Core predictors of ‘hassles’ among patients with multimorbidity in primary care

A major problem in current primary care is that services are set up for single long term conditions, whereas many older patients have more than one.  Studies conducted through interviews only suggest that patients experience ‘hassles’ in their care, including multiple appointments, poor co-ordination, and conflicting recommendations.  However, there is limited significant evidence on the hassles that patients experience, or factors predicting hassles.

This study involved mailing questionnaires to 1460 patients with multimorbidity identified from 4 large practices in Greater Manchester.  Patients completed measures including demography, multimorbidity, and ‘hassles’ that patients with multimorbidity experience utilising the services (primary care).

The most frequently reported hassles related to lack of information about conditions and treatment options and poor communication among health professionals, as well as poor access to specialist care.  Our studies found that the major causes of the reported hassles are numbers of long-term conditions, current employment status, and symptoms of depression predicted high levels of hassles.  These suggest that for patients living with multiple long term conditions, the greater the number of long term condition the higher the level of hassles and being in paid employment suggest a higher level of hassles, as well as not having a regular discussion with their GP in the las one year suggest a higher level of hassle.

As expected, increasing numbers of long-term conditions were associated with increasing reports of hassles.  It is not clear whether the associations with depression and age represent reporting issues, or more clinically important effects.  The study did suggest that frequent discussions with the GP might be important in reducing perceptions of hassles.  A priority for future research should be development and testing of new models of service delivery to improve the experience of patients with multimorbidity and overall health outcome.



What are the core predictors of ‘hassles’ among patients with multimorbidity in primary care? A cross sectional study.
Adeniji C, Kenning C, Coventry PA, Bower P.
BMC Health Serv Res. 2015 Jul 3


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