title: Does patient experience of multimorbidity predict self-management and health outcomes in a prospective study in primary care?
abstract: BACKGROUND
  There is a need to better understand the mechanisms which lead to poor outcomes in patients with multimorbidity, especially those factors that might be amenable to intervention.
  
  
  OBJECTIVE
  This research aims to explore what factors predict self-management behaviour and health outcomes in patients with multimorbidity in primary care in the UK.
  
  
  METHODS
  A prospective study design was used. Questionnaires were mailed out to 1460 patients with multimorbidity. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery and outcomes (three measures of self-management: behaviours, Self-monitoring and Insight and medication adherence; and a measure of self-reported health).
  
  
  RESULTS
  In total, 36% (n = 499) of patients responded to the baseline survey and 80% of those respondents completed follow-up. Self-management behaviour at 4 months was predicted by illness perceptions around the consequences of individual conditions. Self-monitoring and Insight at 4 months was predicted by patient experience of 'Hassles' in health services. Self-reported medication adherence at 4 months was predicted by health status, Self-monitoring and Insight and 'Hassles' in health services. Perceived health status at 4 months was predicted by age and patient experience of multimorbidity.
  
  
  CONCLUSIONS
  This research shows that different factors, particularly around patients' experiences of health care and control over their treatment, impact on various types of self-management. Patient experience of multimorbidity was not a critical predictor of self-management but did predict health status in the short term. The findings can help to develop and target interventions that might improve outcomes in patients with multimorbidity.
authors.affiliation: Institute of Population Health, NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), Cassandra.kenning@manchester.ac.uk.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Kenning
authors.affiliation: Institute of Population Health, NIHR Collaboration for Applied Health Research and Care, Greater Manchester (GM-CLAHRC), Manchester Academic Health Science Centre (MAHSC).
authors.forename: Peter A
authors.initials: PA
authors.lastname: Coventry
authors.affiliation: Institute of Population Health, NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC).
authors.forename: Chris
authors.initials: C
authors.lastname: Gibbons
authors.affiliation: Institute of Population Health, School of Nursing, Midwifery and Social Work and.
authors.forename: Penny
authors.initials: P
authors.lastname: Bee
authors.affiliation: Institute of Population Health, NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC).
authors.forename: Louise
authors.initials: L
authors.lastname: Fisher
authors.affiliation: Institute of Population Health, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001294:Attitude to Health; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D004739:England / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006304:Health Status; D006801:Humans; D007389:Internal-External Control; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries; D012648:Self Care / Q000523:psychology* / Q000706:statistics & numerical data; D057566:Self Report; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
keywords: Co-existent conditions; health services; primary health care; prospective studies; self-care; self-report.