title: Multimorbidity and delivery of care for long-term conditions in the English National Health Service: baseline data from a cohort study.
abstract: OBJECTIVE
  Many patients with long-term conditions have multiple conditions. Current delivery of care is not designed around their needs and they may face barriers to effective self-management. This study assessed the relationships between multimorbidity, the delivery of care, and self-management.
  
  
  METHODS
  We surveyed 2439 patients with long-term conditions concerning their experience of the delivery of care and self-management in England in 2011. We assessed multimorbidity in terms of a count of long-term conditions and the presence of 'probable depression'. We explored the relationships between multimorbidity, patient experience of the delivery of care, and self-management
  
  
  RESULTS
  Neither measure of multimorbidity was a significant predictor of patients' experience of the delivery of care. Patients with multimorbidity reported higher levels of self-management behaviour, while the presence of depression was associated with less positive attitudes towards self-management.
  
  
  CONCLUSIONS
  The current data do not demonstrate a consistent impact of multimorbidity on patients' experience of care or on self-management. Further research is required to assess those types of multimorbidity that are associated with significant deficits, or to identify other aspects of care that might be problematic in the context of multiple conditions.
authors.affiliation: Professor of Health Services Research, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.forename: Mark
authors.initials: M
authors.lastname: Hann
authors.forename: Jo
authors.initials: J
authors.lastname: Rick
authors.forename: Kelly
authors.initials: K
authors.lastname: Rowe
authors.forename: Jenni
authors.initials: J
authors.lastname: Burt
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.forename: Joanne
authors.initials: J
authors.lastname: Protheroe
authors.forename: Gerry
authors.initials: G
authors.lastname: Richardson
authors.forename: David
authors.initials: D
authors.lastname: Reeves
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000458:organization & administration*; D003863:Depression / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012648:Self Care; D013222:State Medicine; D011795:Surveys and Questionnaires
keywords: long-term conditions care; multimorbidity; patient experience; self care