Multimorbidity and quality of life in primary care: A systematic review

被引：495
作者：
Fortin M. [1 ]
Lapointe L. [1 ]
Hudon C. [1 ]
Vanasse A. [1 ]
Ntetu A.L. [2 ]
Maltais D. [2 ]
机构：
[1] Departement de Medecine de Famille, Université de Sherbrooke, Sherbrooke, Que. J1H 5N4
[2] Departement des Sciences Humaines, Universite du Quebec a Chicoutimi, Chicoutimi, Que. G7H 2B1
来源：
Health and Quality of Life Outcomes | / 2卷 / 1期
关键词：
Psychiatric Diagnosis; Primary Care Setting; Psychiatric Comorbidity; Potential Confounding Variable; Psychological Dimension;
D O I：
10.1186/1477-7525-2-51
中图分类号：
学科分类号：
摘要：
Background: Many patients with several concurrent medical conditions (multimorbidity) are seen in the primary care setting. A thorough understanding of outcomes associated with multimorbidity would benefit primary care workers of all disciplines. The purpose of this systematic review was to clarify the relationship between the presence of multimorbidity and the quality of life (QOL) or health-related quality of life (HRQOL) of patients seen, or likely to be seen, in the primary care setting. Methods: Medline and Embase electronic databases were screened using the following search terms for the reference period 1990 to 2003: multimorbidity, comorbidity, chronic disease, and their spelling variations, along with quality of life and health-related quality of life. Only descriptive studies relevant to primary care were selected. Results: Of 753 articles screened, 108 were critically assessed for compliance with study inclusion and exclusion criteria. Thirty of these studies were ultimately selected for this review, including 7 in which the relationship between multimorbidity or comorbidity and QOL or HRQOL was the main outcome measure. Major limitations of these studies include the lack of a uniform definition for multimorbidity or comorbidity and the absence of assessment of disease severity. The use of self-reported diagnoses may also be a weakness. The frequent exclusion of psychiatric diagnoses and presence of potential confounding variables are other limitations. Nonetheless, we did find an inverse relationship between the number of medical conditions and QOL related to physical domains. For social and psychological dimensions of QOL, some studies reveal a similar inverse relationship in patients with 4 or more diagnoses. Conclusions: Our findings confirm the existence of an inverse relationship between multimorbidity or comorbidy and QOL. However, additional studies are needed to clarify this relationship, including the various dimensions of QOL affected. Those studies must employ a clear definition of multimorbidity or comorbidity and valid ways to measure these concepts in a primary care setting. Pursuit of this research will help to better understand the impact of chronic diseases on patients. © 2004 Fortin et al; licensee BioMed Central Ltd.
引用
收藏
页数：12
相关论文
共 71 条
  • [1] Wu S.Y., Green A., Projection of chronic illness prevalence and cost inflation, (2000)
  • [2] Daveluy C., Pica L., Audet N., Courtemanche R., Lapointe F., Enquête Sociale Et De Santé, (2000)
  • [3] Fortin M., Bravo G., Hudon C., Vanasse A., Lapointe L., Prévalence de la multimorbidité en médecine de première ligne, (2003)
  • [4] Akker vd M., Buntinx F., Metsemakers J.F., Roos S., Knottnerus J.A., Multimorbidity in general practice: Prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases, J. Clin. Epidemiol., 51, pp. 367-375, (1998)
  • [5] Knottnerus J.A., Metsemakers J.F.M., Hoppener O., Limonard C.B.G., Chronic illness in the community and the concept of "social prevalence, Fam. Pract., 9, pp. 5-21, (1992)
  • [6] Schellevis F.G., Velden J., Lisdonk E., Eijk J.Th.M., Weel C., Comorbidity of chronic diseases in general practice, J. Clin. Epidemiol., 46, pp. 469-473, (1993)
  • [7] Metsemakers J.F.M., Hoppener O., Knottnerus J.A., Kocken R.J.J., Limonard C.B.G., Computerized health information in the Netherlands: A registration network of family practices, Br. J. Gen. Pract., 42, pp. 102-106, (1992)
  • [8] Wolff J.L., Starfield B., Anderson G., Prevalence, expenditures, and complications of multiple chronic conditions in elderly, Arch. Intern. Med., 162, pp. 2269-2276, (2002)
  • [9] Hoffman C., Rice D., Sung H.Y., Persons with chronic conditions: Their prevalence and costs, JAMA, 276, pp. 1473-1479, (1996)
  • [10] Feinstein A.R., The pre-therapeutic classification of co-morbidity in chronic disease, J. Chron. Dis., 23, pp. 455-469, (1970)
12345678