Treatment burden for patients with multimorbidity: cross-sectional study with exploration of a single-item measure

Abstract

Background: Treatment burden is the effort required of patients to look after their health, and the impact this has on their wellbeing. Quantitative data on treatment burden for patients with multimorbidity are sparse, and no single-item treatment burden measure exists. Aim: To determine the extent of, and associations with, high treatment burden among older adults with multimorbidity, and explore the performance of a novel single-item treatment burden measure. Design and Setting: Cross-sectional postal survey via general practices in Dorset. Method: Patients ≥55y, living at home, with ≥3 long-term conditions (LTCs) were identified by practices. Treatment burden was measured using the Multimorbidity Treatment Burden Questionnaire. Data collected included: sociodemographics; LTCs; medications; and characteristics including health literacy and financial resource. Associations with high treatment burden were investigated via logistic regression. Performance of a single-item measure was evaluated. Results: 835 responses were received (response rate 42%) across 8 practices: mean age 75y; 55% female; 99% White. Notably 39% self-reported <3 LTCs. 18% reported high treatment burden; making lifestyle changes and arranging appointments were notable sources of difficulty. After adjustment, limited health literacy, and financial difficulty, displayed strong associations with high treatment burden; more LTCs and more prescribed regular medications were also independently associated. The single-item measure discriminated moderately between high/non-high burden; sensitivity 89%, but specificity 58%. Conclusion: High treatment burden was relatively common, underlining the importance of minimising avoidable burden. Further development of a single-item measure is required. More vulnerable patients, with less capacity to manage, are at greater risk of being overburdened.