Determinants associated with deprivation in multimorbid patients in primary care-A cross-sectional study in Switzerland

Deprivation usually encompasses material, social, and health components. It has been shown to be associated with greater risks of developing chronic health conditions and of worse outcome in multimorbidity. The DipCare questionnaire, an instrument developed and validated in Switzerland for use in primary care, identifies patients subject to potentially higher levels of deprivation. To identifying determinants of the material, social, and health profiles associated with deprivation in a sample of multimorbid, primary care patients, and thus set priorities in screening for deprivation in this population. Secondary analysis from a nationwide cross-sectional study in Switzerland. A random sample of 886 adult patients suffering from at least three chronic health conditions. The outcomes of interest were the patients' levels of deprivation as measured using the DipCare questionnaire. Classification And Regression Tree analysis identified the independent variables that separated the examined population into groups with increasing deprivation scores. Finally, a sensitivity analysis (multivariate regression) confirmed the robustness of our results. Being aged under 64 years old was associated with higher overall, material, and health deprivation; being aged over 77 years old was associated with higher social deprivation. Other variables associated with deprivation were the level of education, marital status, and the presence of depression or chronic pain. Specific profiles, such as being younger, were associated with higher levels of overall, material, and health deprivation in multimorbid patients. In contrast, patients over 77 years old reported higher levels of social deprivation. Furthermore, chronic pain and depression added to the score for health deprivation. It is important that GPs consider the possibility of deprivation in these multimorbid patients and are able to identify it, both in order to encourage treatment adherence and limit any forgoing of care for financial reasons

Proportion of primary care physicians delivering the twelve recommended measures of preventive care, stratified by country.

<p>Proportion of primary care physicians delivering the twelve recommended measures of preventive care, stratified by country.</p

Primary care physicians’ characteristics in the two countries (n = 518).

<p>Primary care physicians’ characteristics in the two countries (n = 518).</p

Proportion of primary care physicians delivering the twelve recommended measures of preventive care, stratified by gender and age group.

<p>Proportion of primary care physicians delivering the twelve recommended measures of preventive care, stratified by gender and age group.</p

Univariate subgroup comparisons in the sample of multimorbid patients.

<p>N = 888.</p

Observed and predicted mean health utility and VAS, and the differences between them in 888 multimorbid patients.

<p>Observed and predicted mean health utility and VAS, and the differences between them in 888 multimorbid patients.</p

Distributions of the EQ-5D-3L (EQ-5D items and visual analog scale) among multimorbid patients.

<p>N = 888.</p

Number of recommended measures of preventive care provided by primary care physicians, according to socio-demographic characteristics of the responders.

<p>Number of recommended measures of preventive care provided by primary care physicians, according to socio-demographic characteristics of the responders.</p

Most frequently reported EQ-5D health states and distributions of corresponding mean HU and mean VAS values among a sample of multimorbid patients.

<p>N = 888.</p

Association between GP characteristics and overall confidence across different EOLC competencies.

<p>Association between GP characteristics and overall confidence across different EOLC competencies.</p