Family Medicine

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Original abstract World Book of Family Medicine – European Edition 2015 http://www.woncaeurope.org/content/3851-prevention-and-health-promotion-clinical-practice-views-general-practitionerseurope References 1. Brotons C , Björkelund C, Bulc M, Ciurana R, Godycki-Cwirko M, Jurgova E, et al. on behalf of the EUROPREV network. Prevention and health promotion in clinical practice: the views of general practitioners in Europe. Prev Med 2005; 40:595- 601. 2. Brotons C, Bulc M, Sammut M , Sheehan M, da Silva Martins C M, Björkelund C, et al. Attitudes toward preventive services and lifestyle: the views of primary care patients in Europe. The EUROPREVIEW patient study. Family practice 2012; 29 (suppl. 1): i168-i176. 3. Johansson K, Bendtsen P, Akerlind I. Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation. Eur J Public Health 2005; 15: 615-20. 4. Cervical Cytology Screening. The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin 2009; 109: 1-12. 5. Yabroff KR, Saraiya M, Meissner HI, Haggstrom DA, Wideroff L, Yuan G, et al. Specialty Differences in Primary Care Physician Reports of Papanicolaou Test Screening Practices: A National Survey, 2006 to 2007. Ann Int Med 2009; 151: 602- 11. 6. Chamot E, Charvet A, Perneger TV. Overuse of mammography during the first round of an organized breast cancer screening programme. J Eval Clin Pract 2009; 15: 620-5. 72
World Book of Family Medicine – European Edition 2015 Marjan van den Akker, MD, PhD marjan.vandenakker@maastrichtuniversity.nl 22 – Determinants of Multimorbidity Marjan van den Akker, MD, PhD Maastricht University, School CAPHRI, dept of Family Medicine, KU Leuven,dept of General Practice Co-authors Christiane Muth, Job FM Metsemakers, J André Knottnerus, Frank Buntinx Introduction Multimorbidity, often defined as the co-occurrence of two or more (chronic) diseases within a patient, without an index disease being specified (1), is the rule rather than the exception in daily clinical practice. In Western countries the prevalence of multimorbidity in the general population ranges around 20-30% when the whole population was considered, and ranges between 55-98% when only older persons were included (2), with Asian studies showing similar results. Risk Factors Associated for Multimorbidity The main risk factor for multimorbidity seems to be age: in older populations the prevalence of the most common diseases, such as heart failure and dementia, is much higher than among younger patients, resulting in frequent co-occurrence of diseases. Multimorbidity is therefore often positioned as a condition of older patients. This is confirmed when looking at relative numbers, but increasingly it is recognized, that in absolute numbers the majority of patients suffering from multimorbidity is less than 65 years of age, with Barnett et al (3) reporting just over half of the people with multimorbidity to be 65 years of age or less. Secondly, women and persons from low social classes consistently appeared to be more prone to multimorbidity across Western and Asian studies (2, 4). In a Brazilian study, Andrade et al (5) reported that somatic and mental disorders also frequently co-occur in a population sample of a developing country. The results suggest that substantial proportions of both chronic medical and psychiatric morbidities are not attributable to disorder-specific risks but rather to a few generic liability factors associated with many disorders, like lifestyle and distress. This supports the notion of general disease susceptibility (6). Thirdly, ethnic, educational and cultural differences seem to play an important role: Black Americans had significantly higher initial levels of multimorbidity relative to white Americans in a national representative sample of US adults (7). The same study by Quinones et al. showed that higher education is associated with fewer reported diseases. Methodological Influences on Prevalence Estimates Already in the late 1990s it was recognized that many of the choices related to design of the study, definition and operationalisation of multimorbidity strongly influence the reported prevalence and incidence of multimorbidity (8). The influence of methodological decisions on the reported amount of multimorbidity is considerable. Starting with the various definitions of multimorbidity, where the minimum numbers of diseases differ (two vs three or more chronic conditions), or where multimorbidity is defined as the simultaneous presence of diseases/symptoms, cognitive and physical functional limitations, or the 73
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Family Medicine

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