Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required

Autor: Alessandra Buja, Gianfranco Damiani, Rosa Gini, Modesta Visca, Bruno Federico, Daniele Donato, Paolo Francesconi, Alessandro Marini, Andrea Donatini, Salvatore Brugaletta, Vincenzo Baldo, Maria Donata Bellentani, Valore Project
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Male
Pediatrics
Non-Clinical Medicine
Epidemiology
Coronary Disease
chronic diseases
Medical Sociology
Health care
Odds Ratio
Quality of Care
Medicine
Young adult
Disease management (health)
Cause of death
disparities
Aged
80 and over
education.field_of_study
Multidisciplinary
Chronic Disease Management
Age Factors
health care research
Disease Management
Middle Aged
Socioeconomic Aspects of Health
Population Surveillance
primary care
Female
Public Health
Research Article
Adult
medicine.medical_specialty
Adolescent
Clinical Research Design
Science
Population
Young Adult
Diabetes management
Diabetes Mellitus
Humans
Health Care Quality
education
Settore MED/42 - IGIENE GENERALE E APPLICATA
Primary Care
Aged
Quality Indicators
Health Care
Retrospective Studies
Lifecourse Epidemiology
Health Care Policy
Primary Health Care
business.industry
Retrospective cohort study
Odds ratio
Chronic Disease
business
Delivery of Health Care
Zdroj: PLoS ONE, Vol 9, Iss 3, p e91340 (2014)
PLoS ONE
Popis: BackgroundOur 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.MethodsThis 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.ResultsThe 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.ConclusionOur 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.
Databáze: OpenAIRE
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