Clinical, functional, mental and sociofamiliar features in pluripathological patients. One-year prospective study in Primary Health Care

Objectives. To analyze clinical, functional, mental, sociofamiliar, and evolutional characteristics of pluripathological patients (PP) in Primary Health Care setting. Patients and method. Prospective, multiinstitutional cohort study in four Primary Health Care Institutions by active identification of PP from a computerized registry using the Spanish Andalusian Health Care Council criteria. A clinical interview was proposed to all identified patients. The clinical data, Barthel index (BI), Pfeiffer scale, clinical vulnerability (CV), sociofamiliar features by the Gijon scale, and 1-year admissions and mortality were analyzed. An univariant and multivariant analysis was performed in order to know the risk factors associated to previously described variables. Results. Overall, 806 PP were detected (1.38% of the population). Cardiovascular categories were the most prevalent. A total of 662 patients (69%) were eligible for the interview. Median BI was 90 (0-100), and 24% of patients had severe functional impairment (BI < 60). Twenty-nine percent of them had been admitted to hospital at least once in the last 3 months. Patients with more functional impairment and CV were older, having more defining categories, especially E category. A total of 174 patients (37.75%) had cognitive impairment. This group was older, with more functional impairment, and worse sociofamiliar support. One-year mortality was 6.1%, and was correlated with CV and older age. Conclusions. The definition of PP used selects in the Primary Care setting a population with a high level of multidimensional frailty having a high prevalence of functional, cognitive deterioration, sociofamiliar problems, CV and consumption of health care resources. Due to this multidimensional deterioration, it is recommendable to make an integral evaluation in the health care practice of these patients.