Braakman, A. (Anne) (2017) Welke kenmerken van de huisartspraktijk zijn gerelateerd aan het verhoogde risico op multimorbiditeit en polyfarmacieonder depressieve ouderen? thesis, Medicine.
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Abstract
Introduction A depressive disorder is a common problem among elderly patients and is often treated by the general practitioner. In a previous study of this research line it was found that a depression or any other psychological disorder in elderly patients was associated with an increased number of chronic diseases and an increase in the number of chronically used medicines. This resulted in higher rates of multimorbidity, polypharmacy and a higher Drug Burden Index (DBI), which means a higher exposure to medicines with anticholinergic and sedative properties. Furthermore, it was found in multilevel analyses that a significant part of the variance in these measures could be explained by the practice level. Because multimorbidity and polypharmacy lead to reduced quality of life, complexity of therapy and poor medication adherence, it is important to investigate which characteristics of the practices are responsible for the variance found. The aim of this study is to determine whether the practice characteristics urbanization, region, presence of a ‘POH-GGZ’, presence of a ‘POH-somatiek’ and practice structure are related to the higher risk of multimorbidity and polypharmacy in elderly with a depression or other psychological disorder. Method This cross-sectional study was performed using primary care data for 2012. These came from a database that combines morbidity and GP-care data from NIVEL Primary Care Database with pharmacy dispensing data from the Foundation of Pharmaceutical Statistics (SFK) and socio-demographic data from Statistics Netherlands (CBS). From this database, depressive elderly (≥60 years) were matched on age and gender with a control group including patients with a psychological disorder not being depression, and with a mentally healthy control group. Multivariate, multilevel regression analyses were performed for the number of chronic diseases, multimorbidity, the number of chronically used medicines, polypharmacy and the DBI. In all analyses the influence of the practice characteristics was examined on level 2. Afterwards, a likelihood ratio test was done to compare the multilevel model from this study with the same multilevel model without specification of the practice characteristics. Results The multilevel model for multimorbidity was significantly improved after the specification of the practice characteristics: patients from practices located in a rural village or commuter town had higher odds ratios (1.69 and 1.48 respectively) for multimorbidity than patients from practices located in a big city. Patients from practices located in the Dutch region ‘west’ had a lower odds ratio (0.50) for multimorbidity than patients from practices located in region ‘north’. The multilevel models for all other measures did not significantly differ from the models without specification of the practice characteristics. Conclusion The practice characteristics urbanization and region are partly responsible for the practice variation in the higher odds of depressed elderly on multimorbidity. The practice variation in the number of chronic diseases, the number of chronically used medicines, polypharmacy and the DBI cannot be explained by the characteristics in this study. In order to give specific advice to general practitioners on improving healthcare for depressed elderly, future research should investigate other GP or practice characteristics.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleiders: and Verhaak, Prof. Dr. P.F.M. and Holvast, Drs. F. and Afdeling huisartsgeneeskunde and Universitair Medisch Centrum Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/279 |
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