Polymorbidity in diabetes in older people: consequences for care and vocational training

van Bussel, B., Pijpers, E., Ferreira, I., Castermans, P. and Kruseman, A. Nieuwenhuijzen (2007) Polymorbidity in diabetes in older people: consequences for care and vocational training. Postgraduate Medical Journal, 83 986: 763-767. doi:10.1136/pgmj.2007.062356

Author van Bussel, B.
Pijpers, E.
Ferreira, I.
Castermans, P.
Kruseman, A. Nieuwenhuijzen
Title Polymorbidity in diabetes in older people: consequences for care and vocational training
Journal name Postgraduate Medical Journal   Check publisher's open access policy
ISSN 0032-5473
Publication date 2007-12
Sub-type Article (original research)
DOI 10.1136/pgmj.2007.062356
Open Access Status Not yet assessed
Volume 83
Issue 986
Start page 763
End page 767
Total pages 5
Place of publication London, United Kingdom
Publisher B M J Group
Language eng
Formatted abstract
Objective: To investigate the prevalence of complicating and concurrent morbidities in older diabetic patients and to evaluate to what extent their occurrence affects the burden of disease and use of medical healthcare.

Study design: Cross-sectional analysis of retrospectively obtained data on comorbidities and use of medical healthcare. Healthcare registration systems were used to retrieve data on 300 patients with diabetes aged ≥60 years who, according to the severity of their disease and intensity of care required, were treated in a regional general practitioner (GP), diabetes nurse specialist (DNS) or medical specialist (MS) practice.

Results: Complicating and concurrent morbidities were often found irrespective of the type of practice involved. After adjustments for differences in sex, age and glycosylated haemoglobin (HbA1c), the extent of complicating comorbidities showed sequential increases in patients managed by GP, DNS and MS (mean number of 3.6, 4.7 and 6.7, respectively; ptrend<0.001). However, the mean number of concurrent comorbidities was similar across all three settings (2.1, 1.8 and 2.0, respectively). Both complicating and concurrent comorbidities were similarly associated with the extent of drug use (β = 0.49 (95% CI 0.40 to 0.58) and β = 0.57 (95% CI 0.52 to 0.72), respectively) and the number of consultations with specialists other than the main care giver (β = 1.19 (95% CI 1.15 to 1.24) and β = 1.21 (95% CI 1.14 to 1.28), respectively). However, the mean number of different specialists involved in a patient's care per additional concurrent comorbidity was twice as high as per any additional complicating comorbidity (β = 0.60 (95% CI 0.48 to 0.71) vs β = 0.31 (95% CI 0.24 to 0.39)).

Conclusions: The use of healthcare facilities by older patients with diabetes is substantial, irrespective of the complexity of the disease and the kind of practice involved. The common manifestation of complicating and concurrent comorbidities and their varying complexity in individual patients requires a patient-oriented rather than a disease-oriented approach and vocational training programmes for care givers that are tailored to the complexity of multiple chronic diseases.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
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