Multimorbidity and quality of preventive care in Swiss university primary care cohorts.
BACKGROUND
Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings.


METHODS
We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50-80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND's Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator.


RESULTS
Participants (mean age 63.5 years, 44% women) had a mean of 2.6 (SD 1.9) comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9). Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47%) and those with schizophrenia (35%).


CONCLUSIONS
In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.
Insitute of General Practice BIHAM, Faculty of Medicine, University of Bern, Bern, Switzerland; Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
Sven
S
Streit
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Clinical Trials Unit, Department of Clinical Research, Bern University Hospital, Bern, Switzerland.
Bruno R
BR
da Costa
Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
Douglas C
DC
Bauer
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland; Service of Endocrinology, Diabetes, and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
Tinh-Hai
TH
Collet
Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
Stefan
S
Weiler
Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland.
Lukas
L
Zimmerli
Insitute of General Practice BIHAM, Faculty of Medicine, University of Bern, Bern, Switzerland.
Peter
P
Frey
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Jacques
J
Cornuz
Department of Community Medicine and Primary Care, University Hospitals of Geneva, and Faculty of Medicine, Geneva, Switzerland.
Jean-Michel
JM
Gaspoz
Division of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland.
Edouard
E
Battegay
Veterans Affairs Center for Clinical Management Research, HSR&D Center of Excellence; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
Eve
E
Kerr
Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
Drahomir
D
Aujesky
Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
Nicolas
N
Rodondi
D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services; D011320:Primary Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D013557:Switzerland