Chronic diseases in general practice: The longitudinal dimension

Background and aim: care for chronic conditions takes place mainly in general practice. This study analysed chronic morbidity in general practice: incidence, prevalence and co-morbidity of the most common chronic diseases.Setting: the Continuous Morbidity Registration, Department of General Practice and Social Medicine, University of Nijmegen; four general practices, since 1967 on-going.Methods: incidence, prevalence and their trends between 1971 and 1992, and co-morbidity were computed from the standard registration, as rates of numbers per 1,000 patients on the practice list per year.Results: the ten most common chronic diseases were hypertension, obesity, ischaemic heart disease, arthritis hip/knee, asthma/COPD, eczema, diabetes mellitus, hay fever, hyperlipidaemia, psoriasis, with an incidence of 2 - 5/1,000/year, and prevalence between 13 - 54/1,000/year. Between 1971 - 1992 the prevalence, but not the incidence increased. Thirty-eight per cent of patients had more than one of these chronic diseases (co-morbidity).Conclusions: general practitioners frequently diagnose new cases of chronic morbidity, but are more often involved in the follow-up care of patients. There is an upward trend in this respect, and a substantial number of patients have co-morbidity. This will require patient orientated continuity of care.