[Prevalence of patients with high complexity and/or high dependency for case management in primary care]

Abstract

Objective: To identify the percentage of the population over 18 years with high complexity or high dependency using the case management model.

Method: Observational, cross-sectional, descriptive study. Community level. Simple random sampling. Sample size calculation: 551 individuals were needed, with a rate of replacement for losing participation of 40%.

Variables: High complexity ≥ 4 of following criteria: age, comorbidity, high drug consumption, terminal disease, hospital admissions, visits to Emergency Departments, falls, functional dependency, mental deterioration, to live alone or with family with capacity for limited support; High dependency (Barthel ≤ 30 and/or Pfeiffer ≥ 8; social-demographic variables; health services use; chronic diseases; specific treatments and caregiver data.

Analysis: Descriptive for all variables and associated factors (95% CI). Correlation between variables was studied using the Kappa index.

Results: A total of 327 patients were studied, with a mean age of 49 years (SD = 18), of whom 179 (54.7%) were women. Six individuals had high complexity (1.8%, 95% CI: 0.38%-3.29%), 4 women (67%), 5 > 75 years old (83%) and 1 < 65 years old, mean age = 79.5 years (SD = 12.6). Five women presented high dependency (1.5%, 95% CI: 0.49-3.53), 4 > 75 years old (80%) and 1 < 65 years old, mean age = 82 years (SD = 14.8). Seven individuals in total presented high complexity and/or high dependency criteria (2.14%, 95% CI: 0.86-4.3), 5 women (71.4%); 6 > 75 years old and 1 < 65 years old, mean age = 81.3 years (SD = 12.4). Prevalence > 65 years (8.3%) and < 65 (0.6%) (P = .001). Correlation Kappa Index between high complexity and high dependency variables was 0.723.

Discussion: The percentage of patients who had high complexity or high dependency compared to the general population is significant, although lower than expected. In the planning of future programs for case management those persons who have high dependency and aged less than 65 years should also be taken into account along with those who have high complexity.