title: Health care utilization of patients with multiple chronic diseases in the Netherlands: Differences and underlying factors.
abstract: To examine health care utilization of people with multiple chronic diseases in The Netherlands compared to people with a single chronic disease, and to identify subgroups of multimorbid patients according to health care utilization.
  
  
  
  All patients diagnosed with one or more chronic diseases in 2008-2009 (N=54,051) were selected from the nationwide NIVEL Primary Care Database, and data on their GP contacts and medication in 2010 were retrieved. Data on hospital admissions, household size and income were added. Chi-square-tests and multivariate regression analyses were performed to analyze differences between multimorbid patients and patients with a single chronic disease, and between subgroups of multimorbid patients derived from cluster analysis.
  
  
  
  Multimorbid patients (37% of all patients) had more GP contacts, prescribed medications, and hospital admissions (all p<.0001) than patients with a single chronic disease. The largest cluster of multimorbid patients (57%) had a relatively low level of health care utilization, a smaller cluster (36%) had higher levels of health care utilization, and 7.6% of patients were heavy health care users (p<.0001 for all variables). The latter were older, more often female, had a lower income, lived in a smaller household, had more chronic diseases, and more often had specific chronic diseases such as COPD, diabetes and heart failure.
  
  
  
  The majority of multimorbid patients have only slightly higher health care utilization than patients with a single chronic disease. Extensive health care utilization among multimorbid patients seems to be related to patient characteristics as well as chronic disease numbers and patterns.
authors.affiliation: NIVEL, Utrecht, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Hopman
authors.affiliation: NIVEL, Utrecht, The Netherlands.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Heins
authors.affiliation: NIVEL, Utrecht, The Netherlands.
authors.forename: Joke C
authors.initials: JC
authors.lastname: Korevaar
authors.affiliation: NIVEL, Utrecht, The Netherlands.
authors.forename: Mieke
authors.initials: M
authors.lastname: Rijken
authors.affiliation: NIVEL, Utrecht, The Netherlands; Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: F.Schellevis@nivel.nl.
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; 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; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care
keywords: Chronic disease; Epidemiology; Health care utilization; Multimorbidity