Health-related needs of people with multiple chronic diseases: differences and underlying factors

Abstract

Purpose

To examine the health-related needs of people with multiple chronic diseases in the Netherlands compared to people with one chronic disease, and to identify different subgroups of multimorbid patients based on differences in their health problems.

Methods

Participants were 1092 people with one or more chronic diseases of a nationwide prospective panel study on the consequences of chronic illness in the Netherlands. They completed the EQ-6D, a multi-dimensional questionnaire on health problems (October 2013). Chi-square tests and analyses of variance were performed to test for differences between multimorbid patients and patients with one chronic disease. To identify subgroups of multimorbid patients, cluster analysis was performed and differences in EQ-6D scores between clusters were tested with Chi-square tests.

Results

Multimorbid patients (51 % of the total sample) experience more problems in most health domains than patients with one chronic disease. Almost half (44 %) of the multimorbid people had many health problems in different domains. These people were more often female, had a smaller household size, had a lower health literacy, and suffered from more chronic diseases. Remarkably, a small subgroup of multimorbid patients (4 %, mostly elderly males) is characterized by all having cognitive problems.

Conclusions

Based on the problems they experience, we conclude that patients with multimorbidity have relatively many and diverse health-related needs. Extensive health-related needs among people with multimorbidity may relate not only to the number of chronic diseases they suffer from, but also to their patient characteristics. This should be taken into account, when identifying target groups for comprehensive support programmes.

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Fig. 1

Notes

  1. 1.

    The distribution of the chronic disease categories is quite similar to that of a large nationwide database containing health data, including the medical diagnoses of chronic diseases, of about 10 % of the Dutch population (NIVEL’s Primary Care Database [17]).

  2. 2.

    All diseases (ICPC codes of 70 and higher), except for P codes (psychiatric problems/mental disorders) and Z codes (social problems).

References

  1. 1.

    van Oostrom, S. H., Gijsen, R., Stirbu, I., Korevaar, J. C., Schellevis, F. G., H. S. J. Picavet, & Hoeymans, N. (2014). Rise in the prevalence of chronic diseases and multimorbidity from 2001 to 2011 in the Dutch population, Manuscript submitted for publication.

  2. 2.

    Boyd, C., & Fortin, M. (2010). Future of multimorbidity research: How should understanding of multimorbidity inform health system design? Public Health Reviews, 32, 451–474.

    Google Scholar 

  3. 3.

    Uijen, A. A., & van de Lisdonk, E. H. (2008). Multimorbidity in primary care: Prevalence and trend over the last 20 years. European Journal of General Practice, 14(1), 28–32. doi:10.1080/13814780802436093.

    Article  PubMed  Google Scholar 

  4. 4.

    Bower, P., Macdonald, W., Harkness, E., Gask, L., Kendrick, T., Valderas, J. M., et al. (2011). Multimorbidity, service organization and clinical decision making in primary care: A qualitative study. Family Practice, 28(5), 579–587. doi:10.1093/fampra/cmr018.

    Article  PubMed  Google Scholar 

  5. 5.

    Smith, S. M., Soubhi, H., Fortin, M., Hudon, C., & O’Dowd, T. (2012). Managing patients with multimorbidity: Systematic review of interventions in primary care and community settings. Cochrane Database of Systematic Reviews,. doi:10.1002/14651858.CD006560.pub2.

    Google Scholar 

  6. 6.

    Marengoni, A., Angleman, S., Melis, R., Mangialasche, F., Karp, A., Garmen, A., et al. (2011). Aging with multimorbidity: A systematic review of the literature. Aging Research Reviews, 10, 430–439. doi:10.1016/j.arr2011.03.003.

    Article  PubMed  Google Scholar 

  7. 7.

    Vogeli, C., Shields, A. E., Lee, T. A., Gibson, T. B., Marder, W. D., Weiss, K. B., et al. (2007). Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine, 22(Suppl. 3), 391–395. doi:10.1007/s11606-007-0322-1.

    PubMed Central  Article  PubMed  Google Scholar 

  8. 8.

    Fortin, M., Bravo, G., Hudon, C., Lapointe, L., Almirall, J., Dubois, M. F., et al. (2006). Relationship between multimorbidity and health-related quality of life of patients in primary care. Quality of Life Research, 15, 83–91.

    Article  PubMed  Google Scholar 

  9. 9.

    Sprangers, M. A., de Regt, E. B., Andries, F., van Agt, H. M., Bijl, R. V., de Boer, J. B., et al. (2000). Which chronic conditions are associated with better or poorer quality of life? Journal of Clinical Epidemiology, 53(9), 895–907.

    Article  PubMed  CAS  Google Scholar 

  10. 10.

    Rijken, M., van Kerkhof, M., Dekker, J., & Schellevis, F. G. (2005). Comorbidity of chronic diseases: Effects of disease pairs on physical and mental functioning. Quality of Life Research, 14(1), 45–55. doi:10.1007/s11136-004-0616-2.

    Article  PubMed  Google Scholar 

  11. 11.

    Rijken, M., Struckmann, V., Dyakova, M., Melchiorre, M. G., Rissanen, S., & van Ginneken, E. (2013). ICARE4EU: Improving care for people with multiple chronic conditions in Europe. Eurohealth, 19(3), 29–31.

    Google Scholar 

  12. 12.

    Ishikawa, H., & Yano, E. (2008). Patient health literacy and participation in the health-care process. Health Expectations, 11(2), 113–122. doi:10.1111/j.1369-7625.2008.00497.x.

