Healthcare needs, experiences and treatment burden in primary care patients with multimorbidity: An evaluation of process of care from patients' perspectives

Abstract

Background: Patients 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.

Objective: This study aimed to explore the extent to which treatment burden was associated with healthcare needs and patients' experiences.

Methods: Multisite 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.

Results: The 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.

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.

Keywords: Primary Care Assessment Tool (PCAT); Treatment Burden Questionnaire (TBQ); health services evaluation; multimorbidity; patients' experiences; process of care.