Long term condition morbidity in English general practice: a cross-sectional study using three composite morbidity measures.

Charlotte Weston,Stevo Durbaba,Peter Schofield,Patrick White,Alexander Gilkes,Mark Ashworth

doi:10.1186/s12875-016-0563-3

Abstract

BackgroundThe burden of morbidity represented by patients with long term conditions (LTCs) varies substantially between general practices. This study aimed to determine the characteristics of general practices with high morbidity burden.MethodRetrospective cross-sectional study; general practices in England, 2014/15. Three composite morbidity measures (MMs) were constructed to quantify LTC morbidity at practice level: a count of LTCs derived from the 20 LTCs included in the UK Quality and Outcomes Framework (QOF) disease registers, expressed as ‘number of QOF LTCs per 100 registered patients’; the % of patients with one or more QOF LTCs; the % of patients with one or more of 15 broadly defined LTCs included in the GP Patient Survey (GPPS). Determinants of MM scores were analysed using multi-level regression models. Analysis was based on a national dataset of English general practices (n = 7779 practices); GPPS responses (n = 903,357); general practice characteristics (e.g. list size, list size per full time GP); patient demographic characteristics (age, deprivation status); secondary care utilisation (out-patient, emergency department, emergency admission rates).ResultsMean MM scores (95% CIs) were: 57.7 (±22.3) QOF LTCs per 100 registered patients; 22.8% (±8.2) patients with a QOF LTC; 63.5% (±11.7) patients with a GPPS LTC. The proportion of elderly patients and social deprivation scores were the strongest predictors of each MM score; scores were largely independent of practice characteristics. MM scores were positive predictors of secondary care utilization and negative predictors’ access, continuity of care and overall satisfaction.ConclusionsWide variation in LTC morbidity burden was observed across English general practice. Variation was determined by demographic factors rather than practice characteristics. Higher rates of secondary care utilisation in practices with higher morbidity burden have implications for resource allocation and commissioning budgets; lower reported satisfaction in these practices suggests that practices may struggle with increased workload. There is a need for a readily available metric to define the burden of morbidity and multimorbidity in general practice.

Highlights

The burden of morbidity represented by patients with long term conditions (LTCs) varies substantially between general practices
Wide variation in LTC morbidity burden was observed across English general practice
One in six patients registered with a general practitioners (GPs) have one or more LTCs that feature in the Quality and Outcomes Framework (QOF), the pay-forperformance scheme which rewards GPs for achieving clinical targets in patients with LTCs; approximately one third of all GP consultations are related to LTCs [2]

Summary

Introduction

The burden of morbidity represented by patients with long term conditions (LTCs) varies substantially between general practices. In the last two decades there has been an increasing focus in primary care on the management of long term conditions (LTCs) with a parallel reduction in presentation of acute self-limiting conditions to general practitioners (GPs) [1]. Huntley et al performed a systematic review to identify and compare measures of morbidity burden suitable for use in primary care research. These included proposed measures of morbidity such as simple disease counts or weightings according to the perceived severity, mortality or resource utilization of specific LTCs [3].

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