Journal of multimorbidity and comorbidity最新文献

{"title":"Physician-led in-hospital multidisciplinary team conferences with multiple medical specialities present - A scoping review.","authors":"Daniel Pilsgaard Henriksen,&nbsp;Zandra Nymand Ennis,&nbsp;Vasiliki Panou,&nbsp;Jørgen Hangaard,&nbsp;Per Bruno Jensen,&nbsp;Sofie Lock Johansson,&nbsp;Subagini Nagarajah,&nbsp;Marianne Kjær Poulsen,&nbsp;Mette Juel Rothmann,&nbsp;Karoline Schousboe,&nbsp;Stine Jorstad Bugge,&nbsp;Louise Brügmann Jessen,&nbsp;Ida Ransby Schneider,&nbsp;Ann Dorthe Olsen Zwisler,&nbsp;Kurt Højlund,&nbsp;Per Damkier","doi":"10.1177/26335565221141745","DOIUrl":"https://doi.org/10.1177/26335565221141745","url":null,"abstract":"<p><strong>Introduction: </strong>Multidisciplinary Team Conferences (MDTs) are complex interventions in the modern healthcare system and they promote a model of coordinated patient care and management. However, MDTs within chronic diseases are poorly defined. Therefore, the aim of this scoping review was to summarise the current literature on physician-led in-hospital MDTs in chronic non-malignant diseases.</p><p><strong>Method: </strong>Following the PRISMA-ScR guideline for scoping reviews, a search on MDT interventions in adult patients, with three or more medical specialties represented, was performed.</p><p><strong>Results: </strong>We identified 2790 studies, from which 8 studies were included. The majority of studies were non-randomised and focused on a single disease entity such as infective endocarditis, atrial fibrillation, IgG4-related disease, or arterial and venous thrombosis. The main reason for referral was confirmation or establishment of a diagnosis, and the MDT members were primarily from medical specialties gathered especially for the MDT. Outcomes of the included studies were grouped into process indicators and outcome indicators. Process indicators included changes in diagnostic confirmation as well as therapeutic strategy and management. All studies reporting process indicators demonstrated significant changes before and after the MDT.</p><p><strong>Conclusion: </strong>MDTs within chronic diseases appeared highly heterogeneous with respect to structure, reasons for referral, and choice of outcomes. While process indicators, such as change in diagnosis, and treatment management/plan seem improved, such have not been demonstrated through outcome indicators.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221141745"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f3/9f/10.1177_26335565221141745.PMC9742578.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10361274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal trajectories of treatment burden: A prospective survey study of adults living with multiple chronic conditions in the midwestern United States.","authors":"David T Eton,&nbsp;Roger T Anderson,&nbsp;Jennifer L St Sauver,&nbsp;Elizabeth A Rogers,&nbsp;Mark Linzer,&nbsp;Minji K Lee","doi":"10.1177/26335565221081291","DOIUrl":"https://doi.org/10.1177/26335565221081291","url":null,"abstract":"<p><strong>Objectives: </strong>Determine whether there are different longitudinal patterns of treatment burden in people living with multiple chronic conditions (MCC) and, if so, explore predictors that might reveal potential routes of intervention.</p><p><strong>Methods: </strong>We analyzed data from a prospective mailed survey study of 396 adults living with MCC in southeastern Minnesota, USA. Participants completed a measure of treatment burden, the Patient Experience with Treatment and Self-management (PETS), and valid measures of health-related and psycho-social concepts at baseline, 6, 12, and 24 months. Latent class growth mixture modeling (LCGM) determined trajectories of treatment burden in two summary index scores of the PETS: Workload and Impact. Multivariable logistic regressions were used to identify independent predictors of the trajectories.</p><p><strong>Results: </strong>LCGM supported a 2-class model for PETS Workload, including a group of consistently high workload (<i>N</i> = 69) and a group of consistently low workload (<i>N</i> = 311) over time. A 3-class model was supported for PETS Impact, including groups of consistently high impact (<i>N</i> = 62), consistently low impact (<i>N</i> = 278), and increasing impact (<i>N</i> = 51) over time. Logistic regression analyses showed that the following factors were associated with patterns of consistently high or increasing treatment burden over time: lower health literacy, lower self-efficacy, more interpersonal challenges with others, and worse subjective reports of physical and mental health (all <i>p</i> < .05).</p><p><strong>Conclusions: </strong>Different longitudinal patterns of treatment burden exist among people with MCC. Raising health literacy, enhancing self-efficacy, and lessening the effects of negative social interactions might help reduce treatment burden.