期刊
DIABETES RESEARCH AND CLINICAL PRACTICE
卷 122, 期 -, 页码 113-123出版社
ELSEVIER IRELAND LTD
DOI: 10.1016/j.diabres.2016.10.009
关键词
Diabetes; Community-living older adults; Health service utilization; Health service costs; Comorbidity; Multimorbidity
资金
- Canadian Institutes of Health Research Signature Initiative in Community-Based Primary Healthcare [TTF 128261]
- Ontario Ministry of Health and Long-Term Care Health (MOHLTC) System Research Fund Program [06669]
- Institute for Clinical Evaluative Sciences (ICES)
- Ontario MOHLTC
- CIHR New Investigators Awards
- Canada Research Chair program
Aims: This study describes the comorbid conditions in Canadian, community-dwelling older adults with diabetes and the association between the number of comorbidities and health service use and costs. Methods: This retrospective cohort study used multiple linked administrative data to determine 5-year health service utilization in a population-based cohort of community-living individuals aged 66 and over with a diabetes diagnosis as of April 1, 2008 (baseline). Utilization included physician visits, emergency department visits, hospitalizations, and home care services. Results: There were 376,421 cohort members at baseline, almost all (95%) of which had at least one comorbidity and half (46%) had 3 or more. The most common comorbidities were hypertension (83%) and arthritis (61%). Service use and associated costs consistently increased as the number of comorbidities increased across all services and follow-up years. Conditions generally regarded as nondiabetes-related were the main driver of service use. Over time, use of most services declined for people with the highest level of comorbidity (3+). Hospitalizations and emergency department visits represented the largest share of costs for those with the highest level of comorbidity (3+), whereas physician visits were the main costs for those with fewer comorbidities. Conclusions: Comorbidities in community-living older adults with diabetes are common and associated with a high level of health service use and costs. Accordingly, it is important to use a multiple chronic conditions (not single-disease) framework to develop coordinated, comprehensive and patient-centred programs for older adults with diabetes so that all their needs are incorporated into care planning. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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