Multimorbidity in Māori and Pacific patients: cross-sectional study in a Dunedin general practice
Tim Stokes 1 , Mayur Azam 2 , Fiona Doolan Noble 11 Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
2 Otago Medical School, University of Otago, Dunedin, New Zealand
Correspondence to: Tim Stokes, Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand. Email: tim.stokes@otago.ac.nz
Journal of Primary Health Care 10(1) 39-43 https://doi.org/10.1071/HC17046
Published: 29 March 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Multimorbidity is a major issue in primary health care.
AIM: To determine the prevalence of multimorbidity and polypharmacy in one general practice in relation to age, sex and socioeconomic deprivation in Māori and Pacific patients.
METHODS: A cross-sectional study using data manually extracted from electronic medical records was conducted using a stratified random sample of Māori and Pacific patients aged ≥ 35 years who were enrolled with a large urban Dunedin general practice. The data were analysed to identify the number and type of morbidities, and prevalence of multimorbidity and polypharmacy in relation to age, sex and socioeconomic deprivation.
RESULTS: Half (52.5% [95% CI 44.5–60.4]) of Māori and 64.3% (95% CI 51.9–75.4) of Pacific patients had multimorbidity; 22.8% (95% CI 16.6–30.1) of Māori and 10.0% (95% CI 4.1–19.5) of Pacific patients had physical and mental health co-morbidity. Fewer (13.6% [95% CI 8.7–19.8]) Māori than Pacific patients (32.9% [95% CI 22.1–45.1]) had polypharmacy. The prevalence of multimorbidity in both Māori and Pacific patients increased with age and with increasing levels of socioeconomic deprivation. The eight most prevalent chronic conditions in both Māori and Pacific patients were obesity, anxiety or depression, hypertension, asthma or chronic obstructive pulmonary disease, gout, diabetes, cardiovascular disease and osteoarthritis.
CONCLUSION: The high prevalence of multimorbidity in Māori and Pacific patients requires the New Zealand health system to deliver culturally competent primary health care and to re-orientate health-care delivery around multimorbidity.
KEYWORDS: Primary health care; multimorbidity; Māori; Pacific; cross-sectional study
References
[1] Valderas JM, Starfield B, Sibbald B, et al. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009; 7 357–63.| Defining comorbidity: implications for understanding health and health services.Crossref | GoogleScholarGoogle Scholar |
[2] Mangin D, Heath I, Jamoulle M. Beyond diagnosis: rising to the multi-morbidity challenge. BMJ (Clinical Research edn). 2012; 344 e3526
[3] Goodwin N, Dixon A, Anderson GF, Wodchis W. Providing integrated care for older people with complex needs. Lessons from seven international case studies. London: King’s Fund; 2014.
[4] Mercer SW, Smith SM, Wyke S, et al. Multi-morbidity in primary care: developing the research agenda. Fam Pract. 2009; 26 79–80.
| Multi-morbidity in primary care: developing the research agenda.Crossref | GoogleScholarGoogle Scholar |
[5] Violan C, Foguet-Boreu Q, Flores-Mateo G, et al. Prevalence, determinants and patterns of multi-morbidity in primary care: a systematic review of observational studies. PLoS One. 2014; 9 e102149
| Prevalence, determinants and patterns of multi-morbidity in primary care: a systematic review of observational studies.Crossref | GoogleScholarGoogle Scholar |
[6] Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multi-morbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380 37–43.
| Epidemiology of multi-morbidity and implications for health care, research, and medical education: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
[7] Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet. 2009; 374 65–75.
| Indigenous health part 1: determinants and disease patterns.Crossref | GoogleScholarGoogle Scholar |
[8] Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002; 162 2269–76.
| Prevalence, expenditures, and complications of multiple chronic conditions in the elderly.Crossref | GoogleScholarGoogle Scholar |
[9] Salisbury C, Johnson L, Purdy S, et al. Epidemiology and impact of multi-morbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2011; 61 e12–21.
| Epidemiology and impact of multi-morbidity in primary care: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar |
[10] Nishtala PS, Salahudeen MS. Temporal trends in polypharmacy and hyperpolypharmacy in older New Zealanders over a 9-year period: 2005–2013. Gerontology. 2015; 61 195–202.
| Temporal trends in polypharmacy and hyperpolypharmacy in older New Zealanders over a 9-year period: 2005–2013.Crossref | GoogleScholarGoogle Scholar |
[11] Statistics NZ. 2013 Census QuickStats about a place: Otago Region. Wellington: Statistics NZ; 2013.
[12] Ministry of Health. Tatau Kahukura: Māori health statistics Nga mana hauora tutohu: Health status indicators: cardiovascular Disease. Wellington: Ministry of Health; 2015.
[13] Ministry of Health. Annual Update of Key Results 2015/16: New Zealand Health Survey. Wellington: Ministry of Health; 2016.
[14] Salmond CE, Crampton P. Development of New Zealand’s deprivation index (NZDep) and its uptake as a national policy tool. Can J Public Health. 2012; 103 S7–11.
[15] Robinson PC, Merriman TR, Herbison P, Highton J. Hospital admissions associated with gout and their comorbidities in New Zealand and England 1999–2009. Rheumatology. 2013; 52 118–26.
| Hospital admissions associated with gout and their comorbidities in New Zealand and England 1999–2009.Crossref | GoogleScholarGoogle Scholar |
[16] Rumball-Smith J, Sarfati D, Hider P, Blakely T. Ethnic disparities in the quality of hospital care in New Zealand, as measured by 30-day rate of unplanned readmission/death. Int J Qual Health Care. 2013; 25 248–54.
| Ethnic disparities in the quality of hospital care in New Zealand, as measured by 30-day rate of unplanned readmission/death.Crossref | GoogleScholarGoogle Scholar |
[17] Hill S, Sarfati D, Blakely T, et al. Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors. J Epidemiol Community Health. 2010; 64 117–23.
| Survival disparities in Indigenous and non-Indigenous New Zealanders with colon cancer: the role of patient comorbidity, treatment and health service factors.Crossref | GoogleScholarGoogle Scholar |
[18] Signal L, Semper K, Stairmand J, et al. A walking stick in one hand and a chainsaw in the other: patients’ perspectives of living with multi-morbidity. N Z Med J. 2017; 130 65–76.
[19] McKinlay E, Graham S, Horrill P. Culturally and linguistically diverse patients’ views of multi-morbidity and general practice care. J Prim Health Care. 2015; 7 228–35.
[20] Stokes T, Tumilty E, Doolan-Noble F, Gauld R. Multi-morbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study. BMC Fam Pract. 2017; 18 51
| Multi-morbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