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221081291"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/e4/10.1177_26335565221081291.PMC9106306.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10662894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates","authors":"M. Jäger, Mathias Constantin Lindhardt, J. R. Pedersen, Mette Dideriksen, M. Nyberg, A. Bricca, U. Bodtger, J. Midtgaard, S. Skou","doi":"10.1177/26335565221100172","DOIUrl":"https://doi.org/10.1177/26335565221100172","url":null,"abstract":"Background Behavior change and exercise are considered critical for successful self-management in people with multimorbidity, however, little is known about people’s needs, experiences, and preferences. Purpose The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. Research design Analysis was carried out by means of a hybrid inductive-deductive approach using Framework Analysis that enabled the subsequent use of the COM-B model in relation to the study of exercise behavior specifically. Study sample We conducted 17 interviews (9 focus groups; 8 key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 healthcare professionals, 5 relatives, and 5 patient advocates). Data analysis Through an inductive Framework analysis, we constructed three themes: Patient education, supporting behavior change, and lack of a “burning platform.” Subsequent deductive application of the COM-B profile (applied solely to data related to exercise behavior) unveiled a variety of barriers to exercise and self-management support (pain, fatigue, breathlessness, lack of motivation, financial issues, accessibility, decreased social support). Results Overall, the four groups shared common understandings while also expressing unique challenges. Conclusions Future interventions and/or policies targeting exercise behavior in people living with multimorbidity should address some of the barriers identified in this study.","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49591586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity, disease count, mortality and emergency care use in persons attending the emergency department: a cross-sectional data-linkage study.","authors":"Chris McParland,&nbsp;Mark A Cooper,&nbsp;David J Lowe,&nbsp;Bethany Stanley,&nbsp;Bridget Johnston","doi":"10.1177/26335565221147417","DOIUrl":"https://doi.org/10.1177/26335565221147417","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity (two or more concurrent chronic conditions) is associated with poorer health outcomes and increased healthcare utilisation in primary care and general populations. Less is known about the prevalence of multimorbidity in emergency department attenders, or its association with poor outcomes in this population.</p><p><strong>Aim: </strong>This study sought to explore the relationship between multimorbidity, mortality and health-care utilisation in a large urban cohort of persons attending emergency departments.</p><p><strong>Methods: </strong>Validated algorithms for the identification of 28 chronic conditions from ICD-10 codes were deployed on a cross-sectional sample of patients attending emergency departments in Glasgow, Scotland between April 2019 and March 2020. Analysis was conducted on complete cases (n=63,328) and compared with results from data with imputed missing values (n=75,723). Models adjusted for age, sex, deprivation and ethnicity were fitted to test for the association between (i) multimorbidity, (ii) complex multimorbidity, (iii) disease count and the following outcomes: admission to hospital, reattendance at 30 and 90 days, and death during admission.</p><p><strong>Results: </strong>Multimorbidity, complex multimorbidity and disease count were significantly associated with hospital admission and emergency department reattendance. Those with 1-3 conditions were at increased risk of inpatient mortality.</p><p><strong>Conclusion: </strong>This study further evidences the impact of multimorbidity and disease burden on health-care use, and mortality to a lesser extent. Deployed algorithms were sufficiently sensitive to detect associations, despite limited access (21 months) to secondary-care data. This should allow for the construction of more robust models to prospectively identify persons at risk of poor outcomes in similar populations.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221147417"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d3/46/10.1177_26335565221147417.PMC9761223.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10420283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specific multimorbidity patterns modify the impact of an exercise intervention in older hospitalized adults.","authors":"Nicolas Martínez-Velilla,&nbsp;Arkaitz Galbete,&nbsp;Albert Roso-Llorach,&nbsp;Fabricio Zambom-Ferraresi,&nbsp;Mikel L Sáez de Asteasu,&nbsp;Mikel Izquierdo,&nbsp;Davide L Vetrano,&nbsp;Amaia Calderón-Larrañaga","doi":"10.1177/26335565221145461","DOIUrl":"https://doi.org/10.1177/26335565221145461","url":null,"abstract":"<p><strong>Background: </strong>Different multimorbidity patterns present with different prognoses, but it is unknown to what extent they may influence the effectiveness of an individualized multicomponent exercise program offered to hospitalized older adults.