Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Israel Journal of Health Policy Research
Published in: Israel Journal of Health Policy Research 1/2014

Open Access 01-12-2014 | Original research article

Multiple chronic disorders - health care system’s modern challenge in the Maccabi Health Care System

Authors: Jonathan E Arbelle, Gabriel Chodick, Alex Goldstein, Avi Porath

Published in: Israel Journal of Health Policy Research | Issue 1/2014

Login to get access

Abstract

Background

One of the major challenges health care systems face in modern time is treating chronic disorders. In recent years, the increasing occurrence of multiple chronic disorders (MCC) in single individuals has compounded the complexity of health care. In 2008, it was estimated that worldwide as many as one quarter of the population between the ages of sixty five to sixty nine suffered from two or more chronic conditions and this prevalence rose with age. Clinical guidelines provide guidance for management of single disorders, but not for MCC. The aim of the present study was the study of the prevalence, distribution and impact of MCC in a large Israeli health system.

Methods

We performed a cross-sectional study of MCC in the Maccabi Healthcare System (MHS), Israel’s second largest healthcare service, providing care for approximately two million people. Data regarding chronic conditions was collected through electronic medical records and organizational records, as was demographic and socioeconomic data. Age and sex specific data were compared with previously published data from Scotland.

Results

Two thirds of the population had two or more chronic disorders. This is significantly higher than previously published rates. A correlation between patient age and number of chronic disorders was found, as was a correlation between number of chronic disorders and low socioeconomic status, with the exception of children due to a high prevalence of learning disabilities, asthma, and visual disturbances.

Discussion

MCC is very prevalent in the MHS population, increases with age, and except for children is more prevalent in lower socioeconomic classes, possibly due to the a combination of the structure of the Israeli universal insurance and requirements of the ministry of education for exemptions and benefits. A higher than previously reported prevalence of MCC may be due to the longtime use of use of integrated electronic medical records.

