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Relationship Between Multimorbidity and Health-Related Quality of Life of Patients in Primary Care

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Abstract

Previous studies about the association of multimorbidity and the health-related quality of life (HRQOL) in primary-care patients are limited because of their reliance on simple counts of diseases from a limited list of diseases and their failure to assess the severity of disease. We evaluated the association while taking into account the severity of the medical conditions based on the Cumulative Illness Rating Scale (CIRS) score, and controlling for potential confounders (age, sex, household income, education, self-perception of economic status, number of people living in the same dwelling, and perceived social support). We randomly selected 238 patients to construct quintiles of increasing multimorbidity (CIRS). Patients completed the 36-item Medical Outcomes study questionnaire (SF-36) to evaluate their HRQOL. Applying bivariate and multivariate linear regression analyses, we used the CIRS as either a continuous or a categorical (quintiles) variable. Use of the CIRS revealed a stronger association of HRQOL with multimorbidity than using a simple count of chronic conditions. Physical more than mental health deteriorated with increasing multimorbidity. Perceived social support and self-perception of economic status were significantly related to all scales of the SF-36 (p < 0.05). Increased multimorbidity adversely affected HRQOL in primary-care adult patients, even when confounding variables were controlled for.

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Abbreviations

BP:

Bodily pain

CIRS:

Cumulative Illness Rating Scale

GH:

General health

HRQOL:

Quality of life

HT:

Health transition

MCS:

Mental component summary

MH:

Mental health

PCS:

Physical component summary

PF:

Physical functioning

RE:

Role emotional

RP:

Role physical

SF:

Social functioning

SF-36:

36-item Medical Outcomes Study questionnaire

VT:

Vitality scale

References

  1. C Hoffman D Rice HY Sung (1996) ArticleTitlePersons with chronic conditions. Their prevalence and costs JAMA 276 1473–1479 Occurrence Handle10.1001/jama.276.18.1473 Occurrence Handle1:STN:280:ByiD28%2Fit1c%3D Occurrence Handle8903258

    Article  CAS  PubMed  Google Scholar 

  2. JF Metsemakers P Hoppener JA Knottnerus RJ Kocken CB Limonard (1992) ArticleTitleComputerized health information in The Netherlands: a registration network of family practices Br J Gen Pract 42 102–106 Occurrence Handle1:STN:280:ByyC2M3isVI%3D Occurrence Handle1493025

    CAS  PubMed  Google Scholar 

  3. M Akker Particlevan den F Buntinx JF Metsemakers S Roos JA Knottnerus (1998) ArticleTitleMultimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases J Clin Epidemiol 51 367–375 Occurrence Handle9619963

    PubMed  Google Scholar 

  4. M Fortin G Bravo C Hudon A Vanasse L Lapointe (2005) ArticleTitlePrevalence of multimorbidity among adults seen in family practice Ann Fam Med 3 223–228 Occurrence Handle10.1370/afm.272 Occurrence Handle15928225

    Article  PubMed  Google Scholar 

  5. I McDowell C Newell (1996) Measuring Health. A Guide to Rating Scales and Questionnaires Oxford University Press New York 380–492

    Google Scholar 

  6. VS Fan JR Curtis S Tu MB McDonell SD Fihn (2002) ArticleTitleUsing quality of life to predict hospitalization and mortality in patients with obstructive lung diseases Chest 122 429–436 Occurrence Handle10.1378/chest.122.2.429 Occurrence Handle12171813

    Article  PubMed  Google Scholar 

  7. CJ Howes MC Reid C Brandt B Ruo MW Yerkey B Prasad C Lin P Peduzzi MD Ezekowitz (2001) ArticleTitleExercise tolerance and quality of life in elderly patients with chronic atrial fibrillation J Cardiovasc Pharmacol Ther 6 23–29 Occurrence Handle1:STN:280:DC%2BD3MzpvVWjtQ%3D%3D Occurrence Handle11452333

    CAS  PubMed  Google Scholar 

  8. AJ Schaeffer JR Landis JS Knauss KJ Propert RB Alexander MS Litwin JC Nickel MP O’Leary RB Nadler MA Pontari DA Shoskes SI Zeitlin JE Fowler SuffixJr CA Mazurick L Kishel JW Kusek LM Nyberg (2002) ArticleTitleChronic Prostatitis Collaborative Research Network G. Demographic and clinical characteristics of men with chronic prostatitis: the national institutes of health chronic prostatitis cohort study J Urol 168 593–598 Occurrence Handle12131316

