Patients with multiple long-term health conditions are more likely to report poorer experiences in primary care than those with fewer health problems, according to recent findings by researchers from the University of Cambridge and RAND Europe.
The research used data from nearly 1 million patients in England to understand how people with multimorbidity, or more than one long-term condition, felt about the care provided by their general practice surgery, what is known as general or family practice in the U.K. and the United States. People with multiple long-term health conditions reported worse primary care experiences overall — and specifically when it came to accessing care and communicating with doctors, nurses and receptionists — than patients who had either one long-term health problem or none.
Potential reasons for the findings
The impact of disease on quality of life may manifest itself in terms of disability, which in turn affects the patient's experience of primary care. For example, a hearing disability may make communication harder, adversely impacting a person's ability to book an appointment over the phone or affecting the quality of face-to-face consultation with the doctor.
The results showed that health-related quality of life, particularly living with “pain,” also might be important. Differences in perception among people with long-term health conditions — influenced by pain or perhaps depression — may affect the way patients report their experiences of primary care.
In addition, poorer health care experiences reported by people with multiple long-term conditions could be explained by their different and more complex health care needs. For example, they may require longer consultations, or prescribing by doctors that avoids inappropriate polypharmacy (the use of too many medicines at the same time). These needs do not fit well with management systems and health guidelines designed for patients with only one health problem at a time.
What are the implications for policy?
Health policymakers and clinicians need to recognise that the patient experience and health care needs of people with multimorbidity are likely to be different than those with a single long-term condition. A patient-centred model that takes into account the severity of disease — and the impact of combinations of diseases, on patient quality of life and health care experiences — could make a difference.
More importantly, the findings emphasise the need to minimise the burden of treatment, as well as the burden of disease, particularly for people with multiple long-term health conditions. The research also highlights the critical need to (re)design health care to meet the needs of those who depend on it most.
Katie Saunders is an analyst with RAND Europe and Charlotte Paddison is a health psychologist in the Department of Public Health and Primary Care at the University of Cambridge.
Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.