    Article  PubMed  Google Scholar 

  13. 13.

    de Bruin, S. R., Heijink, R., Lemmens, L., Struijs, J. N., & Baan, C. A. (2011). Impact of disease management programs on health-care expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: A systematic review of the literature. Health Policy, 101, 105–121. doi:10.1016/j.healthpol.2011.03.006.

    Article  PubMed  Google Scholar 

  14. 14.

    Boult, C., Green, A. F., Boult, L. B., Pacala, J. T., Snyder, C., & Leff, B. (2009). Successful models of comprehensive care for older adults with chronic conditions: Evidence for the institute of medicine’s “retooling for an Aging America” report. Journal of the American Geriatrics Society, 57, 2328–2337. doi:10.1111/j.1532-5415.2009.02571.x.

    Article  PubMed  Google Scholar 

  15. 15.

    Baanders, A. N., Rijken, P. M., & Peters, L. (2002). Labour participation of the chronically ill: A profile sketch. European Journal of Public Health, 12(2), 124–130.

    Article  PubMed  Google Scholar 

  16. 16.

    Hingstman, L., & Kenens, R. J. (2009). Cijfers uit de registratie van huisartsen: Peiling 2009. Utrecht: NIVEL.

    Google Scholar 

  17. 17.

    NIVEL. NIVEL Primary Care Database. http://www.nivel.nl/node/3418. Accessed on June 08, 2015.

  18. 18.

    Krabbe, P. F. M., Stouthard, M. E. A., Essink-Bot, M. L., & Bonsel, G. J. (1999). The effect of adding a cognitive dimension to the EuroQol multiattribute health-status classification system. Journal of Clinical Epidemiology, 52, 293–301. doi:10.1016/S0895-4356(98)00163-2.

    Article  PubMed  CAS  Google Scholar 

  19. 19.

    Hoeymans, N., van Lindert, H., & Westert, G. P. (2005). The health status of the Dutch population as assessed by the EQ-6D. Quality of Life Research, 14(3), 655–663. doi:10.1007/s11136-004-1214-z.

    Article  PubMed  CAS  Google Scholar 

  20. 20.

    Brooks, R. (1996). EuroQol: The current state of play. Health Policy, 37, 53–72.

    Article  PubMed  CAS  Google Scholar 

  21. 21.

    de Jong-Gierveld, J., & Kamphuis, F. H. (1985). The development of a Rasch-type loneliness-scale. Applied Psychological Measurement, 9, 289–299. doi:10.1177/014662168500900307.

    Article  Google Scholar 

  22. 22.

    van Tilburg, T. G., & de Leeuw, E. D. (1991). Stability of scale quality under various data collection procedures: A mode comparison of the “De Jong-Gierveld Loneliness Scale.”. International Journal of Public Opinion Research, 3, 69–85. doi:10.1093/ijpor/3.1.69.

    Article  Google Scholar 

  23. 23.

    van Knippenberg, F. C., & de Haes, J. C. (1988). Measuring the quality of life of cancer patients: Psychometric properties of instruments. Journal of Clinical Epidemiology, 41(11), 1043–1053.

    Article  PubMed  Google Scholar 

  24. 24.

    Ishikawa, H., Takeuchi, T., & Yano, E. (2008). Measuring functional, communicative and critical health literacy among diabetic patients. Diabetes Care, 31, 874–879. doi:10.2337/dc07-1932.

    Article  PubMed  Google Scholar 

  25. 25.

    Lamberts, H., & Wood, M. (1987). International classification of primary care. Oxford: Oxford University Press.

    Google Scholar 

  26. 26.

    Nationale Raad voor de Volksgezondheid. Standaardisatie van chroniciteitsbegrippen. Vooronderzoek naar het definiëren en specificeren van chroniciteit van gezondheidsproblemen ten behoeve van classificaties. Zoetermeer, The Netherlands: Nationale Raad voor de Volksgezondheid, 1995.

  27. 27.

    Stata.com (2014). Cluster analysis. Retrieved from http://www.stata.com/features/cluster-analysis/ on December 12, 2014.

  28. 28.

    Fortin, M., Bravo, G., Hudon, C., Lapointe, L., Dubois, M. F., & Almirall, J. (2006). Psychological distress and multimorbidity in primary care. Annals of Family Medicine, 4, 417–422.

    PubMed Central  Article  PubMed  Google Scholar 

  29. 29.

    Thoits, P. A. (1986). Social support as coping assistance. Journal of Consulting and Clinical Psychology, 54(4), 416–423.

    Article  PubMed  CAS  Google Scholar 

  30. 30.

    Gauthier, S., Reisberg, B., Zaudig, M., et al. (2006). Mild cognitive impairment. Lancet, 367, 1262–1270. doi:10.1016/S0140-6736(06)68542-5.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research arises from the Joint Action on Chronic Diseases and Promoting Healthy Ageing Across the Life Cycle (JA-CHRODIS) which has received funding from the European Union, in the framework of the Health Programme (2008–2013). NIVEL has also received funding from the Netherlands Ministry of Health, Welfare and Sports to contribute to this joint action.

Funding

This study was funded by the Joint Action on Chronic Diseases and Promoting Healthy Ageing Across the Life Cycle (JA-CHRODIS; Grant Agreement No.: 20132201) and the Dutch Ministry of Health, Welfare and Sport (Grant No.: 322095).

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Correspondence to Mieke Rijken.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hopman, P., Schellevis, F.G. & Rijken, M. Health-related needs of people with multiple chronic diseases: differences and underlying factors. Qual Life Res 25, 651–660 (2016). https://doi.org/10.1007/s11136-015-1102-8

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Keywords

  • Multimorbidity
  • Chronic disease
  • Health problems
  • Needs
  • Quality of life
  • Health survey
  • Netherlands