Hows does treatment burden change over time among people with multimorbidity? A follow-up survey and evaluation of a single-item measure

Problem

Treatment burden is the workload of being a patient and its impact on wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. The aim of this study was to quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity.

Approach

A 2.5-year follow-up of a cross-sectional postal survey via six general practices in Dorset, England. GP practices identified participants of the baseline survey. Data on treatment burden (measured using the Multimorbidity Treatment Burden Questionnaire; MTBQ), sociodemographics, clinical variables, health literacy and financial resource were collected. Change in treatment burden was described, and associations assessed using regression models. Diagnostic test performance metrics evaluated the single-item measure relative to the MTBQ.

Findings

301 participants were recruited (77.6% response rate). Overall, there was a 2.6% increase in treatment burden. 98 (32.6%) and 53 (17.6%) participants experienced an increase and decrease, respectively, in treatment burden category. An increase in treatment burden was associated with having more than five long-term conditions (ß:8.26 (95% CI: 4.20 to 12.32) and living ≥10 minutes (vs <10 minutes) from the GP (aß:3.88 (95% CI: 1.32 to 6.43)), particularly for participants with limited health literacy (mean difference: aß:9.59 (95% CI: 2.17 to 17.00)). The single-item measure performed moderately with sensitivity: 56.5%; specificity: 92.5%, positive predictive value 66.0%, negative predictive value of 89.2%, positive likelihood ratio 7.53, negative likelihood ratio 0.47. ConclusionsTreatment burden changes over time for people with multimorbidity. Improving access to primary care, particularly for those living further away from services, and enhancing health literacy, may mitigate increases in burden.

Consequences

As the UK population ages, more people are living with several long-term health problems and need to manage their differing demands. This includes attending many appointments with different doctors and health professionals, taking several medications and making lifestyle changes. The workload and impact of doing these things has been called ‘treatment burden’. Some people may feel ‘overburdened’ by everything they have to do to look after their health, and this may lead to them not adhering to treatment plans. Our study suggests improving access to primary care, particularly for those living further away from services, and enhancing health literacy, may mitigate increases in this burden.