Does patient experience of multimorbidity predict self-management and health outcomes in a prospective study in primary care?

Fam Pract. 2015 Jun;32(3):311-6. doi: 10.1093/fampra/cmv002. Epub 2015 Feb 24.

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.

Keywords: Co-existent conditions; health services; primary health care; prospective studies; self-care; self-report..

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / psychology
  • Attitude to Health*
  • Chronic Disease / epidemiology
  • Chronic Disease / psychology*
  • Comorbidity*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / psychology
  • England / epidemiology
  • Female
  • Forecasting
  • Health Status
  • Humans
  • Internal-External Control
  • Male
  • Medication Adherence / psychology*
  • Medication Adherence / statistics & numerical data
  • Middle Aged
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Primary Health Care / statistics & numerical data*
  • Prospective Studies
  • Registries
  • Self Care / psychology*
  • Self Care / statistics & numerical data
  • Self Report
  • Surveys and Questionnaires