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Vol. 20. Núm. S1.
Informe SESPAS 2006: Los desajustes en la salud en el mundo desarrollado
Páginas 182-191 (Marzo 2006)
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Vol. 20. Núm. S1.
Informe SESPAS 2006: Los desajustes en la salud en el mundo desarrollado
Páginas 182-191 (Marzo 2006)
Parte IV. Ecosalud y participación social
DOI: 10.1157/13086042
Open Access
La comorbilidad en atención primaria
The comorbidity in primary care
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...
Luis Palomoa,??
Autor para correspondencia
luispalomo@wanadoo.es

Correspondencia: Luis Palomo. Centro de Salud de Coria. C/ Cervantes, s/n. 10800 Coria. Cáceres. España.
, Carlos Rubiob, Juan Gérvasc
a Centro de Salud de Coria. Red Española de Atención Primaria. Cáceres. España
b Centro de Salud Plaza de Argel. Red Española de Atención Primaria. Cáceres. España
c Red Española de Atención Primaria. Madrid. España
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Resumen

La cronificación de un número cada vez mayor de enfermedades en poblaciones que viven cada vez más años acarrea un incremento de la comorbilidad. Su frecuencia se comprueba en los registros de morbilidad atendida y su importancia se manifiesta en el uso de los servicios, en los tratamientos, en la supervivencia, y en la calidad de vida de los pacientes afectados.

Una asociación frecuente, como diabetes y depresión, ocasiona más gastos en atención primaria, más atención urgente, más ingresos, más probabilidad de tener riesgo vascular, menor adherencia al tratamiento y a la dieta, peor percepción del estado físico y mental y, en general, más gastos totales. La tasa anual de mortalidad se multiplica en presencia de anemia o de insuficiencia cardíaca o renal. La percepción de la calidad de vida se relaciona más con la comorbilidad mental que con la física. La comorbilidad incrementa los ingresos evitables y las complicaciones prevenibles asociadas a ingreso hospitalario. La ideación suicida es mayor con enfermedad pulmonary obstructiva crónica (EPOC) que con otras enfermedades crónicas orgánicas. El riesgo de crisis coronaria aguda se incrementa con la edad en pacientes con fibrilación auricular y la comorbilidad incrementa el uso de inhibidores de la enzima de conversión de la angiotensina (IECA), la toma de antidepresivos y las visitas al psiquiatra.

Palabras clave:
Comorbilidad
Atención primaria
Calidad de vida
Abstract

As patients live longer, and more illnesses become chronic, comorbidity rates increase. This increase shows in attended morbidity registers, and its importance is revealed by the use of services, treatments, the survival rates and the patients’ life quality.

A frequent coexistence of illnesses, such as diabetes and depression, increases the cost of primary care and emergency treatments and the number of hospital admissions; increases the probability of cardiovascular risk and non-adherence to treatment and diet; causes a perception of poor physical and mental health and, on the whole, increases global costs. The annual mortality rate shoots up when anemia and cardiovascular or kidney failure occur. Mental comorbidity has a greater effect on the patients’ perception of their life quality than physical comorbidity. Comorbidity increases the number of hospital admissions which could have been prevented, as well as the avoidable complications related to them. Suicidal thoughts occur more frequently in patients suffering from chronic obstructive pulmonary disease (COPD) than in those suffering from other chronic organic illnesses. In patients suffering from atrial fibrillation, the risk of acute coronary crisis increases as they age and the comorbidity increases the use of angiotensin-converting enzymes (ICAE), antidepressant drugs and the visits to the psychiatrist.

Key words:
Comorbidity
Primary care
Quality of life
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En este trabajo se emplea el término comorbilidad como sinónimo de multimorbilidad, sin que este término implique una jerarquías entre enfermedades, a no ser que se haga mención expresa a una enfermedad índice. Por otra parte, el término comorbilidad es el comúnmente utilizado en la literatura médica internacional.

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