1. Table 1: Analyses of predictors of health care hassles
What ‘hassles’ do patients with multimorbidity report? Which patients report most ‘hassles’?
Charles Adeniji, Peter Bower, Cassandra Kenning
Centre for Primary Care, Institute of Population Health, University of Manchester
Background
‘Hassles’ scale
Table 1: Analyses of predictors of health care hassles
Lack of information about my medical condition (55%)
Lack of information about treatment options (60%)
Lack of information about why my medication was prescribed (50 %)
Problems getting my medication refilled on time (23%)
Uncertainty about when or how to take my medications (18%)
Side effect from my medications (48 %)
Lack of information about referral to a specialist (24%)
Having to wait a long time to get a specialist appointment (60%)
Poor communication between different doctors or clinics (55 %)
Disagreement between doctors about diagnosis or treatment (31%)
Lack of information about why I need lab test or x-rays (32 %)
Having to wait too long to find out results of lab tests or x-rays (42 %)
Difficulty getting advice between appointments (46 %)
Lack of time to discuss all my problems during appointments (43%)
Having my concerns ignored or overlooked (36 %)
Appointments that interfere with my work, family, or hobbies (24%)
Primary care services are designed for single long term conditions, whereas many older patients have more than one (Salisbury 2011)
Patients with multimorbidity experience ‘hassles’ in their care, including multiple appointments, poor co-ordination, and conflicting recommendations (Bayliss 2007;Fortin 2007; Smith 2012)
There is limited quantitative evidence on the hassles that patients experience, or factors predicting hassles
Conclusion
References
Methods
Results
The OPTIMUM study surveyed 1500 patients with multimorbidity from 4 practices in Greater Manchester
Measures included demography, multimorbidity and ‘hassles’ using the Parchman scale
The Parchman scale evaluates difficulties that patients experience during encounters with the health care system
The next panel shows the items in the hassles scale
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 may be important in reducing hassles
New models of service delivery need to be tested to improve the experience of patients with multimorbidity
Overall, 32% of patients completed the measures
Most frequent hassles related to lack of information, poor communication, and poor access to specialist care
Numbers of long-term conditions, current employment, and symptoms of depression predicted high levels of hassles
Reports of a discussion with the GP about long-term conditions in the last 12 months and increasing age were associated with lower reported hassles
Bayliss, E et al (2007) The Annals of Family Medicine, 5(5),
Fortin, M et al (2007) British Medical Journal, 334(7602), 1016
Parchman, M. et al (2005) Medical Care, 43(11),
Salisbury, C. et al (2011). British Journal of General Practice, 61(582), e12-e21
Smith, S. et al (2012). Cochrane Database Syst Rev, 4
Univariate Analysis
Multivariate Analysis
Clinical
Number of conditions
7 , 2-20
0.055
0.011
0.219
0.000*
0.042
0.012
0.167
0.001*
Depression (1=No, 2= Yes)
No = 58.3%; Yes = 41.7%
0.340
0.074
0.210
-0.103
0.086
-0.064
0.233
Combined Anxiety and Depression (HADS) Baseline score (0-40)
13 ± 7.8,
0.005
0.400
0.038
0.006
0.352
Others
How long had LTC? (grpd: less than 5 years and more than 5 years)
less than 5 years = 15 .1% ; more than 5yrs = 84.9%
0.004
0.104
0.002
0.969
-0.099
0.098
-0.044
0.311
Overall health score (1=poor, 2=fair, 3=good, 4= very good, and 5=excellent)
Poor=16%, fair=41.6%, good=32.9%, very good=7.8%, excellent=0.8%, missing=0.8%
-0.207
-0.225
-0.021
0.049
-0.023
0.666
Discussed with GP in 12 month (1=No, 2= Yes)
No = 21.8%; others = 78.2%
-0.188
0.091
-0.096
0.038*
-0.183
0.084
-0.095
0.030*
Number of observations = 429, F change =10.224;R square change = .228