Clustering Complex Chronic Patients: A Cross-Sectional Community Study From the General Practitioner's Perspective

Area of Science:

• Primary Care Research
• Health Services Research
• Epidemiology

Background:

• Complex Chronic Patients (CCPs) represent a significant challenge in primary care.
• Understanding the heterogeneity of CCPs is crucial for effective healthcare management.
• General practitioner (GP) perspectives are vital for defining patient complexity.

Purpose of the Study:

• To characterize subgroups of Complex Chronic Patients (CCPs) using cluster analysis.
• To identify distinct patient profiles from the general practitioner's viewpoint.
• To inform targeted interventions for CCPs.

Main Methods:

• Cross-sectional, population-based study involving 43,647 inhabitants over 14 years old.
• Utilized a Two-Step Cluster method based on GP clinical judgment and complexity domains (clinical and social).
• Data collected from three urban primary care centers in Sabadell, Catalonia, Spain.

Main Results:

• Identified three distinct CCP subgroups.
• Cluster 1: Primarily managed by primary care, 63% high-risk (Adjusted Morbidity Groups - GMA).
• Cluster 2: Younger, higher social deprivation, severe mental disease, 48% high-risk (GMA).
• Cluster 3: High-risk (GMA), advanced chronic disease, functional loss, geriatric syndromes, and decision-making uncertainty.

Conclusions:

• CCP characterization reveals distinct patient profiles and needs.
• Identified clusters offer an improved epidemiological understanding of CCPs.
• Findings support the development of targeted interventions for specific CCP subgroups.