Abstract
BackgroundPatients with multimorbidity often experience treatment burden as a result of fragmented, specialist‐driven healthcare. The ‘family doctor team' is an emerging service model in China to address the increasing need for high‐quality routine primary care.ObjectiveThis study aimed to explore the extent to which treatment burden was associated with healthcare needs and patients' experiences.MethodsMultisite surveys were conducted in primary care facilities in Guangdong province, southern China. Interviewer‐administered questionnaires were used to collect data from patients (N = 2160) who had ≥2 clinically diagnosed long‐term conditions (multimorbidity) and had ≥1 clinical encounter in the past 12 months since enrolment registration with the family doctor team. Patients' experiences and treatment burden were measured using a previously validated Chinese version of the Primary Care Assessment Tool (PCAT) and the Treatment Burden Questionnaire, respectively.ResultsThe mean age of the patients was 61.4 years, and slightly over half were females. Patients who had a family doctor team as the primary source of care reported significantly higher PCAT scores (mean difference 7.2 points, p < .001) and lower treatment burden scores (mean difference −6.4 points, p < .001) when compared to those who often bypassed primary care. Greater healthcare needs were significantly correlated with increased treatment burden (β‐coefficient 1.965, p < .001), whilst better patients' experiences were associated with lower treatment burden (β‐coefficient −0.252, p < .001) after adjusting for confounders.ConclusionThe inverse association between patients' experiences and treatment burden supports the importance of primary care in managing patients with multimorbidity.Patient ContributionPrimary care service users were involved in the instrument development and data collection.
Highlights
Multimorbidity – the presence of two or more chronic conditions within an individual – has been increasingly common over recent decades [1,2,3,4]
Interviewer-administered questionnaires including items derived from our previous research [2, 22] were used to collect data on demographics, socio-economic status, health characteristics, healthcare needs, service utilisation, and the process of care from study participants
Summary of main findings Our study demonstrated that in the absence of a secondary care gatekeeping function in primary care, approximately one third of multimorbid patients who had enrolled with the community health centres (CHCs) family doctor team were still in favour of using specialist care regularly over primary care
Summary
Multimorbidity – the presence of two or more chronic conditions within an individual – has been increasingly common over recent decades [1,2,3,4]. A typical team is comprised of one GP clinician and several healthcare personnel including nurses, public health doctors, and if available and suitable, pharmacists and social workers. This supports a broader range of systematic preventive care approaches, including health assessment, health promoting interventions, health advice, and when necessary, home visits to support self-management. The ‘family doctor team’ is an emerging service model in China to address the increasing need for high-quality routine primary care. Conclusion: The inverse association between patients’ experiences and treatment burden supports the importance of primary care in managing patients with multimorbidity. Patient contribution: Primary care service users were involved in the instrument development and data collection. (250 words)
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