Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.

<h4>Background</h4>Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was...

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Autores principales:	Alessandra Buja, Gianfranco Damiani, Rosa Gini, Modesta Visca, Bruno Federico, Daniele Donato, Paolo Francesconi, Alessandro Marini, Andrea Donatini, Salvatore Brugaletta, Vincenzo Baldo, Maria Donata Bellentani, Valore Project
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/341697d20ce4451c95f2e2d5bcc722ca
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spelling	oai:doaj.org-article:341697d20ce4451c95f2e2d5bcc722ca2021-11-18T08:28:02ZSystematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.1932-620310.1371/journal.pone.0091340https://doaj.org/article/341697d20ce4451c95f2e2d5bcc722ca2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24632818/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group.<h4>Methods</h4>This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level.<h4>Results</h4>The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds), adults (45-64), and oldest old (+85) than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y), adults (45-64 y), the very old (75-84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old.<h4>Conclusion</h4>Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.Alessandra BujaGianfranco DamianiRosa GiniModesta ViscaBruno FedericoDaniele DonatoPaolo FrancesconiAlessandro MariniAndrea DonatiniSalvatore BrugalettaVincenzo BaldoMaria Donata BellentaniValore ProjectPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e91340 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Alessandra Buja Gianfranco Damiani Rosa Gini Modesta Visca Bruno Federico Daniele Donato Paolo Francesconi Alessandro Marini Andrea Donatini Salvatore Brugaletta Vincenzo Baldo Maria Donata Bellentani Valore Project Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
description	<h4>Background</h4>Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF) and coronary heart disease (CHD), by age group.<h4>Methods</h4>This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level.<h4>Results</h4>The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds), adults (45-64), and oldest old (+85) than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y), adults (45-64 y), the very old (75-84 y) and the oldest old (+85 y) patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old.<h4>Conclusion</h4>Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.
format	article
author	Alessandra Buja Gianfranco Damiani Rosa Gini Modesta Visca Bruno Federico Daniele Donato Paolo Francesconi Alessandro Marini Andrea Donatini Salvatore Brugaletta Vincenzo Baldo Maria Donata Bellentani Valore Project
author_facet	Alessandra Buja Gianfranco Damiani Rosa Gini Modesta Visca Bruno Federico Daniele Donato Paolo Francesconi Alessandro Marini Andrea Donatini Salvatore Brugaletta Vincenzo Baldo Maria Donata Bellentani Valore Project
author_sort	Alessandra Buja
title	Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
title_short	Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
title_full	Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
title_fullStr	Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
title_full_unstemmed	Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
title_sort	systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/341697d20ce4451c95f2e2d5bcc722ca
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Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.

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