Abstract
BackgroundMultimorbid patients may experience a high burden of treatment. This has a negative impact on treatment adherence, health outcomes and health care costs. The objective of our study was to identify factors associated with the self-perceived burden of treatment of multimorbid patients in primary care and to compare them with factors associated with GPs assessment of this burden.MethodA cross sectional study in general practices, 100 GPs in Switzerland and up to 10 multimorbid patients per GP. Patients reported their self-perceived burden of treatment using the Treatment Burden Questionnaire (TBQ, possible score 0–150), whereas GPs evaluated the burden of treatment on a Visual Analog Scale (VAS) from 1 to 9. The study explored medical, social and psychological factors associated with burden of treatment, such as number and type of chronic conditions and drugs, severity of chronic conditions (CIRS score), age, quality of life, deprivation, health literacy.ResultsThe GPs included 888 multimorbid patients. The overall median TBQ was 20 and the median VAS was 4. Both patients’ and GPs’ assessment of the burden of treatment were inversely associated with patients’ age and quality of life. In addition, patients’ assessment of their burden of treatment was associated with a higher deprivation score and lower health literacy, and with having diabetes or atrial fibrillation, whereas GPs’ assessment of this burden was associated with the patient having a greater number of chronic conditions and drugs, and a higher CIRS score.ConclusionBoth from patients’ and GPs’ perspectives TB appears to be higher in younger patients. Whereas for patients the burden of treatment is associated with socio-economic and psychological factors, GPs’ assessments of this burden are associated with medical factors. Including socio-economic and psychological factors on patients’ self-perception is likely to improve GPs’ assessments of their patients’ burden of treatment thus favoring patient-centered care.
Highlights
Multimorbid patients may experience a high burden of treatment
Patients’ assessment of their burden of treatment was associated with a higher deprivation score and lower health literacy, and with having diabetes or atrial fibrillation, whereas General practitioner (GP)’ assessment of this burden was associated with the patient having a greater number of chronic conditions and drugs, and a higher Cumulative Illness Rating Scale (CIRS) score
Multimorbidity is increasing in prevalence and becoming a major health concern worldwide. [1,2,3] It is associated with a higher burden of disease, poorer health outcomes and reduced quality of life, more frequent hospital admissions, a higher number of provider visits, higher mortality and increasing healthcare costs. [4,5,6,7,8] Multimorbity is associated with polypharmacy and its potentially negative consequences on safety of care. [9, 10] The prevalence of multimorbidity is high in primary care (PC) and these patients require long-term care. [11]
Summary
Multimorbid patients may experience a high burden of treatment This has a negative impact on treatment adherence, health outcomes and health care costs. The objective of our study was to identify factors associated with the self-perceived burden of treatment of multimorbid patients in primary care and to compare them with factors associated with GPs assessment of this burden. Physicians increasingly encourage multimorbid patients to develop self-management skills For patients this involves finding time for health education, lifestyle changes, selfassessment and monitoring. Little evidence is available in relation to the factors associated with the burden of treatment for multimorbid patients in primary care. [16] The association between patient characteristics and burden of treatment has not been explored before Knowledge of these factors could guide GPs in identifying patients exposed to a higher burden of treatment
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