title: Health care utilization of patients with multiple chronic diseases in The Netherlands: Differences and underlying factors.
abstract: OBJECTIVE
  To examine health care utilization of people with multiple chronic diseases in The Netherlands compared to people with one chronic disease, and to identify different subgroups of multimorbid patients based on differences in health care utilization.
  
  
  METHODS
  All patients diagnosed with one or more chronic diseases in 2008-2009 (N=17,443) were selected from the nationwide NIVEL Primary Care Database, and data on their GP contacts were included. Data on hospital admissions (from the Dutch Hospital Data database) and household size and income (from the Integral Household Incomes database 2010) were added. Chi-square-tests and multivariate regression analyses were performed to test for differences between multimorbid patients and patients with one chronic disease, and between subgroups of multimorbid patients derived from cluster analysis.
  
  
  RESULTS
  Multimorbid patients (40% of the total sample) had more GP contacts, prescribed medications, and hospital admissions (all p<.0001) than patients with one chronic disease. The largest cluster of multimorbid patients (80%) was characterized by a relatively low level of health care utilization. Two smaller clusters comprised patients with a (very) high level of health care utilization - these people were mainly older, more often female, had a lower income, a smaller household size, and suffered from more chronic diseases.
  
  
  CONCLUSIONS
  Among the vast majority of multimorbid patients health care utilization is only slightly higher compared to patients with one chronic disease. Extensive health care utilization among people with multimorbidity seems to be related to patient characteristics as well as illness characteristics.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Hopman
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Heins
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands. Electronic address: M.Rijken@nivel.nl.
authors.forename: Mieke
authors.initials: M
authors.lastname: Rijken
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands; Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010359:Patient Readmission; D012044:Regression Analysis; D035862:Vulnerable Populations
keywords: Chronic disease; Epidemiology; Health care utilization; Multimorbidity