</p><p><strong>Methods: </strong>This study is a secondary analysis of a randomized controlled trial conducted in the Department of Geriatric Medicine of a tertiary hospital. In addition to the standard care, an exercise-training multicomponent program was delivered to the intervention group during the acute hospitalization period. Multimorbidity patterns were determined through fuzzy c-means cluster analysis, over 38 chronic diseases. Functional, cognitive and affective outcomes were considered.</p><p><strong>Results: </strong>Three hundred and six patients were included in the analyses (154 control; 152 intervention), with a mean age of 87.2 years, and 58.5% being female. Four patterns of multimorbidity were identified: <i>heart valves and prostate diseases</i> (26.8%); <i>metabolic diseases and colitis</i> (20.6%); <i>psychiatric, cardiovascular and autoimmune diseases</i> (16%); and an <i>unspecific</i> pattern (36.6%). The Short Physical Performance Battery (SPPB) test improved across all patterns, but the intervention was most effective for patients in the <i>metabolic/colitis</i> pattern (2.48-point difference between intervention/control groups, 95% CI 1.60-3.35). Regarding the Barthel Index and the Mini Mental State Examination (MMSE), the differences were significant for all multimorbidity patterns, except for the <i>psychiatric/cardio/autoimmune</i> pattern. Differences concerning quality of life were especially high for the p<i>sychiatric/cardio/autoimmune</i> pattern (16.9-point difference between intervention/control groups, 95% CI 4.04, 29.7).</p><p><strong>Conclusions: </strong>Patients in all the analyzed multimorbidity patterns improved with this tailored program, but the improvement was highest for those in the metabolic pattern. Understanding how different chronic disease combinations are associated with specific functional and cognitive responses to a multicomponent exercise intervention may allow further tailoring such interventions to older patients' clinical profile.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221145461"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3a/69/10.1177_26335565221145461.PMC9749545.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10401020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evaluation of the role of technology in the pathways to comorbidity care implementation project to improve management of comorbid substance use and mental disorders","authors":"Maria Gabriela Uribe Guajardo, A. Baillie, Eva Louie, Vicki Giannopoulos, K. Wood, Ben Riordan, P. Haber, K. Morley","doi":"10.1177/26335565221096977","DOIUrl":"https://doi.org/10.1177/26335565221096977","url":null,"abstract":"In substance use treatment settings, comorbid mental health problems can occur in up to 70% of people. An integrated approach for managing comorbidity, implementing evidence-based intervention in drug and alcohol settings, remains problematic. Technology can help in adopting evidence-based practice to implement effective treatment healthcare pathways. This study sought to examine aspects of tailored portal utilization (barriers and facilitators) by participants taking part in a program aimed at improving the implementation of evidence-based practice for comorbidity management Pathways to Comorbidity Care (PCC). Method A self-report questionnaire and a semi-structured interview were designed to measure clinician satisfaction with the PCC portal and e-resources throughout a 9-month intervention. An adapted version of the “Non-adoption, Abandonment, Scale-up, Spread and, Sustainability” (NASSS) framework facilitated discussion of the findings. Results Twenty participants from drug and alcohol services responded to all measures. Facilitators included: (i). clinician acceptance of the portal; (ii). guidance from the clinical supervisor or champion to encourage e-resource use. Barriers included: (i). complexity of the illness (condition); (ii). participants’ preference (adopter system) for face-to-face resources and training modes; and, (iii). lack of face-to-face training on how to use the portal (technology and organization). Conclusion Based on the NASSS framework, we identified several barriers and facilitators of the use of the portal including the complexity of illness, lack of face-to-face training, and clinician preference for training mediums. Recommendations include ongoing organizational support, in-house clinical supervision, and consultation with clinical providers to assist in the development of tailored e-health resources and open training