Abstract
BackgroundThe daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multiple long-term conditions (MLTCs) is understudied.AimTo test whether co-residence with a person with MLTCs (compared with a co-resident without MLTCs) is associated with utilisation and cost of primary, community, secondary health care, and formal social care.Design & settingLinked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged ≥50 years in two-person households in 2016–2018.MethodTwo-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health, and social care by MLTC status of individuals and co-residents, adjusted for age, sex, and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink (CPRD).ResultsForty-eight per cent of people with MLTCs in two-person households were co-resident with another person with MLTCs. They were 1.14 (95% confidence interval [CI] = 1.00 to 1.30) times as likely to have community care activity and 1.24 (95% CI = 0.99 to 1.54) times as likely to have mental health care activity compared with those co-resident with a healthy person. They had more primary care visits (8.5 [95% CI = 8.2 to 8.8] versus 7.9 [95% CI = 7.7 to 8.2]) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar.ConclusionCare utilisation for people with MLTCs varies by household context. There may be potential for connecting health and community service input across household members.
Highlights
Meeting the needs of people with multiple long-term conditions (MLTCs) is a key challenge facing health and social care systems.In the UK, around 25% of people have ≥2 conditions and their care needs account for >50% of primary and secondary care costs, and a substantial portion of community and social care costs.[1,2,3] Trials of initiatives to improve outcomes and reduce hospital or emergency care use of those with MLTCs have not shown success, at least in the short term.[4,5]Initiatives have focused on providing patient-centred care for people with MLTCs,[6] but if elements of care use and costs are to be reduced more research is needed on their drivers
Forty-eight per cent of people with MLTCs in two-person households were co-resident with another person with MLTCs. They were 1.14 (95% confidence interval [CI] = 1.00 to 1.30) times as likely to have community care activity and 1.24 times as likely to have mental health care activity compared with those co-resident with a healthy person
Care utilisation for people with MLTCs varies by household context
Summary
Initiatives have focused on providing patient-centred care for people with MLTCs,[6] but if elements of care use and costs are to be reduced more research is needed on their drivers. The daily responsibility for managing their conditions usually falls primarily on the individuals themselves and on their informal carers. Around half of carers in England provide care for someone in the same household.[7] studies of the household context and its impact on service use and cost among people with MLTCs have focused on household size 8 and not household members’. The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multiple long-term conditions (MLTCs) is understudied
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