Conclusions

To effectively deal with MCC health care systems must devise strategies, including but not limited to, information technologies that enable shared teamwork based on clinical guidelines which address the problem of multiple, as opposed to single chronic disorders in patients.
Appendix
Available only for authorised users
Literature
1.
The World Health Report 2008 - Primary Health Care (Now More Than Ever). 2008
2.
National Quality Forum: Multiple Chronic Conditions Measurement Framework. National Quality Forum: Multiple Chronic Conditions Measurement Framework. 2012, Washington DC: National Quality Forum
3.
Taylor AW, Price K, Gill TK, Adams R, Pilkington R, Carrangis N, Shi Z, Wilson D: Multimorbidity - not just an older person’s issue. Results from an Australian biomedical study. BMC Public Health. 2010, 10: 718-10.1186/1471-2458-10-718.PubMedCentralCrossRefPubMed
4.
Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA: Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health. 2012, 12: 201-10.1186/1471-2458-12-201.PubMedCentralCrossRefPubMed
5.
Moth G, Vestergaard M, Vedsted P: Chronic care management in Danish general practice–a cross-sectional study of workload and multimorbidity. BMC Fam Pract. 2012, 13: 52-10.1186/1471-2296-13-52.PubMedCentralCrossRefPubMed
6.
Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA: Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. British J Gen Pract: J Royal College of Gen Pract. 2011, 61: e12-e21. 10.3399/bjgp11X548929.CrossRef
7.
Marengoni A, Winblad B, Karp A, Fratiglioni L: Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health. 2008, 98: 1198-1200. 10.2105/AJPH.2007.121137.PubMedCentralCrossRefPubMed
8.
van den Bussche H, Koller D, Kolonko T, Hansen H, Wegscheider K, Glaeske G, von Leitner EC, Schafer I, Schon G: Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health. 2011, 11: 101-10.1186/1471-2458-11-101.PubMedCentralCrossRefPubMed
9.
van Oostrom SH, Picavet HS, van Gelder BM, Lemmens LC, Hoeymans N, van Dijk CE, Verheij RA, Schellevis FG, Baan CA: Multimorbidity and comorbidity in the Dutch population - data from general practices. BMC Public Health. 2012, 12: 715-10.1186/1471-2458-12-715.PubMedCentralCrossRefPubMed
10.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012, 380: 37-43. 10.1016/S0140-6736(12)60240-2.CrossRefPubMed
11.
Field TS, Gurwitz JH, Harrold LR, Rothschild J, DeBellis KR, Seger AC, Auger JC, Garber LA, Cadoret C, Fish LS, Garber LD, Kelleher M, Bates DW: Risk factors for adverse drug events among older adults in the ambulatory setting. J Am Geriatr Soc. 2004, 52: 1349-1354. 10.1111/j.1532-5415.2004.52367.x.CrossRefPubMed
12.
Condelius A, Edberg AK, Jakobsson U, Hallberg IR: Hospital admissions among people 65+ related to multimorbidity, municipal and outpatient care. Arch Gerontol Geriatr. 2008, 46: 41-55. 10.1016/j.archger.2007.02.005.CrossRefPubMed
13.
Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA: Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001, 54: 661-674. 10.1016/S0895-4356(00)00363-2.CrossRefPubMed
14.
Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW: Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005, 294: 716-724. 10.1001/jama.294.6.716.CrossRefPubMed
15.
Wolff JL, Starfield B, Anderson G: Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002, 162: 2269-2276. 10.1001/archinte.162.20.2269.CrossRefPubMed
16.
Chodick G, Porath A, Alapi H, Sella T, Flash S, Wood F, Shalev V: The direct medical cost of cardiovascular diseases, hypertension, diabetes, cancer, pregnancy and female infertility in a large HMO in Israel. Health Policy. 2010, 95: 271-276. 10.1016/j.healthpol.2009.12.007.CrossRefPubMed
17.
Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C: Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med. 2012, 10: 134-141. 10.1370/afm.1363.PubMedCentralCrossRefPubMed
18.
19.
Heymann AD, Chodick G, Halkin H, Kokia E, Shalev V: [Description of a diabetes disease register extracted from a central database]. Harefuah. 2007, 146: 15-17. 79PubMed
20.
Chodick G, Heymann AD, Shalev V, Kookia E: The epidemiology of diabetes in a large Israeli HMO. Eur J Epidemiol. 2003, 18: 1143-1146.CrossRefPubMed
21.
Shalev V, Chodick G, Goren I, Silber H, Kokia E, Heymann AD: The use of an automated patient registry to manage and monitor cardiovascular conditions and related outcomes in a large health organization. Int J Cardiol. 2011, 152: 345-349. 10.1016/j.ijcard.2010.08.002.CrossRefPubMed
22.
Chodick G, Porath A, Alapi H, Sella T, Flash S, Wood F, Shalev V: The direct medical cost of cardiovascular diseases, hypertension, diabetes, cancer, pregnancy and female infertility in a large HMO in Israel. Health policy (Amsterdam, Netherlands). 2010, 95: 271-276. 10.1016/j.healthpol.2009.12.007.CrossRef
23.
Kodesh A, Goldshtein I, Gelkopf M, Goren I, Chodick G, Shalev V: Epidemiology and comorbidity of severe mental illnesses in the community: findings from a computerized mental health registry in a large Israeli health organization. Soc Psychiatry Psychiatr Epidemiol. 2012, 47: 1775-1782. 10.1007/s00127-012-0478-9.CrossRefPubMed
24.
Bloom B, Cohen RA, Freeman G: Summary health statistics for U.S. children: National Health Interview Survey: National Center for Health Statistics. Vital Health Stat. 2011, 2012: 10.
25.
26.
27.
28.
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001, 20: 64-78. 10.1377/hlthaff.20.6.64.CrossRef
29.
Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002, 288: 1909-1914. 10.1001/jama.288.15.1909.CrossRefPubMed
30.
Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T: Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2012, 4: CD006560
31.
Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW: Adapting clinical guidelines to take account of multimorbidity. BMJ. 2012, 345: e6341-10.1136/bmj.e6341.CrossRefPubMed
Metadata
Title
Multiple chronic disorders - health care system’s modern challenge in the Maccabi Health Care System
Authors
Jonathan E Arbelle
Gabriel Chodick
Alex Goldstein
Avi Porath
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Israel Journal of Health Policy Research / Issue 1/2014
Electronic ISSN: 2045-4015
DOI
https://doi.org/10.1186/2045-4015-3-29

Other articles of this Issue 1/2014

Israel Journal of Health Policy Research 1/2014 Go to the issue

Original research article

Israeli nurse practice environment characteristics, retention, and job satisfaction

Integrative article

“The mothers have eaten unripe grapes and the children's teeth are set on edge”: the potential inter-generational effects of the Holocaust on chronic morbidity in Holocaust survivors’ offspring

Original research article

Coping strategies for existencial and spiritual suffering in Israeli patients with advanced cancer

Original research article

Do rich Israelis wait less for medical care?

Commentary

Inequalities in waiting times by socioeconomic status

Original research article

Reducing the cesarean delivery rates for breech presentations: administration of spinal anesthesia facilitates manipulation to cephalic presentation, but is it cost saving?