opportunities on how to operate and effectively utilize these resources.","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47999537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term conditions, multimorbidity and colorectal cancer risk in the UK Biobank cohort.","authors":"Neave Me Corcoran,&nbsp;Frances S Mair,&nbsp;Barbara Nicholl,&nbsp;Sara Macdonald,&nbsp;Bhautesh Dinesh Jani","doi":"10.1177/26335565221110123","DOIUrl":"https://doi.org/10.1177/26335565221110123","url":null,"abstract":"<p><strong>Purpose: </strong>Early identification of colorectal cancer (CRC) is an international priority. Multimorbidity (presence of ≥2 long-term conditions (LTCs)) is increasing and the relationship between CRC and LTCs is little-understood. This study explores the relationship between individual LTCs, multimorbidity and CRC incidence and mortality.</p><p><strong>Methods: </strong>Longitudinal analysis of the UK Biobank cohort, participants recruited 2006-2010; <i>N</i> = 500,195; excluding previous CRC at baseline. Baseline data was linked with cancer/mortality registers. Demographic characteristics, lifestyle factors, 43 LTCs, CRC family history, non-CRC cancers, and multimorbidity count were recorded. Variable selection models identified candidate LTCs potentially predictive of CRC outcomes and Cox regression models tested for significance of associations between selected LTCs and outcomes.</p><p><strong>Results: </strong>Participants' age range: 37-73 (mean age 56.5; 54.5% female). CRC was diagnosed in 3669 (0.73%) participants, and 916 (0.18%) died from CRC during follow-up (median follow-up 7 years). CRC incidence was higher in the presence of heart failure (Hazard Ratio (HR) 1.96, 95% Confidence Interval (CI) 1.13-3.40), diabetes (HR 1.15, CI 1.01-1.32), glaucoma (HR 1.36, CI 1.06-1.74), male cancers (HR 1.44, CI 1.01-2.08). CRC mortality was higher in presence of epilepsy (HR 1.83, CI 1.03-3.26), diabetes (HR 1.32, CI 1.02-1.72), osteoporosis (HR 1.67, CI 1.12-2.58). No significant association was found between multimorbidity (≥2 LTCs) and CRC outcomes.</p><p><strong>Conclusions: </strong>The associations of certain LTCs with CRC incidence and mortality has implications for clinical practice: presence of certain LTCs in patients presenting with CRC symptoms could trigger early investigation and diagnosis. Future research should explore causative mechanisms and patient perspectives.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221110123"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/26/10.1177_26335565221110123.PMC9483970.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10858780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and feasibility of an inter-agency physical activity and education programme for adults with multimorbidity in primary care: Activ8.","authors":"Aine Ryan,&nbsp;Susan M Smith,&nbsp;Vanda Cummins,&nbsp;Catriona Murphy,&nbsp;Rose Galvin","doi":"10.1177/26335565221142350","DOIUrl":"https://doi.org/10.1177/26335565221142350","url":null,"abstract":"<p><strong>Background: </strong>While physical activity is widely recommended for many long-term conditions, it may be difficult to achieve for patients managing multiple conditions. We aimed to determine the feasibility of an inter-agency exercise and education programme for patients with multimorbidity in primary care.</p><p><strong>Methods: </strong>We conducted an uncontrolled pilot study with adults with multimorbidity, recruited in two community healthcare organisations in an urban area in Ireland. The six-week pilot intervention combined an individually tailored gym-based exercise programme and education to support self-management. Feasibility of the Activ8 programme was assessed using a mixed methods process evaluation. Outcome measures at baseline and at 6 weeks included recruitment and retention, gait speed, grip strength, quality of life and self-efficacy. Focus groups and interviews explored participants and facilitators' perceptions of the programme.</p><p><strong>Results: </strong>19 participants with ≥2 chronic conditions were recruited over three-weeks with similar attrition at both sites (≤40%). Overall, the results indicate that Activ8 was feasible and acceptable to patients and practitioners. Quantitative outcome measures suggested improvements in most outcomes. Qualitative data analysis indicated that Activ8 addressed an overarching concept of <i>patient-centeredness</i> among participants. Three key themes included perceived personal programme impact, the personalised composition of the programme and the evolving nature of primary care practice.</p><p><strong>Conclusion: </strong>While further definitive evidence is needed and attrition from the programme needs to be considered, the Activ8 Programme was acceptable to both patients and professionals in two different primary care areas with the potential for positive impacts for adults living with multimorbidity.