    PubMed  Google Scholar 

  9. J Xuan LJ Kirchdoerfer JG Boyer GJ Norwood (1999) ArticleTitleEffects of comorbidity on health-related quality-of-life scores: an analysis of clinical trial data Clin Ther 21 383–403 Occurrence Handle10.1016/S0149-2918(00)88295-8 Occurrence Handle1:STN:280:DyaK1M3is1GhsA%3D%3D Occurrence Handle10211540

    Article  CAS  PubMed  Google Scholar 

  10. M Fortin L Lapointe C Hudon AL Ntetu D Maltais A Vanasse (2004) ArticleTitleMultimorbidity and quality of life in primary care: a systematic review Health and Quality of life Outcomes 2 51 Occurrence Handle10.1186/1477-7525-2-51 Occurrence Handle15380021

    Article  PubMed  Google Scholar 

  11. L Cheng S Cumber C Dumas R Winter KM Nguyen LZ Nieman (2003) ArticleTitleHealth related quality of life in pregeriatric patients with chronic diseases at urban, public supported clinics Health and Quality of Life Outcomes 1 63 Occurrence Handle10.1186/1477-7525-1-63 Occurrence Handle14613559

    Article  PubMed  Google Scholar 

  12. M Wensing E Vingerhoets R Grol (2001) ArticleTitleFunctional status, health problems, age and comorbidity in primary care patients Qual Life Res 10 141–148 Occurrence Handle10.1023/A:1016705615207 Occurrence Handle1:STN:280:DC%2BD3MrmtF2ltw%3D%3D Occurrence Handle11642684

    Article  CAS  PubMed  Google Scholar 

  13. H Michelson C Bolund Y Brandberg (2000) ArticleTitleMultiple chronic health problems are negatively associated with health related quality of life (HRQoL) irrespective of age Qual Life Res 9 1093–1104 Occurrence Handle10.1023/A:1016654621784 Occurrence Handle1:STN:280:DC%2BD3Mzjtlemtw%3D%3D Occurrence Handle11401042

    Article  CAS  PubMed  Google Scholar 

  14. P Cuijpers P Lammeren Particlevan B Duzijn (1999) ArticleTitleRelation between quality of life and chronic illnesses in elderly living in residential homes: a prospective study Int Psychogeriatr 11 445–454 Occurrence Handle10.1017/S1041610299006067 Occurrence Handle1:STN:280:DC%2BD3c%2FpslWltw%3D%3D Occurrence Handle10631590

    Article  CAS  PubMed  Google Scholar 

  15. A Grimby A Svanborg (1997) ArticleTitleMorbidity and health-related quality of life among ambulant elderly citizens Aging Clin Exp Res 9 356–364 Occurrence Handle1:STN:280:DyaK1c7itVKitQ%3D%3D

    CAS  Google Scholar 

  16. DG Fryback EJ Dasbach R Klein BE Klein N Dorn K Peterson PA Martin (1993) ArticleTitleThe beaver dam health outcomes study: initial catalog of health-state quality factors Med Decis Making 13 89–102 Occurrence Handle1:STN:280:ByyB2cjkslE%3D Occurrence Handle8483408

    CAS  PubMed  Google Scholar 

  17. GI Kempen M Jelicic J Ormel (1997) ArticleTitlePersonality, chronic medical morbidity, and health-related quality of life among older persons Health Psychol 16 539–546 Occurrence Handle10.1037/0278-6133.16.6.539 Occurrence Handle1:STN:280:DyaK1c%2FkvVansg%3D%3D Occurrence Handle9386999

    Article  CAS  PubMed  Google Scholar 

  18. V Groot Particlede H Beckerman GJ Lankhorst LM Bouter (2003) ArticleTitleHow to measure comorbidity. a critical review of available methods J Clin Epidemiol 56 221–229 Occurrence Handle12725876

    PubMed  Google Scholar 

  19. J Ormel M VonKorff B Ustun S Pini A Korten T Oldehinkel (1994) ArticleTitleCommon mental disorders and disability across cultures: results from the WHO collaborative study on psychological problems in general health care JAMA 272 1741–1748 Occurrence Handle10.1001/jama.272.22.1741 Occurrence Handle1:STN:280:ByqD2MnjvFY%3D Occurrence Handle7966922

    Article  CAS  PubMed  Google Scholar 

  20. World Health Organization. Innovative Care for Chronic Conditions. Building blocks for action. Geneva, Switzerland: World Health Organization; 2002 [cited 2004 Dec 28] Available from: http://www.who.int/chronic_conditions/en/icccglobalreport.pdf

