Comorbidity in Family Medicine - Causal or Casual? What is the Effect of Illness Diversity? A Longitudinal Observational Study in Primary Care

2019 ◽  
Author(s):  
Jean Karl Soler ◽  
Nicola Buono ◽  
Inge Okkes
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Observational Study ◽  
Longitudinal Observational Study

scholarly journals Comorbidity in Primary Care – Causal or Casual? A Longitudinal Observational Study in Family Medicine

2021 ◽  
Author(s):  
Jean Karl Soler ◽  
Nicola Buono ◽  
Inge Okkes
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
The Netherlands ◽  
Observational Study ◽  
Family Practice ◽  
Age Groups ◽  
Odds Ratios ◽  
Family Doctors ◽  
Longitudinal Observational Study ◽  
Transition Project

Abstract Background. Comorbidity is increasingly important in the medical literature, with ever-increasing impacts as populations age. Comorbidity has multiple and complex implications for the processes of diagnosis, treatment, prognosis, management and health care. The objective of this study is to measure casual versus causal comorbidity in primary care in three family practice populations.Methods. This is a longitudinal observational study using the Transition Project datasets. Transition Project family doctors in the Netherlands, Malta and Serbia recorded details of all patient contacts in an episode of care structure using electronic medical records and the International Classification of Primary Care, collecting data on all elements of the doctor-patient encounter, including diagnoses (1,178,178 in the Netherlands, 93,606 in Malta, 405,150 in Serbia), observing 158,370 patient years in the Netherlands, 43,577 in Malta, 72,673 in Serbia. Comorbidity was measured using the odds ratio of both conditions being incident or rest-prevalent in the same patient in one-year dataframes, as against not.Results. Comorbidity in family practice in the three population databases is expressed as odds ratios between the 41 joint most prevalent (joint top 20) episode titles in the three populations. Specific associations were explored in different age groups to observe the changes in odds ratios with increasing age as a surrogate for a temporal or biological gradient.Conclusion. After applying accepted criteria for testing the causality of associations, it is reasonable to conclude that most observed primary care comorbidity is casual. It would be incorrect to assume causal relationships between co-occurring diseases in family medicine, even if such a relationship might be plausible or consistent with current conceptualisations of the causation of disease. Most observed comorbidity in primary care is the result of increasing illness diversity.Trial registration.This study was performed on electronic patient record datasets made publicly available by the University of Amsterdam Department of General Practice, and did not involve any patient intervention.Funding. Self-funded.

scholarly journals The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingmar Schäfer ◽  
Heike Hansen ◽  
Agata Menzel ◽  
Marion Eisele ◽  
Daniel Tajdar ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Rural Areas ◽  
Longitudinal Observational Study ◽  
Multivariable Analyses ◽  
Gastrointestinal Complaints ◽  
Urban And Rural Areas ◽  
Quota Sampling ◽  
Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

scholarly journals Profile Of Children Referred To Primary Health Care Physiotherapy: A Longitudinal Observational Study In Norway

2020 ◽  
Author(s):  
Kari Anne I Evensen ◽  
Siw Sellæg ◽  
Anne-Cath Stræte ◽  
Anne E. Hansen ◽  
Ingebrigt Meisingset
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Observational Study ◽  
Motor Development ◽  
Daily Activities ◽  
Child Health Care ◽  
Longitudinal Observational Study ◽  
Primary Health

Abstract Background Children are referred to primary care physiotherapy services for a variety of reasons, ranging from concerns for motor development to the need for extensive habilitation services. There is limited knowledge about their characteristics and outcome. The aim of this study was to describe the variation in baseline demographical and clinical characteristics as well as treatment outcome at follow-up six months after baseline. Methods Children referred to primary care physiotherapy in a municipality in Norway were invited to participate in this longitudinal observational study. The children’s demographics, causes of referral, functional diagnoses, influence on their daily activities, main goals and planned treatments were registered at baseline. Goal attainment and treatment compliance were registered at follow-up maximum six months after baseline. Results Baseline characteristics were registered for 148 children by the physiotherapist and for 101 (68.2%) children by their parents. Half of the children were referred from child health care centres due to concerns for motor development, asymmetry and orthopaedic conditions, and most of these children were below the age of one year. There was partly agreement between causes of referral and the physiotherapists’ functional diagnoses. The children’s daily activities were little affected by the problem or complaint for which they were referred. About a third of the children needed only examination. Follow-up data was registered for 64 children. The majority achieved their main treatment goal and the treatment was carried out as planned. Conclusions This study describes the profile of a broad spectrum of children referred to physiotherapy in primary health care in Norway. Our findings may guide further interdisciplinary collaboration and knowledge transfer between professionals involved in child health care with the goal to balance the use of resources to the need for physiotherapy. Trial registration: ClinicalTrials.gov Identifier: NCT03626389. Registered on August 13th 2018 (retrospectively registered).

scholarly journals Depression, Comorbidities, and Prescriptions of Antidepressants in a German Network of GPs and Specialists with Subspecialisation in Anthroposophic Medicine: A Longitudinal Observational Study

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Elke Jeschke ◽  
Thomas Ostermann ◽  
Horst C. Vollmar ◽  
Manuela Tabali ◽  
Harald Matthes
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Hypericum Perforatum ◽  
Treatment Strategies ◽  
Antidepressant Medication ◽  
Anthroposophic Medicine ◽  
Services Research ◽  
Factors Associated ◽  
Longitudinal Observational Study ◽  
Treatment Of Depression

Background. Depression is a major reason for counselling in primary care. Our study aims at evaluating pharmacological treatment strategies among physicians specialised in anthroposophic medicine (AM).Methods. From 2004 to 2008, twenty-two German primary care AM-physicians participated in this prospective, multicentre observational study. Multiple logistic regression was used to determine factors associated with a prescription of any antidepressant medication.Results. A total of 2444 patients with depression were included (mean age: 49.1 years (SD: 15.4); 77.3% female). 2645 prescriptions of antidepressants for 833 patients were reported. Phytotherapeutic preparations fromHypericum perforatumwere the most frequently prescribed antidepressants over all (44.6% of all antidepressants), followed by amitriptyline (16.1%). The likelihood of receiving an antidepressant medication did not depend on comorbidity after controlling for age, gender, physician specialisation, and type of depression (adjusted OR(AOR)=1.01; CI: 0.81–1.26). Patients who had cancer were significantly less likely to be prescribed an antidepressant medication than those who had no cancer (AOR=0.75; CI: 0.57–0.97).Conclusion. This study provides a comprehensive analysis of everyday practice for the treatment of depression in AM -physicians. Further analysis regarding the occurrence of critical combinations is of high interest to health services research.

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