The Article in Brief

Background: This study examined the relationships between comorbidity (having more than 1 medical condition at the same time) and use of medical services in patients aged 65 years and older. Specifically, the study looked at how often these patients visit primary care doctors and specialists.
What This Study Found: Patients with more medical conditions have more visits to specialists. However, patients with any level of comorbidity have a high number of specialist visits, including visits for conditions that might normally be handled by the primary care doctor. The number of doctor visits for comorbid conditions is much higher than the number of visits for any individual condition in individual patients. Primary care doctors diagnose about one third of conditions in patients’ with comorbidity.
Implications:
* It is important to consider comorbidity in the care of elderly patients.
* The high number of visits to specialists, including for situations that might be better handled by a primary care physician, could contribute to higher medical costs without improving the health of elderly patients. Policy makers and health care organizations need to reevaluate the roles of specialists.
* Patients with multiple medical conditions might be helped by having a case manager to coordinate their care, rather than a disease manager who focuses on a single condition.
* Primary care doctors have skills to care for patients with multiple conditions, including skills in prioritizing patient needs and managing complex medication effects. Their care of patients with comorbidity is strengthened when they clearly divide responsibilities with specialists and collaborate with other health professionals working in teams.