Rein Vos, Marjan van den Akker, Jos Boesten, Caroline Robertson & Job Metsemakers 



    Physicians are frequently confronted with complex health situations of patients, but knowledge of intensive forms of multimorbidity and their development during life is lacking.

    This study explores patterns and trajectories of chronic health problems of patients with multimorbidity particularly those with more than ten conditions and type and variety of organ systems involved in these patterns during life.


    Life time prevalence patterns of chronic health problems were determined in patients with illness trajectories accumulating more than ten chronic health problems during life as registered by general practitioners in the South of the Netherlands in the Registration Network Family Practices (RNH).


    Overall 4,560 subjects (5%) were registered with more than ten chronic health problems during their life (MM11+), accounting for 61,653 (20%) of the 302,808 registered health problems in the population (N = 87,837 subjects). More than 30% accumulates 4 or more chronic health conditions (MM4-5: 4–5 conditions (N = 14,199; 16.2%); MM6-10: 6–10 conditions (N = 14,365; 16.4%).

    Gastro-intestinal, cardiovascular, locomotor, respiratory and metabolic conditions occur more frequently in the MM11+ patients than in the other patients, while the nature and variety of body systems involved in lifetime accumulation of chronic health problem clusters is both generic and specific. Regarding chronic conditions afflicting multiple sites throughout the body, the number of neoplasms seems low (N = 3,592; 5.8%), but 2,461 (49%) of the 4,560 subjects have registered at least one neoplasm condition during life. A similar pattern is noted for inflammation (N = 3,537, 78%), infection (N = 2,451, 54%) and injury (N = 3,401, 75%).


    There are many challenges facing multimorbidity research, including the implementation of a longitudinal, life-time approach from a family practice perspective. The present study, although exploratory by nature, shows that both general and specific mechanisms characterize the development of multimorbidity trajectories. A small proportion of patients has a high number of chronic health problems (MM11+) and keeps adding health problems during life. However, GP’s need to realise that more than one third of their patients accumulate four or more chronic health problems (MM4-5 and MM6-10) during life.

    Marc Verbeke M.D., Diëgo Schrans M.D., Sven Deroose M.D., Jan De Maeseneer M.D. Ph.D
     Department of General Practice and Primary Health Care, Ghent University, Belgium
    The International Classification of Primary Care (ICPC) has become a standard all over the world. It became a standard tool to classify the important elements in the Electronic Patient Record (EPR) of the GP: reasons for encounter (RFE) reflecting the patient’s view, process of care (decision, action, intervention or plans) reflecting the care process, and the assessment (diagnosis or health issue) reflecting the doctor’s view. ICPC-2 is fully compatible with structuring data in the episode of care model and it’s reflecting the essential elements of each patient/provider encounter. To implement ICPC-2 in the EPR a Thesaurus has been developed in Belgium with double encoded clinical labels. The implementation is now mandatory for labelled EPR systems in Belgium. The use of ICPC 2 may improve the accessibility and use of online Expert systems and Guidelines. Keywords: Medical Informatics, ICPC, primary care, thesaurus, medical record

    Abstract Background and Objective:
     Family physicians (FP) play a key role in the diagnosis and treatment of health problems in the community and for evidence-based guidance, clinical research must be based on primary care data. This paper analyses the state-of-the-art approaches to the collection of data and the building of databases in family practice.
     Experience in the Netherlands in family practice-based research networks (PBRNs) is explored in registering and analyzing primary care data, illustrated with four examples of PBRN studies.
     PBRNs bring together practices and FPs with a research interest to collect data and pursue research under routine patient care conditions. This directs research at relevant questions of family practice. Important features of success are practitioners’ ownership of data and the use of data in improving the care of patients in the participating practices. International standardization of terminology and definitions in the international classification of primary care improves the scientificquality of data recorded in registration networks and PBRNs.
     Through primary care registration networks and PBRNs it is possible to tap in unselected care of patients and at the same time produce scientifically rigorous data. This enables research that represents the realities of primary care with valid data.