title: Why do patients with multimorbidity in England report worse experiences in primary care? Evidence from the General Practice Patient Survey.
abstract: OBJECTIVE
  To describe and explain the primary care experiences of people with multiple long-term conditions in England.
  
  
  METHODS
  Using questionnaire data from 906,578 responders to the English 2012 General Practice Patient Survey, we describe the primary care experiences of patients with long-term conditions, including 583,143 patients who reported one or more long-term conditions. We employed mixed effect logistic regressions to analyse data on six items covering three care domains (access, continuity and communication) and a single item on overall primary care experience. We controlled for sociodemographic characteristics, and for general practice using a random effect, and further, controlled for, and explored the importance of, health-related quality of life measured using the EuroQoL (EQ-5D) scale.
  
  
  RESULTS
  Most patients with long-term conditions report a positive experience of care at their general practice (after adjusting for sociodemographic characteristics and general practice, range 74.0-93.1% reporting positive experience of care across seven questions) with only modest variation by type of condition. For all three domains of patient experience, an increasing number of comorbid conditions is associated with a reducing percentage of patients reporting a positive experience of care. For example, compared with respondents with no long-term condition, the OR for reporting a positive experience is 0.83 (95% CI 0.80 to 0.87) for respondents with four or more long-term conditions. However, this relationship is no longer observed after adjusting for health-related quality of life (OR (95% CI) single condition=1.23 (1.21 to 1.26); four or more conditions=1.31 (1.25 to 1.37)), with pain making the greatest difference among five quality of life variables included in the analysis.
  
  
  CONCLUSIONS
  Patients with multiple long-term conditions more frequently report worse experiences in primary care. However, patient-centred measures of health-related quality of life, especially pain, are more important than the number of conditions in explaining why patients with multiple long-term conditions report worse experiences of care.
authors: Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
authors: Charlotte A M
authors: CA
authors: Paddison
authors: RAND Europe, Cambridge, UK.
authors: Catherine L
authors: CL
authors: Saunders
authors: Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
authors: Gary A
authors: GA
authors: Abel
authors: Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
authors: Rupert A
authors: RA
authors: Payne
authors: Department of Primary Care, University of Exeter, Exeter, UK.
authors: John L
authors: JL
authors: Campbell
authors: Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
authors: Martin
authors: M
authors: Roland
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D003142:Communication; D003625:Data Collection; D004739:England; D005260:Female; D058006:General Practice; D006262:Health; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction; D011320:Primary Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Multimorbidity; PRIMARY CARE; Patient experience