Longitudinal Patterns of Nursing Care Needs Among Highly Complex Chronic Patients in the Canary Islands: A Population-Based Retrospective Cohort Study

Background/Objectives: The care provided to people with high-complexity chronic diseases requires knowing their longitudinal evolution and care needs. This study describes population-level longitudinal patterns of nursing care needs among highly complex chronic patients in the Canary Islands (Spain) and analyses the associations between nursing diagnoses and sociodemographic, clinical and contextual variables. Methods: A retrospective and population-based cohort study with yearly follow-up (2016–2024) was conducted. The subjects included were 92,855 patients classified as presenting high/very high complexity in Primary Health Care. Sociodemographic and clinical variables were analysed, as well as use of health resources and 40 NANDA-I nursing diagnoses duly recorded in electronic health records. Descriptive, bivariate and multivariate analyses were performed by means of generalized estimating equations. Results: The cohort was predominantly female, with a mean age of 70.5 years old. Approximately 44% of participants died during follow-up. Arterial hypertension, diabetes, osteoarthritis, polypharmacy and frailty prevailed. The most frequent diagnoses were as follows: readiness for enhanced health self-management; impaired skin integrity; high-complexity chronic patient frailty syndrome; impaired urinary elimination; and risk for falls. In the multivariate model, gender, age, complexity and province showed independent associations with different diagnostic patterns, whereas time was especially related to frailty, risk for falls, discomfort and self-care deficit. Conclusions: These patients show heterogeneous population-level temporal patterns in documented nursing care needs, highlighting the value of standardised nursing terminology and longitudinal follow-up to inform individualised care planning in Primary Health Care. Geographical variations in recorded nursing diagnoses may partly reflect differences in clinical documentation practices rather than solely differences in underlying care needs.