Quality of life and burden of morbidity in primary care users with multimorbidity

Abstract

Purpose

The aim of this study was to assess the quality of life, number of diseases and burden of morbidity of multimorbid primary care users and whether a simple disease count or a multimorbidity burden score is more predictive of quality of life.

Patients and methods

Primary care patients with at least 1 of 11 specified chronic conditions were invited to participate in a postal survey. Participants completed the Disease Burden Impact Scale (DBIS) questionnaire, the five dimension-five level Euro-Qol (EQ-5D-5L) and standard demographics questions. The DBIS asks participants to self-report chronic conditions and to rate the impact of each condition. Descriptive statistics and analysis of variance were used to determine quality of life, count of diseases and burden of morbidity. Multiple linear regression analyses determined whether disease count or the DBIS, adjusted for demographics, was more predictive of the EQ-5D-5L scores.

Results

Thirty-one percent (n=917) responded, from which 69 were excluded as they reported no or only one condition, leaving 848 (92%) in the analysis. Slightly more women (50.9%) participated; the mean age was 67.0 (SD 13.9) and the mean number of conditions was 6.5 (SD 3.49). The mean scores were: DBIS 15.5 (SD 12.00; score range 0–140, with higher scores indicating higher multimorbidity burden), EQ-5D-5L score 0.69 (SD 0.28; score range −0.28 [a state worse than death] to 1 [best possible health state]) and EQ-5D Visual Analog Scale (EQ-VAS) 65.44 (SD 23.66; score range 0–100 with higher scores meaning better health). The model using the DBIS score was more predictive of the EQ-5D-5L score and EQ-VAS than the model using the disease count (R²_adj=0.53 using DBIS and R²_adj=0.42 using disease count for EQ-5D-5L score, and R²_adj=0.44 using DBIS versus R²_adj=0.34 using disease count for EQ-VAS). All models were statistically significant (p<0.001).

Conclusion

The DBIS is a useful measure for assessing multimorbidity from the perspective of primary care users in particular, as it is more predictive of health outcomes than a simple count of conditions.

Keywords:

• multimorbidity
• quality of life
• chronic disease
• disease burden
• patient-reported outcomes

Acknowledgments

We thank the participants with long-term conditions for taking part in this study, all the organizations which helped us to recruit participants and Dr Louise Geneen for the support given in data collection. We also thank Dr Elizabeth Bayliss, University of Colorado, for granting permission to use the DBIS questionnaire. This research was funded by the Policy Research Programme (PRP) in the Department of Health England, which supports the Quality and Outcomes of Person-centred Care Policy Research Unit (QORU), and by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust. The abstract of this paper was presented at the 24th Annual Conference of the International Society for Quality of Life Research, Philadelphia, Pennsylvania, USA, 18–21 October 2017 as an oral presentation of the interim findings. The poster’s abstract was published in “Abstracts” in Quality of Life Research, October 2017, Volume 26, Supplement 1, https://link.springer.com/content/pdf/10.1007%2Fs11136-017-1658-6.pdf.

The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Author contributions

The study was conceived and designed by MP, RF, JF, CJ and EG. Data collection and cleaning were undertaken by CMP and LK. MP led the data analysis with the support of LK, CMP and CJ. All authors contributed to the data interpretation. MP led the drafting and revising of the manuscript, supported by all the other authors. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.