Implications of comorbidity for primary care costs in the UK: a retrospective observational study. Brilleman, S. L., Purdy, S., Salisbury, C., Windmeijer, F., Gravelle, H., & Hollinghurst, S. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 63(609):e274--282, April, 2013. doi abstract bibtex BACKGROUND: Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear. AIM: To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each. DESIGN: Retrospective observational study using data on 86 100 patients in the General Practice Research Database. METHOD: Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately. RESULTS: Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, particularly when co-occurring with other cardiovascular conditions. CONCLUSION: Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.
@article{brilleman_implications_2013,
title = {Implications of comorbidity for primary care costs in the {UK}: a retrospective observational study},
volume = {63},
issn = {1478-5242},
shorttitle = {Implications of comorbidity for primary care costs in the {UK}},
doi = {10.3399/bjgp13X665242},
abstract = {BACKGROUND: Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear.
AIM: To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each.
DESIGN: Retrospective observational study using data on 86 100 patients in the General Practice Research Database.
METHOD: Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately.
RESULTS: Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, particularly when co-occurring with other cardiovascular conditions.
CONCLUSION: Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.},
language = {eng},
number = {609},
journal = {The British Journal of General Practice: The Journal of the Royal College of General Practitioners},
author = {Brilleman, Samuel L. and Purdy, Sarah and Salisbury, Chris and Windmeijer, Frank and Gravelle, Hugh and Hollinghurst, Sandra},
month = apr,
year = {2013},
pmid = {23540484},
pmcid = {PMC3609475},
keywords = {Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Comorbidity, Cost of Illness, Cost-Benefit Analysis, Female, Great Britain, Health Expenditures, Humans, Hypertension, Male, Middle Aged, Prevalence, Primary Health Care, Retrospective Studies, depression},
pages = {e274--282}
}
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AIM: To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each. DESIGN: Retrospective observational study using data on 86 100 patients in the General Practice Research Database. METHOD: Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately. RESULTS: Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, particularly when co-occurring with other cardiovascular conditions. CONCLUSION: Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.","language":"eng","number":"609","journal":"The British Journal of General Practice: The Journal of the Royal College of General Practitioners","author":[{"propositions":[],"lastnames":["Brilleman"],"firstnames":["Samuel","L."],"suffixes":[]},{"propositions":[],"lastnames":["Purdy"],"firstnames":["Sarah"],"suffixes":[]},{"propositions":[],"lastnames":["Salisbury"],"firstnames":["Chris"],"suffixes":[]},{"propositions":[],"lastnames":["Windmeijer"],"firstnames":["Frank"],"suffixes":[]},{"propositions":[],"lastnames":["Gravelle"],"firstnames":["Hugh"],"suffixes":[]},{"propositions":[],"lastnames":["Hollinghurst"],"firstnames":["Sandra"],"suffixes":[]}],"month":"April","year":"2013","pmid":"23540484","pmcid":"PMC3609475","keywords":"Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Comorbidity, Cost of Illness, Cost-Benefit Analysis, Female, Great Britain, Health Expenditures, Humans, Hypertension, Male, Middle Aged, Prevalence, Primary Health Care, Retrospective Studies, depression","pages":"e274--282","bibtex":"@article{brilleman_implications_2013,\n\ttitle = {Implications of comorbidity for primary care costs in the {UK}: a retrospective observational study},\n\tvolume = {63},\n\tissn = {1478-5242},\n\tshorttitle = {Implications of comorbidity for primary care costs in the {UK}},\n\tdoi = {10.3399/bjgp13X665242},\n\tabstract = {BACKGROUND: Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear.\nAIM: To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each.\nDESIGN: Retrospective observational study using data on 86 100 patients in the General Practice Research Database.\nMETHOD: Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately.\nRESULTS: Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, particularly when co-occurring with other cardiovascular conditions.\nCONCLUSION: Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.},\n\tlanguage = {eng},\n\tnumber = {609},\n\tjournal = {The British Journal of General Practice: The Journal of the Royal College of General Practitioners},\n\tauthor = {Brilleman, Samuel L. and Purdy, Sarah and Salisbury, Chris and Windmeijer, Frank and Gravelle, Hugh and Hollinghurst, Sandra},\n\tmonth = apr,\n\tyear = {2013},\n\tpmid = {23540484},\n\tpmcid = {PMC3609475},\n\tkeywords = {Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Comorbidity, Cost of Illness, Cost-Benefit Analysis, Female, Great Britain, Health Expenditures, Humans, Hypertension, Male, Middle Aged, Prevalence, Primary Health Care, Retrospective Studies, depression},\n\tpages = {e274--282}\n}\n\n","author_short":["Brilleman, S. 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