  21. BS Linn MW Linn L Gurel (1968) ArticleTitleCumulative illness rating scale J Am Geriatr Soc 16 622–626 Occurrence Handle1:STN:280:CCeB3c7kvFA%3D Occurrence Handle5646906

    CAS  PubMed  Google Scholar 

  22. Miller EA, Towers A. A manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G).: University of Pittsburgh, 1991.

  23. M Harboun J Ankri (2001) ArticleTitle[Comorbidity indexes: review of the literature and application to studies of elderly population][French] Rev Epidemiol Sante Publique 49 287–298 Occurrence Handle1:STN:280:DC%2BD3MvislyltQ%3D%3D Occurrence Handle11427831

    CAS  PubMed  Google Scholar 

  24. C Hudon M Fortin A Vanasse (2005) ArticleTitle Cumulative Illness Rating Scale was a reliable and valid index in a family practice context J Clin Epidemiol 58 603–608 Occurrence Handle10.1016/j.jclinepi.2004.10.017 Occurrence Handle1:STN:280:DC%2BD2M3ktFChsQ%3D%3D Occurrence Handle15878474

    Article  CAS  PubMed  Google Scholar 

  25. JE Ware CD Sherbourne (1992) ArticleTitleThe MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection Med Care 30 473–483 Occurrence Handle1593914

    PubMed  Google Scholar 

  26. Ware JE, Jr. SF-36® Health Survey Update [cited 2004 Dec 28]. Available from: http://www.sf-36.org/tools/sf36.shtml.

  27. SW Dauphinee L Gauthier B Gandek L Magnan U Pierre (1997) ArticleTitleReadying a US measure of health status, the SF-36, for use in Canada Clin Invest Med 20 224–238 Occurrence Handle1:STN:280:ByiH3czitVw%3D Occurrence Handle9258577

    CAS  PubMed  Google Scholar 

  28. CA Cutrona DW Russel (1987) ArticleTitleThe provisions of social support and adaptation to stress Adv Pers Relationships 1 37–67

    Google Scholar 

  29. J Caron (1996) ArticleTitle[The scale of social provisions: their validation in Quebec][French] Santé Mentale au Québec 21 158–180 Occurrence Handle1:STN:280:ByiB3cvns1Q%3D Occurrence Handle9052268

    CAS  PubMed  Google Scholar 

  30. WM Hopman T Towheed T Anastassiades A Tenenhouse S Poliquin C Berger L Joseph JP Brown TM Murray JD Adachi DA Hanley E Papadimitropoulos (2000) ArticleTitleCanadian normative data for the SF-36 health survey Can Mult Osteoporosis Study Res Group. CMAJ 163 265–271 Occurrence Handle1:STN:280:DC%2BD3cvhvVyhsA%3D%3D

    CAS  Google Scholar 

  31. JG Walker HJ Jackson GO Littlejohn (2004) ArticleTitleModels of adjustment to chronic illness: using the example of rheumatoid arthritis Clin Psychol Rev 24 461–488 Occurrence Handle15245831

    PubMed  Google Scholar 

  32. JN Katz MG Larson CB Phillips AH Fossel MH Liang (1992) ArticleTitleComparative measurement sensitivity of short and longer health status instruments Med Care 30 917–925 Occurrence Handle1:STN:280:ByyD383ptlY%3D Occurrence Handle1405797

    CAS  PubMed  Google Scholar 

  33. D Allaire (1988) Questionnaires: mesure verbale du comportament M Robert (Eds) Fondements et étapes de la recherche scientifique en psychologie EditionNumber3 St-Hyacinthe Québec, Edisem 229–275

    Google Scholar 

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Authors and Affiliations

  1. Department of Family Medicine, Sherbrooke University, Sherbrooke, Que, Canada

    Martin Fortin, Catherine Hudon, Lise Lapointe, José Almirall & Alain Vanasse

  2. Department of Community Health Sciences, Sherbrooke University, Sherbrooke, Que, Canada

    Gina Bravo & Marie-France Dubois

  3. Research Center on Aging, Sherbrooke University Geriatric Institute, Sherbrooke, Que, Canada

    Gina Bravo & Marie-France Dubois

Authors
  1. Martin Fortin
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  2. Gina Bravo
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  3. Catherine Hudon
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  4. Lise Lapointe
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  5. José Almirall
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  6. Marie-France Dubois
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  7. Alain Vanasse
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Corresponding author

Correspondence to Martin Fortin.

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Fortin, M., Bravo, G., Hudon, C. et al. Relationship Between Multimorbidity and Health-Related Quality of Life of Patients in Primary Care. Qual Life Res 15, 83–91 (2006). https://doi.org/10.1007/s11136-005-8661-z

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