Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal Research

Comorbidity: Implications for the Importance of Primary Care in ‘Case’ Management

Barbara Starfield, Klaus W. Lemke, Terence Bernhardt, Steven S. Foldes, Christopher B. Forrest and Jonathan P. Weiner
The Annals of Family Medicine May 2003, 1 (1) 8-14; DOI: https://doi.org/10.1370/afm.1
Barbara Starfield
MD, MPH, FRCGP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Klaus W. Lemke
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Terence Bernhardt
BA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Steven S. Foldes
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Christopher B. Forrest
MD, PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jonathan P. Weiner
DrPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Figure 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1.

    Visits to Generalist and Specialist Physicians for Adults with Hypertension

  • Figure 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2.

    Visits to Generalist and Specialist Physicians for Children with Diabetes

Tables

  • Figures
    • View popup
    Table 1.

    Percent Distribution of Comorbidity Groups within Age Groups

    Age GroupNo ComorbidityLow ComorbidityMedium ComorbidityHigh ComorbidityAll
    Adults20.654.315.110.0100.0
    Children17.065.713.93.4100.0
    Total19.657.614.88.0100.0
    • View popup
    Table 2.

    Distribution of Comorbidity Groups within Selected Disease Categories with Health Services Resource Ratios

    Percent Distribution of Comorbidity GroupsHealth Services Resources Ratio by Comorbidity Group
    ConditionPrevalence per 1000LowMediumHighLowMediumHighAll Groups
    Unless otherwise indicated, treated prevalence is for adult conditions. Comorbidity groups are groupings of the Adjusted Clinical Groups. The health services resources ratio compares the expected healthcare resource use for an average patient in the group and the average patient with comorbidity. The ratio for the entire population of adult and pediatric users is 1.0.
    Hypertension64.447.423.129.60.551.785.562.32
    Lipoid metabolism disorder42.345.824.130.20.571.765.142.23
    Asthma, pediatric31.841.734.523.80.410.933.431.31
    Diabetes, adult23.040.426.433.20.622.227.133.21
    Asthma, adult18.832.930.037.00.611.444.922.46
    Ischemic heart disease13.023.626.949.50.693.089.155.52
    Thrombophlebitis2.921.826.451.70.661.887.954.75
    Congestive heart failure2.014.921.563.60.683.1212.969.01
    Multiple sclerosis2.034.628.237.20.672.707.483.78
    Diabetes, pediatric1.942.535.022.50.461.646.542.24
    Chronic liver disease1.318.121.860.10.683.0310.447.06
    • View popup
    Table 3.

    Mean Numbers of Visits with Generalist and Specialist Physicians for Index Condition and for Other Conditions by Comorbidity Group

    Number of Visits for Index Condition (Primary Care / Specialist)Number of Visits for Other Conditions (Primary Care / Specialist)
    Comorbidity GroupComorbidity Group
    ConditionLowMediumHighLowMediumHigh
    Unless otherwise indicated, prevalences are for adults. Comorbidity Groups are an aggregation of the Adjusted Clinical Groups (ACGs).
    a. Fewer than 30 cases in category.
    * P < .05 for comparing mean number of primary care physician visits with mean number of specialist visits.
    ** P < .01
    *** P < .001
    Hypertension1.38/0.12***1.38/0.17***1.25/0.20***1.07/0.61***2.51/2.11***4.79/4.31***
    Lipoid metabolism disorders1.03/0.15***1.01/0.19***0.86/0.18***1.19/0.59***2.62/1.83***4.78/3.87***
    Asthma, children1.05/0.26***1.16/0.28***1.05/0.54***2.29/0.57***4.67/1.35***8.19/3.25***
    Diabetes, adults1.50/0.66***1.62/0.90***1.84/1.32***1.14/0.64***2.31/1.70***4.52/4.43
    Asthma, adults0.91/0.59***0.83/0.64*0.94/1.031.56/0.80***3.73/2.09***6.42/4.78***
    Ischemic heart disease0.96/0.40***0.87/0.59***0.96/0.70***1.30/0.66***2.54/1.62***5.00/3.92***
    Thrombophlebitis1.01/0.17***1.11/0.21***1.26/0.28***1.25/0.69**2.67/1.91*5.24/5.24
    Congestive heart failure0.93/0.491.17/0.49*0.96/0.44**2.44/1.29*3.74/1.72***6.75/6.90
    Multiple sclerosis0.89/1.51**0.54/1.73***0.99/2.19***1.00/0.59**2.49/2.274.27/4.29
    Diabetes, children0.80/1.92**0.74/2.57***1.85/2.63a1.71/0.45***3.07/0.81***4.26/1.33***a
    Chronic liver disease0.71/0.830.33/0.860.68/0.511.29/0.972.83/2.245.51/5.08
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 1 (1)
The Annals of Family Medicine: 1 (1)
Vol. 1, Issue 1
1 May 2003
  • Table of Contents
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Comorbidity: Implications for the Importance of Primary Care in ‘Case’ Management
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
6 + 5 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Comorbidity: Implications for the Importance of Primary Care in ‘Case’ Management
Barbara Starfield, Klaus W. Lemke, Terence Bernhardt, Steven S. Foldes, Christopher B. Forrest, Jonathan P. Weiner
The Annals of Family Medicine May 2003, 1 (1) 8-14; DOI: 10.1370/afm.1