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 ","pages":"26335565221142350"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ff/28/10.1177_26335565221142350.PMC9743022.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10367259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative analysis of factors influencing health-seeking behavior of people living with HIV, hypertension and diabetes in an urban area of Ghana","authors":"M. A. Abdulai, Julian K. Marable, Awudu Wadus, Kwaku Asante","doi":"10.1177/26335565221092664","DOIUrl":"https://doi.org/10.1177/26335565221092664","url":null,"abstract":"Non-communicable diseases are rising globally and lower-middle-income countries are now facing a double-burden of communicable and non-communicable diseases like hypertension and diabetes. Patients with HIV/AIDS are at increased risk of developing hypertension and diabetes. Understanding how this double-burden influences persons living with HIV health-seeking behavior (HSB) is critical to identifying successful interventions and policies. To explore the factors that influence the health-seeking behavior of HIV patients with hypertension and diabetes in an urban setting of Ghana, we undertook a qualitative study consisting of sixteen in-depth interviews (five healthcare providers [HCP] and eleven patients); all recruited from Antiretroviral Therapy (ART) clinics in the Techiman South Municipality of Ghana. Interview questions were designed to explore cognitive, affective, social, and environmental factors that influence an individual’s decision-making process and behavior. All interviews were audio-recorded, transcribed, and analyzed thematically. Participants raised unique challenges while seeking treatment services for HIV, hypertension, and diabetes. Frequent appointments, increased pill burden, food restrictions, alternate sources of care (herbalist and pastors), and negative psychological wellbeing were some of the challenges noted for seeking treatment services. Challenges with the health facility, including separate clinic days for comorbid conditions, high costs of medications and transportation, and long waiting hours were also cited as influencing health-seeking behavior. Results indicate greater challenges for HIV patients living with hypertension and diabetes in accessing treatment services. Understanding this is critical to removing barriers and making treatment more accessible. Further integration of treatment for hypertension and diabetes into HIV care is essential to ensuring patient engagement in continuous care.","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49007286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple comorbid conditions and healthcare resource utilization among adult patients with hyperkalemia: A retrospective observational cohort study using association rule mining","authors":"D. Dai, Ajay Sharma, Paula J. Alvarez, Steven D. Woods","doi":"10.1177/26335565221098832","DOIUrl":"https://doi.org/10.1177/26335565221098832","url":null,"abstract":"Objectives To estimate the prevalence of specific comorbid conditions (CCs) and multiple comorbid conditions (MCCs) among adult patients with hyperkalemia and examine the associations between MCCs and healthcare resource utilization (HRU) and costs. Methods This retrospective observational cohort study was conducted using a large administrative claims database. We identified patients with hyperkalemia (ICD-10-CM: E87.5; or serum potassium >5.0 mEq/L; or NDC codes for either patiromer or sodium polystyrene sulfonate) during the study period (1/1/2016–6/30/2019). The earliest service/claim date with evidence of hyperkalemia was identified as index date. Qualified patients had ≥12 months of enrolment before and after index date, ≥18 years of age. Comorbid conditions were assessed using all data within 12 months prior to the index date. Healthcare resource utilization and costs were estimated using all data within 12 months after the index date. Association rule mining was applied to identify MCCs. Generalized linear models were used to examine the associations between MCCs and HRU and costs. Results Of 22,154 patients with hyperkalemia, 94% had ≥3 CCs. The most common individual CCs were chronic kidney disease (CKD, 85%), hypertension (HTN, 83%), hyperlipidemia (HLD, 81%), and diabetes mellitus (DM, 47%). The most common dyad combination of CCs was CKD+HTN (71%). The most common triad combination was CKD+HTN+HLD (62%). The most common quartet combination was CKD+HTN+HLD+DM (36%). The increased number of CCs were significantly associated with increased ED visits, length of hospital stays, and total healthcare costs (all p-value < 0.0001). Conclusions MCCs are very prevalent among patients with hyperkalemia and are strongly associated with HRU and costs.","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66049934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}