Key result
Extreme age linked to significantly lower guideline-directed chronic disease care versus ages 65–74.
Why the study?
Chronic diseases are the leading cause of death and disability worldwide, prompting evaluation of how primary health care services perform across different age groups in managing diabetes, CHF, and CHD.
Does patient age group affect compliance with evidence-based primary care disease management indicators in patients with coronary heart disease, congestive heart failure, or diabetes?
Cohort (n=1,948,622)
Yes
Does patient age group affect compliance with evidence-based primary care disease management indicators in patients with coronary heart disease, congestive heart failure, or diabetes?
Answers are grounded in this paper and cite their sources.
Primary care adherence to evidence-based chronic disease guidelines for CHD, CHF, and diabetes follows an inverted U-shaped curve across age groups, highlighting significant care gaps in young adults and the very elderly that require more proactive care models.
BACKGROUND: Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group. METHODS: This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. RESULTS: The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds), adults (45-64), and oldest old (+85) than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y), adults (45-64 y), the very old (75-84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. CONCLUSION: Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.
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Buja et al. (2014) conducted a cohort in Diabetes, congestive heart failure (CHF), and coronary heart disease (CHD) (n=1,948,622). Extreme age groups (16-44, 45-64, 75-84, and ≥85 years) vs. Patients aged 65-74 years (reference group) was evaluated on Compliance with evidence-based disease management process indicators (e.g., ACE-inhibitor therapy in CHD patients) (p=<0.001). Extreme age groups (16-44 and >=85 years) had significantly lower adherence to evidence-based chronic disease management for CHD, CHF, and diabetes compared to 65-74 year-olds (p<0.001).
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