TY - JOUR T1 - Identifying multimorbidity clusters with the highest primary care use: 15 years of evidence from a multi-ethnic metropolitan population JF - British Journal of General Practice JO - Br J Gen Pract DO - 10.3399/BJGP.2021.0325 SP - BJGP.2021.0325 AU - Marina Soley-Bori AU - Alessandra Bisquera AU - Mark Ashworth AU - Yanzhong Wang AU - Stevo Durbaba AU - Hiten Dodhia AU - Julia Fox-Rushby Y1 - 2021/10/19 UR - http://bjgp.org/content/early/2021/10/19/BJGP.2021.0325.abstract N2 - Background: People with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may impact differently on primary care use. Aim: To assess the association between multimorbidity clusters and primary care consultations over time. Design and setting: A retrospective longitudinal (panel) study design was used. Data comprised electronic primary care health records of 826,166 patients registered at GP practices in an ethnically diverse, urban setting in London between 2005 and 2020. Method: Primary care consultation rates were modelled using Generalised Estimating Equations. Key controls included the total number of LTCs, five multimorbidity clusters, and their interaction effects, ethnicity, and polypharmacy (proxy of disease severity). Models were also calibrated by consultation type and ethnic group. Results: Individuals with multimorbidity use two to three times more primary care services than those without multimorbidity (IRR=2.3, 95% CI:2.29-2.32). Patients in the alcohol dependency, substance dependence, and HIV cluster have the highest rate of increase in primary care consultations as additional LTCs accumulate, followed by the mental health cluster (anxiety and depression). Differences by ethnic group are observed, with the largest impact in the chronic liver disease and viral hepatitis cluster for individuals of Black or Asian ethnicity. Conclusion: This paper identifies multimorbidity clusters with the highest primary care demand over time as additional LTCs develop, differentiating by consultation type and ethnicity. Targeting clinical practice to prevent multimorbidity progression for these groups may lessen future pressures on primary care demand by improving health outcomes. ER -