Uso de serviços de saúde e multimorbidade em funcionários de uma Universidade no Estado do Rio de Janeiro: Estudo Pró-Saúde.

Abstract

This study aimed to evaluate if there is association of the use of health services and multimorbidity, that is, two or more chronic conditions coexisting in the same individual, in an adult population in the city Rio de Janeiro. A cross-sectional study was conducted using a sample of baseline participants from the Pró-Saúde Study. For this multimodal study it was evaluated by a cumulative scale and by counting of self-reported diseases. Intra and interrater reliability analyzes of the Cumulative Illness Rating Scale and evaluated the association of multimorbidity indices with health services according to sex, age, schooling and time of restriction of usual activities. The exposures of interest has three scores produced by the cumulative scale: number of systems affected, total score and severity index, and two by counting self-reported diseases: number of self-report morbidities and multimorbidity, classified as two or more self-reported morbidities (yes/no) and the outcome of this study was the use of health services (yes / no). The intra and interrater reliability of the scale was measured by means of weighted kappa and intraclass correlation coefficient. A relationship between health service use and multimorbidity indices was estimated using crude and adjusted prevalence estimates. The Cumulative Illness Rating Scale presented nearly perfect reliability for the number of affected systems and total score, and substantial score for the severity index in the intrarater analysis. For interrater reliability, the number of systems affected by near-perfect reliability, substantial total score, and gravity index moderate reliability. Regarding the association of health services according to morbidity indexes, having multimorbidity increases the probability of using health services in the general population. Sex-stratified analyzes showed a modification of the effect of multimorbidity indexes on the use of health services. Multimorbidity indices produced by CIRS were not predictors of service use for males but only the self-reported morbidity score generated. For women, this relationship is opposite, the burden of morbidity was influential in the use of health services. A Cumulative Illness Rating Scale is a reliable scale for measuring biodiversity in the general population for the context of health services. The use of health services is influenced by multimorbidity and this relationship is stronger among men. Different patterns of behavior were found according to sex, this shows the importance of further studies investigating such relationship for the construction of programs and assistance protocols aimed at meeting the specific demand of each group.