Abstract
BackgroundTreatment burden is the effort required of patients to look after their health, and the impact this has on their wellbeing. Quantitative data on treatment burden for patients with multimorbidity are sparse, and no single-item treatment burden measure exists.AimTo determine the extent of, and associations with, high treatment burden among older adults with multimorbidity, and to explore the performance of a novel single-item treatment burden measure.Design and settingCross-sectional postal survey via general practices in Dorset, UK.MethodPatients ≥55 years, living at home, with three or more long-term conditions (LTCs) were identified by practices. Treatment burden was measured using the Multimorbidity Treatment Burden Questionnaire. Data collected were sociodemographics, LTCs, medications, and characteristics including health literacy and financial resource. Associations with high treatment burden were investigated via logistic regression. Performance of a novel single-item measure of treatment burden was also evaluated.ResultsA total of 835 responses were received (response rate 42%) across eight practices. Patients’ mean age was 75 years, 55% were female (n = 453), and 99% were white (n = 822). Notably, 39% of patients self-reported fewer than three LTCs (n = 325). Almost one-fifth (18%) of responders reported high treatment burden (n = 150); making lifestyle changes and arranging appointments were particular sources of difficulty. After adjustment, limited health literacy and financial difficulty displayed strong associations with high treatment burden; more LTCs and more prescribed regular medications were also independently associated. The single-item measure discriminated moderately between high and non-high burden with a sensitivity of 89%, but a specificity of 58%.ConclusionHigh treatment burden was relatively common, underlining the importance of minimising avoidable burden. More vulnerable patients, with less capacity to manage, are at greater risk of being overburdened. Further development of a single-item treatment burden measure is required.
Highlights
Recognition of treatment burden in people living with long-term conditions (LTCs) is increasingly important, given the ageing populations of many countries, and increasing prevalence of LTCs and multimorbidity.[4,5]
The aims of this study were to determine the extent of treatment burden, and explore the characteristics associated with high treatment burden, among adults ≥55 years with three or more specified LTCs documented in their GP records; and to explore the performance of a novel singleitem treatment burden measure in the same sample
High treatment burden was strongly associated with limited health literacy and reported financial difficulty with health care; a greater number of LTCs and more prescribed regular medications were independently associated
Summary
Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing.[1,2,3] Recognition of treatment burden in people living with long-term conditions (LTCs) is increasingly important, given the ageing populations of many countries, and increasing prevalence of LTCs and multimorbidity.[4,5] The workload of health care can include ordering and taking medications, organising and attending healthcare appointments, monitoring health conditions, and modifying lifestyle behaviours.[6] For people living with multimorbidity, clinicians may be following multiple single-disease guidelines, an important driver of polypharmacy and potentially of treatment burden.[7,8] In the UK, the National Institute for Health and Care Excellence 2016 guidance for the assessment and management of multimorbidity[9] advises taking an approach to care that includes ‘improving quality of life by reducing treatment burden’. Treatment burden is the effort required of patients to look after their health, and the impact this has on their wellbeing. Quantitative data on treatment burden for patients with multimorbidity are sparse, and no single-item treatment burden measure exists
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
