چکیده (انگلیسی):

Background:The burden of morbidity represented by patients with long term conditions (LTCs) varies substantially
between general practices. This study aimed to determine the characteristics of general practices with high
morbidity burden.
Method:Retrospective cross-sectional study; general practices in England, 2014/15. Three composite morbidity
measures (MMs) were constructed to quantify LTC morbidity at practice level: a count of LTCs derived from the 20
LTCs included in the UK Quality and Outcomes Framework (QOF) disease registers, expressed as‘number of QOF
LTCs per 100 registered patients’; the % of patients with one or more QOF LTCs; the % of patients with one or
more of 15 broadly defined LTCs included in the GP Patient Survey (GPPS). Determinants of MM scores were
analysed using multi-level regression models. Analysis was based on a national dataset of English general practices
(n= 7779 practices); GPPS responses (n= 903,357); general practice characteristics (e.g. list size, list size per full time
GP); patient demographic characteristics (age, deprivation status); secondary care utilisation (out-patient, emergency
department, emergency admission rates).
Results:Mean MM scores (95% CIs) were: 57.7 (±22.3) QOF LTCs per 100 registered patients; 22.8% (±8.2) patients
with a QOF LTC; 63.5% (±11.7) patients with a GPPS LTC. The proportion of elderly patients and social deprivation
scores were the strongest predictors of each MM score; scores were largely independent of practice characteristics.
MM scores were positive predictors of secondary care utilization and negative predictors’ access, continuity of care
and overall satisfaction.
Conclusions:Wide variation in LTC morbidity burden was observed across English general practice. Variation was
determined by demographic factors rather than practice characteristics. Higher rates of secondary care utilisation in
practices with higher morbidity burden have implications for resource allocation and commissioning budgets;
lower reported satisfaction in these practices suggests that practices may struggle with increased workload. There is
a need for a readily available metric to define the burden of morbidity and multimorbidity in general practice.