Healthcare needs, experiences, and treatment burden in primary care patients with multimorbidity: an evaluation of process of care from patients' perspectives

Background: Patients with multimorbidity often experience treatment burden as a result of fragmented, specialist-driven healthcare. The ‘family doctor team’ is an emerging service model in China to address the increasing need for high-quality routine primary care. Objective: To explore the extent to which treatment burden was associated with healthcare needs and patients’ experiences. Methods: Multi-site surveys were conducted in primary care facilities in Guangdong province, southern China. Interviewer-administered questionnaires were used to collect data from patients (N=2,160) who had ≥two clinically-diagnosed long-term conditions (multimorbidity) and had ≥one clinical encounter in the past 12 months since enrolment registration with the family doctor team. Patients’ experiences and treatment burden were measured using a previously-validated, Chinese version of the Primary Care Assessment Tool (PCAT) and the Treatment Burden Questionnaire, respectively. Results: The mean age of patients was 61.4 years and slightly over half were females. Patients who had a family doctor team as the primary source of care reported significantly higher PCAT scores (mean difference 7.2 points, p<0.001) and lower treatment burden scores (mean difference −6.4 points, p<0.001) when compared to those who often bypassed primary care. Greater healthcare needs were significantly correlated with increased treatment burden (β-coefficient 1.965, p<0.001), whilst better patients’ experiences were associated with lower treatment burden (β-coefficient −0.252, p<0.001) after adjusting for confounders. Conclusion: The inverse association between patients’ experiences and treatment burden supports the importance of primary care in managing patients with multimorbidity. Patient contribution: Primary care service users were involved in the instrument development and data collection. (250 words) Keywords Process of care; multimorbidity; patients’ experiences; primary care assessment tool (PCAT); treatment burden questionnaire (TBQ); health services evaluation