What are the core predictors of 'hassles among patients with multimorbidity in primary care? A cross sectional study

Background A limitation of service delivery in primary care is that health care services are skewed towards improving care for patients with single long term conditions, whereas many older patients seen in the primary care nowadays have more than one condition. Qualitative research suggests that patients experience ‘hassles’ in their care, including multiple appointments, poor co-ordination, and conflicting recommendations. However, there is limited quantitative evidence on the ‘hassles’ that patients with multimorbidity experience, or factors predicting ‘hassles’ in patients with multimorbidity. Methods We conducted a cross sectional study, mailing questionnaires to 1460 patients with multimorbidity identified from the disease registers of four general practices in the UK. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery. Data were analysed using regression modelling to assess the factors predicting ‘hassles’ in patients with multimorbidity. Results In total 33% (n=486) of patients responded to the baseline survey. The ‘hassles’ most often reported by patients related to lack of information about conditions and treatment options, poor communication among health professionals, and poor access to specialist care. There was a significant relationship between numbers of conditions, and reports of ‘hassles’. In multivariate analysis, 5 variables predicted more ‘hassles’: more long-term conditions, symptoms of anxiety and depression, younger age, being in paid employment, and not having a discussion with their GP in the last 12 months. Conclusion This study identifies fives predictors of ‘hassles’ in patients with multimorbidity. Being of younger age (standardised Beta of -0.102, t-test =-1.990, P=0.047) and being in paid employment (standardised Beta of -0.099, t-test =-2.040, P=0.042) remained correlated to greater levels of ‘hassles’. Number of conditions (standardised Beta of 0.167, t-test =3.383, P=0.001), and presence of anxiety/ depression (standardised Beta of 0.352, t-test =6.007, P=0.000) also remained positively correlated and seeing their GP about their long-term conditions in the last 12 months remained a protective factor (standardised Beta of -0.095, t-test = -2.176, P=0.030). This research was funded by the National Institute for Health Research (NIHR) School for Primary Care Research, and via a Research Capability Funding’ grant from the NIHR Collaboration for Leadership in Applied Health Research and Care for Greater Manchester. This article presents independent research commissioned by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. The funders had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; and the preparation, review, or approval of the manuscript.