Entete 3

Multimorbidity in two large Australian primary care practices



By Tom Brett

The Annals of Family Medicine recently published our research on multimorbidity among 7,247 patients attending two large Australian primary care practices (1). Our study set out to examine patterns and prevalence of multimorbidity and to estimate disease severity burden using the Cumulative Illness Rating Scale (CIRS).
We adhered strictly to Miller et al’s approach (2,3) in assessing number of body domains affected, the total score, the ratio of total score to number of domains (yielding a severity index), and importantly, the number of domains with maximum scores at levels 3 and 4. Highlighting the number of domains with severity scores of 3 and 4 is important as it helps guard against severity underestimation especially if there is a risk of severity index dilution with increased numbers of level 1 and 2 scores.
Our purposefully collected data, using combination of free-text electronic records, older hard copy files based on histories recorded by primary care physician, hospital discharge and outpatient letters and radiology and pathology reports, was extremely hard work and not for the fainted hearted! We feel our purposefully collected, multisource medical record data, based on 42 conditions across 14 domains and involving patients across the entire age spectrum provides further useful information for those interested in multimorbidity in primary care.
Our current research interest in the area involves patterns and prevalence of multimorbidity and disease severity burden involving disadvantaged and street-based populations.

1.    Brett T, Arnold-Reed DE, Popescu A, et al. Multimorbidity in patients attending 2 Australian primary care practices. Ann Fam Med 2013; 11(6): 535-542.
2.    Miller MD, Towers A. A manual of guidelines for scoring the Cumulative Illness Rating Scale for geriatrics (CIRS-G). Pittsburg, PA: University of Pittsburgh, 1991.
3.    Miller MD, Paradis CF, Houch PR, et al. Rating chronic illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992; 41 (3): 237-248.

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