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Comorbidity: Implications for the Importance of Primary Care in ‘Case’ Management
Barbara Starfield, Klaus W. Lemke, Terence Bernhardt, Steven S. Foldes, Christopher B. Forrest, Jonathan P. Weiner
The Annals of Family Medicine May 2003, 1 (1) 8-14; DOI: 10.1370/afm.1
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Clinical practice guidelines for cardiovascular disease: how is depression addressed? Protocol for a systematic review
  • The value of family medicine: An impossible job, done impossibly well
  • Changing Reasons for Visiting Primary Care Over a 35-Year Period
  • Older persons experience with health care at two primary level clinics in Cape Town, South Africa: a qualitative assessment
  • Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine
  • What are the most common conditions in primary care?: Systematic review
  • Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study
  • Socioeconomic status and geographical factors associated with active listing in primary care: a cross-sectional population study accounting for multimorbidity, age, sex and primary care
  • Should primary care guidelines be written by family physicians?: YES
  • Les lignes directrices en soins primaires devraient-elles etre redigees par des medecins de famille?: OUI
  • Physician Enabling Skills Questionnaire: Validation d'un outil recemment developpe en contexte de soins primaires
  • Physicians' perceptions of capacity building for managing chronic disease in seniors using integrated interprofessional care models
  • Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well?
  • Redesigning the general practice consultation to improve care for patients with multimorbidity
  • GPs' considerations in multimorbidity management: a qualitative study
  • Adaptive capacity of the Adjusted Clinical Groups Case-Mix System to the cost of primary healthcare in Catalonia (Spain): a observational study
  • Treatment Adjustment and Medication Adherence for Complex Patients With Diabetes, Heart Disease, and Depression: A Randomized Controlled Trial
  • Holding relationships in general practice: What are they? How do they work? Are they worth having?
  • Barbara Starfield: Passage of the Pathfinder of Primary Care
  • Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study
  • Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study
  • Burden of comorbidity in individuals with asthma
  • Learning and Caring in Communities of Practice: Using Relationships and Collective Learning to Improve Primary Care for Patients with Multimorbidity
  • A Science of Connectedness
  • Quality in primary health care: a multidimensional approach to complexity
  • Confronting The Growing Burden Of Chronic Disease: Can The U.S. Health Care Workforce Do The Job?
  • The Medical Home: Growing Evidence to Support a New Approach to Primary Care
  • The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office
  • Specialty Referral Completion Among Primary Care Patients: Results From the ASPN Referral Study
  • Chronic diseases: what happens when they come in multiples?
  • The impact of comorbid chronic conditions on diabetes care.
  • Threads and Yarns: Weaving the Tapestry of Comorbidity
  • Medical generalists: connecting the map and the territory
  • Co-morbidity in general practice
  • Comorbidity and the Use of Primary Care and Specialist Care in the Elderly
  • Is There Time for Management of Patients With Chronic Diseases in Primary Care?
  • Liability Implications of Physician-Directed Care Coordination
  • How Many Problems Do Family Physicians Manage at Each Encounter? A WReN Study
  • The Future of Family Medicine: A Collaborative Project of the Family Medicine Community
  • The First 20 Days
  • Welcome to the Annals of Family Medicine
  • Chronic Illness, Comorbidities, and the Need for Medical Generalism
  • Google Scholar

More in this TOC Section

  • Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients
  • Shared Decision Making Among Racially and/or Ethnically Diverse Populations in Primary Care: A Scoping Review of Barriers and Facilitators
  • Convenience or Continuity: When Are Patients Willing to Wait to See Their Own Doctor?
Show more Original Research

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
  • Person groups:
    • Children's health
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health policy
    • Health services
    • Professional practice
  • Core values of primary care:
    • Access
    • Continuity
    • Comprehensiveness
    • Coordination / integration of care
    • Personalized care
  • Other topics:
    • Multimorbidity

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine