Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data.

Joan Llobera Canaves,Alfonso Leiva,Maria A. Fiol-deRoque,Jose M. Valderas,Fabrice B. R. Parmentier,Ignacio Ricci-Cabello,Aina María Yañez-Juan

doi:10.3390/jcm10081782

Abstract

We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.

Highlights

The safety of primary care is a global priority for healthcare, led by the World HealthOrganization [1]
The aim of this study was to examine the complex relationships between patientreported patient safety outcomes and multimorbidity as conceptualized and measured using the constructs of multimorbidity and polypharmacy, comorbidity, morbidity burden and patient complexity and the pathways by which the multimorbidity constructs may be associated with patient-reported patient safety in primary care
While the findings for men were consistent with these observations for the indirect pathway, we found an unexpected and simultaneous yet remarkably consistent direct association with better patient safety for these constructs

Summary

Introduction

The safety of primary care is a global priority for healthcare, led by the World HealthOrganization [1]. The safety of primary care is a global priority for healthcare, led by the World Health. Around 2% to 3% of all primary care encounters result in a patient safety incident, with 1 in 25 causing a serious harm outcomes [3]. These incidents are frequently related to diagnosis (either delayed or missed) or to treatment (delayed or inappropriate) [4,5]. Multimorbidity, the presence of more than one health condition in an individual [9], is increasingly prevalent and represents a major part of the workload of primary care [10,11] A number of different factors contribute to these incidents, such as the working environment, information transfer at the primary–secondary interface, doctor–patient relationship or continuing education [6,7,8].

Objectives

Methods

Results

Discussion

Conclusion