remote Australia, is used to exemplify the social benefits of nonmedical primary-preventative health intervention. Such practices form part of the “healthy country, health people” concept that is traditionally relied upon by Indigenous peoples. Possible health and wider private good and public good social benefits are shown to occur across multiple disciplines and jurisdictions with the possibility of substantial economies. General principles in the application of nonmedical primary-preventative health activities are developed through consideration of the experience of Afboriginal people participation in traditional caring-for-country. Full article

(This article belongs to the Special Issue Chronic Diseases and Multimorbidity in Primary Care)

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