Document Detail

Implications of comorbidity for primary care costs in the UK: a retrospective observational study.
MedLine Citation:
PMID:  23540484     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear.
AIM: To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each.
DESIGN: Retrospective observational study using data on 86 100 patients in the General Practice Research Database.
METHOD: Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately.
RESULTS: Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, particularly when co-occurring with other cardiovascular conditions.
CONCLUSION: Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.
Samuel L Brilleman; Sarah Purdy; Chris Salisbury; Frank Windmeijer; Hugh Gravelle; Sandra Hollinghurst
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Publication Detail:
Type:  Journal Article; Observational Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of general practice : the journal of the Royal College of General Practitioners     Volume:  63     ISSN:  1478-5242     ISO Abbreviation:  Br J Gen Pract     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-01     Completed Date:  2014-01-21     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  9005323     Medline TA:  Br J Gen Pract     Country:  England    
Other Details:
Languages:  eng     Pagination:  e274-82     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Cardiovascular Diseases / economics,  epidemiology*
Cost of Illness
Cost-Benefit Analysis
Depression / economics,  epidemiology*
Great Britain / epidemiology
Health Expenditures
Hypertension / economics,  epidemiology*
Middle Aged
Primary Health Care* / economics,  statistics & numerical data
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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