Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complex...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/8/1782 |
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| author | Ignacio Ricci-Cabello Aina María Yañez-Juan Maria A. Fiol-deRoque Alfonso Leiva Joan Llobera Canaves Fabrice B. R. Parmentier Jose M. Valderas |
| author_facet | Ignacio Ricci-Cabello Aina María Yañez-Juan Maria A. Fiol-deRoque Alfonso Leiva Joan Llobera Canaves Fabrice B. R. Parmentier Jose M. Valderas |
| author_sort | Ignacio Ricci-Cabello |
| collection | DOAJ |
| description | We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men. |
| first_indexed | 2024-03-10T12:10:14Z |
| format | Article |
| id | doaj.art-11b23c94083a4d38aa8af0d1110c5678 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T12:10:14Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-11b23c94083a4d38aa8af0d1110c56782023-11-21T16:16:07ZengMDPI AGJournal of Clinical Medicine2077-03832021-04-01108178210.3390/jcm10081782Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational DataIgnacio Ricci-Cabello0Aina María Yañez-Juan1Maria A. Fiol-deRoque2Alfonso Leiva3Joan Llobera Canaves4Fabrice B. R. Parmentier5Jose M. Valderas6Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, SpainHealth Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, SpainHealth Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, SpainHealth Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, SpainHealth Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, SpainHealth Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, SpainHealth Services & Policy Research Group, Exeter Collaboration for Academic Primary Care, NIHR School for Primary Care Research, University of Exeter, Exeter EX1 2HZ, UKWe aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.https://www.mdpi.com/2077-0383/10/8/1782multimorbiditypolypharmacypatient safetyprimary carestructural equation modellatent class analysis |
| spellingShingle | Ignacio Ricci-Cabello Aina María Yañez-Juan Maria A. Fiol-deRoque Alfonso Leiva Joan Llobera Canaves Fabrice B. R. Parmentier Jose M. Valderas Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data Journal of Clinical Medicine multimorbidity polypharmacy patient safety primary care structural equation model latent class analysis |
| title | Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data |
| title_full | Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data |
| title_fullStr | Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data |
| title_full_unstemmed | Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data |
| title_short | Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data |
| title_sort | assessing the impact of multi morbidity and related constructs on patient reported safety in primary care generalized structural equation modelling of observational data |
| topic | multimorbidity polypharmacy patient safety primary care structural equation model latent class analysis |
| url | https://www.mdpi.com/2077-0383/10/8/1782 |
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