Continuity of care and multimorbidity in the 50+ Swiss population: An analysis of claims data

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State: Public
Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_AF0972C7210C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Continuity of care and multimorbidity in the 50+ Swiss population: An analysis of claims data
Journal
SSM - Population Health
Author(s)
Nicolet A., Peytremann-Bridevaux I., Bagnoud C., Perraudin C., Wagner J., Marti J.
ISSN
2352-8273 (Print)
ISSN-L
2352-8273
Publication state
Published
Issued date
03/2022
Peer-reviewed
Oui
Volume
17
Pages
101063
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
To assess the relationship between continuity of care (COC) and multimorbidity in the older general population in Switzerland, accounting for relevant determinants of COC, and to apply various expressions of multimorbidity derived from claims data.
We used data on 240'000 insured individuals aged 50+ for the period 2015-2018, received from one of the largest Swiss health insurance company. We calculated Bice-Boxerman index based on all doctor visits (overall COC) and visits to the general practitioners (COC GP). We analyzed the relationship between COC and multimorbidity using generalized linear and probit models. To express multimorbidity, we applied three approaches based on pharmacy-cost groups (PCGs) assigned to an individual. First, we used simple PCG counts. Second, we expressed multimorbidity via clinically relevant disease groups derived from PCGs. Finally, a data-driven approach allowed defining distinct clusters representing different patient complexities.
The association between overall COC and multimorbidity expressed in PCG counts was modest: COC among individuals with 3+ PCGs was 2 percentage points higher than COC among individuals with 0 PCGs. The approach of clinically relevant disease groups showed larger variation in COC and its association with multimorbidity. The data-driven approach showed that most complex ("high-cost high-need") individuals tended to have higher overall COC. Additionally, 70% of the sample visited exclusively one general practitioner (COC GP = 1.0). Other important factors associated with COC in the Swiss context were insurance model with gatekeeping, level of deductibles, and region of residence.
Multimorbid patients require regular medical attention often involving multiple healthcare providers, which can lead to varying COC, depending on types of doctors seen and specific condition of the patient. Insurance models with gatekeeping may facilitate COC, prompting developments of better-designed models of care. This represents important implications for policymakers, health insurance representatives, medical professionals and hospital managers.
Keywords
Public Health, Environmental and Occupational Health, Health Policy, Health (social science)
Pubmed
Open Access
Yes
Funding(s)
Swiss National Science Foundation / 407440_183447
Create date
16/03/2022 16:47
Last modification date
19/05/2022 7:12
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