Morris James E, Roderick Paul J, Harris Scott, Yao Guiqing, Crowe Sam, Phillips David, Duncan Polly, Fraser Simon Ds
School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton.
Department of Health Sciences, University of Leicester, Leicester.
Br J Gen Pract. 2021 Apr 29;71(706):e381-e390. doi: 10.3399/BJGP.2020.0883. Print 2021 May.
Treatment burden is the effort required of patients to look after their health, and the impact this has on their wellbeing. Quantitative data on treatment burden for patients with multimorbidity are sparse, and no single-item treatment burden measure exists.
To determine the extent of, and associations with, high treatment burden among older adults with multimorbidity, and to explore the performance of a novel single-item treatment burden measure.
Cross-sectional postal survey via general practices in Dorset, UK.
Patients ≥55 years, living at home, with three or more long-term conditions (LTCs) were identified by practices. Treatment burden was measured using the Multimorbidity Treatment Burden Questionnaire. Data collected were sociodemographics, LTCs, medications, and characteristics including health literacy and financial resource. Associations with high treatment burden were investigated via logistic regression. Performance of a novel single-item measure of treatment burden was also evaluated.
A total of 835 responses were received (response rate 42%) across eight practices. Patients' mean age was 75 years, 55% were female ( = 453), and 99% were white ( = 822). Notably, 39% of patients self-reported fewer than three LTCs ( = 325). Almost one-fifth (18%) of responders reported high treatment burden ( = 150); making lifestyle changes and arranging appointments were particular sources of difficulty. After adjustment, limited health literacy and financial difficulty displayed strong associations with high treatment burden; more LTCs and more prescribed regular medications were also independently associated. The single-item measure discriminated moderately between high and non-high burden with a sensitivity of 89%, but a specificity of 58%.
High treatment burden was relatively common, underlining the importance of minimising avoidable burden. More vulnerable patients, with less capacity to manage, are at greater risk of being overburdened. Further development of a single-item treatment burden measure is required.
治疗负担是患者照顾自身健康所需付出的努力及其对健康状况的影响。关于多病共存患者治疗负担的定量数据稀少，且不存在单一项目的治疗负担衡量指标。
确定多病共存的老年人中高治疗负担的程度及其相关因素，并探索一种新型单一项目治疗负担衡量指标的性能。
通过英国多塞特郡的全科医疗进行横断面邮寄调查。
各医疗机构识别出年龄≥55岁、居家且患有三种或更多长期疾病（LTCs）的患者。使用多病共存治疗负担问卷来衡量治疗负担。收集的数据包括社会人口统计学信息、长期疾病、药物治疗以及包括健康素养和财务状况在内的特征。通过逻辑回归研究与高治疗负担的相关性。还评估了一种新型单一项目治疗负担衡量指标的性能。
在八个医疗机构共收到835份回复（回复率42%）。患者的平均年龄为75岁，55%为女性（n = 453），99%为白人（n = 822）。值得注意的是，39%的患者自我报告的长期疾病少于三种（n = 325）。近五分之一（18%）的受访者报告有高治疗负担（n = 150）；改变生活方式和安排预约是特别困难的来源。调整后，健康素养有限和经济困难与高治疗负担有很强的相关性；更多的长期疾病和更多的常规处方药也独立相关。该单一项目衡量指标在高负担和非高负担之间有中等程度的区分能力，敏感性为89%，但特异性为58%。
高治疗负担相对常见，这凸显了将可避免的负担降至最低的重要性。管理能力较弱的更脆弱患者负担过重的风险更大。需要进一步开发单一项目治疗负担衡量指标。
