Validation of the Lithuanian multimorbidity treatment burden questionnaire (MTBQ) and its association with primary care patient characteristics

Figures & data

Table 1. Participant characteristics (n = 789).

	N	%
Mean age (SD), years	64.38 (9.7)
Age years (missing data: n = 38, 4.8%)
< 60	223	28.3
60–64	174	22.1
65–70	120	15.2
70+	234	29.7
Gender (missing data: n = 0; 0%)
Male	308	39.0
Female	481	61.0
Educational level (missing data: n = 6, 0.7%)
Primary education (0–10 years)	185	23.4
High school (11–12 years)	99	12.5
Some tertiary education (13–14 years)	275	34.9
University (14+ years)	224	28.4
Employment status (missing data: n = 3, 0.3%)
Employed	301	38.1
Unemployed	72	9.1
Employed in retirement	59	7.5
Retired	319	40.4
Other	35	4.4
Number of self-reported long-term conditions^a (missing data: n = 1, 0.1%)
2	65	8.2
3	216	27.4
4	147	18.7
5	108	13.7
> 5	252	32.0
Number of medications (missing date: n = 0; 0%)
0-4	245	31.1
> 5	544	68.9
Anxiety level (GAD-7 scale) (missing data: n = 2, 0.3%)
Minimal (0–4)	561	71.1
Mild or higher (5–21)	226	28.6
Depression level (PHQ-9 scale)
Minimal (0–4)	522	66.2
Mild or higher (5–27)	267	33.8
Area of residence
Urban	671	85.0
Rural	118	15.0
Health measure scores
Mean quality of life score (SD)b		0.74 (0.19)
Mean self-reported health score (SD)^c		3.62 (0.69)
Mean number of self-reported comorbidities (SD)		2.68(1.20)

^a Number of self-reported conditions including any of the 12 most common long-term conditions in Lithuania that were listed in the survey [2], and any additional self-reported conditions. Conditions within a cluster of similar risk factors and treatment methods (for example, asthma and COPD) were only counted once.

^c Score based on EQ-5D-5L index score [17].

^c Score based on the answers to a single question ‘How would you rate your health?:’ Excellent (1), Very good (2), Good (3), Fair (4), Poor (5).

Table 2. Responses to the Multimorbidity Treatment Burden Questionnaire (n = 789). question items with a large percentage of ‘does not apply’ responses (> 5%) are highlighted in bold.

Please tell us how much difficulty you have with the following:	Not difficult n (%)	A little difficult n (%)	Quite difficult n (%)	Very difficult n (%)	Extremely difficult n (%)	Does not apply n (%)	Missing data n (%)
1. Taking lots of medications	497 (63.0)	173 (21.9)	69 (8.7)	16 (2.0)	4 (0.5)	30 (3.8)	0 (0)
2. Remembering how and when to take medication	583 (73.9)	152 (19.3)	26 (3.3)	10 (1.3)	6 (0.8)	11 (1.4)	1 (0.1)
3. Paying for medications and treatment	640 (81.1)	96 (12.2)	31 (3.9)	10 (1.3)	6 (0.8)	6 (0.8)	0 (0)
4. Collecting prescription medication	718 (91.0)	49 (6.2)	9 (1.1)	1 (0.1)	0 (0)	12 (1.5)	0 (0)
5. Monitoring your medical conditions	662 (83.9)	87 (11.0)	21 (2.7)	5 (0.6)	4 (0.5)	10 (1.3)	0 (0)
6. Arranging appointments with health professionals	579 (73.4)	129 (16.3)	45 (5.7)	27 (3.4)	5 (0.6)	4 (0.5)	0 (0)
7. Seeing lots of different health professionals	422 (53.5)	190 (24.1)	106 (13.4)	47 (6.0)	10 (1.3)	14 (1.8)	0 (0)
8. Getting time off work, arranging transport, etc. to see doctors	516 (65.4)	143 (18.1)	62 (7.9)	35 (4.4)	9 (1.1)	24 (3.0)	0 (0)
9. Getting health care in the evenings and at weekends	321 (40.7)	98 (12.4)	33 (4.2)	8 (1.0)	1 (0.1)	326 (41.3)	2 (0.3)
10. Getting help from community services	323 (40.9)	86 (10.9)	31 (3.9)	3 (0.4)	5 (0.6)	341 (43.2)	0 (0)
11. Obtaining clear and up-to-date information about your condition	691 (87.6)	54 (6.8)	15 (1.9)	2 (0.3)	0 ()	27 (3.4)	0 (0)
12. Making recommended lifestyle changes	399 (50.6)	209 (26.5)	115 (14.6)	34 (4.3)	13 (1.6)	19 (2.4)	0 (0)
13. Having to rely on help from family and friends	693 (87.8)	49 (6.2)	19 (2.4)	1 (0.1)	2 (0.3)	25 (3.2)	0 (0)

