Medicare may encourage a single disease approach but the reality is very different, with Australian figures showing high levels of co-morbidity in primary care patients.

One in three patients visiting a GP has more than one major illness, according to data from more than 9000 patients collected as part of the ongoing BEACH (Bettering the Evaluation And Care of Health) study.

Levels of co-morbidity are not surprisingly much higher in older patients, with 75% of people over 65 having multiple morbidities.

The findings (link), published in the MJA this week (189 (2): 72-77) show that certain combination of co-morbidity are particularly common. About 15% of patients seen by GPs had arthritis or chronic back pain combined with a vascular condition such as hypertension. More than one in ten had a psychological problem combined with a vascular problem, and a similar proportion had a psychological  problem with a musculoskeletal problem.

The study authors, from the Family Medicine Research Centre at the University of Sydney, say the levels of co-morbidity are likely to be higher because they did not measure conditions such as obesity, osteoporosis or kidney disease.

They say it’s important to know about the common disease combinations because some - such as cardiac and respiratory disorders - may have a strong negative synergistic effects. And other co-existing illnesses such as arthritis and GI disorders may have a high risk of increased morbidity and mortality from drug therapies such as NSAIDs, they point out.