Primary care utilisation, adherence to guideline-based pharmacotherapy and continuity and in primary care patients with chronic diseases and comorbidities. A registry study

Background: To determine the prevalence of common chronic diseases and comorbidities in a in whole primary care population and to analyse the associations between primary care utilisation, adherence to guideline-based pharmacotherapy and continuity of care. Methods: Retrospective statistical analysis of routine care data of the whole population of the Swedish county of Jönköping (345 916 inhabitants using primary care services) covering 4.3 years. Participants: 25 829 patients fulfilling the inclusion criteria of ≥1 of 10 common chronic conditions and ≥3 visits to primary care between 2011 and 2015. Primary outcome measures: In order to determine diseases and comorbidity, primary care utilisation, adherence to guideline-based pharmacotherapy, frequencies and percentages, interval and ratio scaled variables were described using means, standard deviations, and various percentiles in the population. Two continuity indices were used (MMCI, COC) to describe continuity. Results: The number of diseases increased with increasing age, and multimorbidity was much more common than single diseases (mean 2.0 per patient). There was a slight positive correlation (0.29) between number of diseases and visits, but visits did not increase proportionally to the number of diseases. Patients with physical conditions combined with anxiety and/or depression made more visits than others. The number of diseases per patient was negatively associated with the adherence to pharmacotherapy guidelines. There was no association between continuity and healthcare utilisation or adherence to pharmacotherapy guidelines. Conclusions: Multimorbid patients are common in primary care and receive efficient services concerning healthcare utilisation. Adherence to pharmacotherapy guidelines is a questionable measure for aged multimorbid patients and existing continuity indices revealed limitations. Holistic and patient-centered measures should be used for quality assessment of care for multimorbid patients in primary care.