Table 3. Association between global MTBQ score and other health and life quality measurement tools (EQ-5D-5L index score, self-rated health score, and the number of comorbidities).

Variable	Spearman’s rank correlations (rs)	P-values
EQ-5D-5L Index Score^a	−0.327	< 0.001
Self-rated health^b	0.230	< 0.001
Number of comorbidities^c	0.164	< 0.001

^a Based on EQ-5D-5L index score [17].

^bScore based on the answers to a single question ‘How would you rate your health?:’Excellent (1), Very good (2), Good (3), Fair (4), Poor (5).

^cNumber of self-reported conditions including hypertension, any of the 12 conditions that were listed in the survey, and any additional self-reported conditions. Conditions within a cluster of similar risk factors and treatment methods (for example, asthma and COPD) were only counted once.

Table 4. Factor reduction analysis results for the study population (N = 789) obtained from rotated component matrix with minimum factor loading values of 0.4.

	Factor 1	Factor 2	Factor 3
Q6	.854
Q7	.839
Q8	.850
Q3		.454
Q4		.449
Q5		.526
Q11		.483
Q12		.598
Q13		.649
Q1			.783
Q2			.808

Table 5. Partial proportional odds analysis for treatment burden within different patient groups (n = 789).

	Treatment burden score
	None (0)	Low (1–9)	Medium (10–21)	High (≥ 22)	Unadjusted OR^a	Adjusted OR^b	P-value
Participants (%)	153 (19.4)	368 (46.6)	197 (25.0)	65 (9.0)
Mean age, years (SD)	65.3 (9.7)	64.5 (9.8)	63.8 (9.5)	63.19 (9.7)	0.988 (0.974 to 1.002)	0.988 (0.974 to 1.002)	0.082
Gender (n, (%))
Female (ref.)	102 (21.2)	220 (45.7)	113 (23.5)	46 (9.6)
Male	51 (16.6)	148 (48.1)	84 (27.3)	25 (8.1)	1.190 (0.910 to 1.555)	1.130 (0.856 to 1.491)	0.204
Number of long-term conditions (n, (%))^c
2–4 (ref.)	106 (24.7)	204 (47.6)	98 (22.8)	21 (4.9)
5+	47 (13.1)	164 (45.6)	99 (27.5)	50 (13.9)	1.949 (1.492 to 2.546)	2.037 (1.531 to 2.711)	< 0.001
Number of medications (n, (%))^d
0–4 (ref.)	58 (23.7)	120 (49.0)	52 (21.2)	15 (6.1)
5+	95 (17.5)	248 (45.6)	145 (26.7)	56 (10.3)	1.518 (1.143 to 2.017)	1.532 (1.141 to 2.058)	0.004
Long-term conditions (n, (%))^e
Cardiovascular Disease (I20)	58 (18.8)	143 (46.3)	80 (25.9)	28 (9.1)	1.072 (0.820 to 1.402)	1.073 (0.810 to 1.422)	0.611
Long-term Ischaemic Heart Disease (I25)	12 (15.4)	38 (48.7)	20 (25.6)	8 (10.3)	1.175 (0.760 to 1.816)	1.307 (0.836 to 2.045)	0.241
Heart Failure (I50)	30 (12.9)	114 (49.1)	58 (25.0)	30 (12.9)	1.444 (1.084 to 1.924)	1.486 (1.105 to 1.999)	0.009
Atrial Fibrillation (I48)	21 (18.8)	50 (44.6)	29 (25.9)	12 (10.7)	1.111 (0.762 to 1.620)	1.189 (0.801 to 1.763)	0.390
Diabetes (E11)	46 (15.9)	137 (47.2)	77 (26.6)	30 (10.3)	1.298 (0.989 to 1.703)	1.184 (0.896 to 1.565)	0.060
Thyroid Gland Diseases (E06.3)	16 (19.8)	42 (51.9)	16 (19.8)	7 (8.6)	0.835 (0.545 to 1.277)	0.793 (0.515 to 1.220)	0.291
Hypothyroidism (E89)	6 (23.1)	8 (30.8)	10 (38.5)	2 (7.7)	1.346 (0.622 to 2.914)	1.345 (0.595 to 3.042)	0.451
Asthma or COPD (J44)	6 (22.2)	8 (29.6)	9 (33.3)	4 (14.8)	1.472 (0.688 to 3.152)	1.430 (0.644 to 3.177)	0.751
Asthma (J45)	14 (18.4)	27 (35.5)	25 (32.9)	10 (13.2)	1.535 (0.970 to 2.428)	1.470 (0.912 to 2.367)	0.067
Joint Disease (M05M06)	5 (17.2)	13 (44.8)	9 (31.0)	2 (6.9)	1.185 (0.589 to 2.383)	1.108 (0.544 to 2.255)	0.734
Osteoporosis (M80M81)	4 (14.3)	10 (35.7)	9 (32.1)	5 (17.9)	1.868 (0.898 to 3.884)	1.912 (0.902 to 4.050)	0.091
Long-term kidney disease (N18)	8 (16.3)	15 (30.6)	18 (36.7)	8 (16.3)	2.034 (1.148 to 3.604)	2.129 (1.188 to 3.815)	0.011
GAD-7 anxiety score (n, (%))^f
Low (0–4)	128 (22.8)	276 (49.2)	127 (22.6)	30 (5.3)
High (5–21)	25 (11.1)	92 (40.7)	69 (30.5)	40 (17.7)	2.392 (1.775 to 3.225)	2.395 (1.762 to 3.255)	< 0.001
PHQ-9 depression score (n, (%))^g
Low (0–4)	119 (22.8)	266 (51.0)	114 (21.8)	23 (4.4)
High (5–27)	34 (12.7)	102 (38.2)	83 (31.1)	48 (18.0)	2.502 (1.877 to 3.334)	2.520 (1.894 to 3.352)	< 0.001
Education level (n, (%))
0–13 years (ref.)	107 (19.1)	257 (45.9)	142 (25.4)	54 (9.6)
14+ years	44 (19.6)	109 (48.7)	54 (24.1)	17 (7.6)	0.900 (0.673 to 1.202)	1.011 (0.750 to 1.363)	0.475
Residential area
Urban (ref.)	139 (20.7)	318 (47.4)	168 (25.0)	46 (6.9)
Rural	14 (11.9)	50 (42.4)	29 (24.6)	25 (21.2)	1.833 (1.263 to 2.659)	1.869 (1.281 to 2.726)	0.001
Scores of health measures^h
Mean self-rated health score (SD)^i	3.35 (0.71)	3.64 (0.62)	3.74 (0.72)	3.87 (0.74)	1.828 (1.494 to 2.238)	1.834 (1.481 to 2.272)	< 0.001
EQ-5D-5L index score (SD)^j	0.81 (0.146)	0.75 (0.174)	0.69 (0.190)	0.63 (0.233)	0.060 (0.028 to 0.128)	0.049 (0.022 to 0.109)	< 0.001

Statistically significant (p < 0.05) values are indicated in bold.

^a Ordinal logistic regression.

^b Ordinal logistic regression adjusted for age, gender, and the number of comorbidities.

^c Number of long-term medical conditions, including hypertension, any of the 12 conditions listed in the survey, and all other conditions listed in the patient’s medical records. Conditions within a cluster of similar risk factors and treatment methods (such as asthma and COPD) were counted only once.

^d Number of regularly consumed medications based on patient self-reported data and medical records.

^e The 12 most frequently self-reported conditions. The reference group consists of individuals without the disorder (for example, the reference group for individuals with osteoporosis consists of individuals without osteoporosis).

^f Scores based on GAD-7 questionnaire [23].

^g Scores based on PHQ-9 questionnaire [24].

^h The scores of health measures are regarded as continuous variables and; therefore, odds ratio values represent the odds for an increase or decrease of the treatment burden category level for a one-unit increase in the health measure score.

ⁱ Score based on the answers to a single question ‘How would you rate your health?:’ Excellent (1), Very good (2), Good (3), Fair (4), Poor (5).

^j Score based on EQ-5D-5L index score [17].

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