Background
Method
Study design
Exclusion criteria
Composite measures of long term condition morbidity
Morbidity measure 1 [number of QOF LTCs per 100 registered patients] (Mean prevalence)a | Morbidity measure 2 [% of patients with one or more QOF LTCs] | Morbidity measure 3 [% of patients with one or more GPPS LTCs] |
---|---|---|
Coronary Heart Disease (3.29%) Peripheral arterial disease (0.63%) Stroke or TIA (1.7%) Hypertension (14.05%) Diabetes (5.31%) Chronic Obstructive Pulmonary Disease (1.89%) Chronic Kidney Disease (3.26%) Asthma (5.97%) Schizophrenia & bipolar affective disorder (0.91%) Atrial fibrillation (1.59%) Dementia (5.31%) Depression (5.72%) Epilepsy (0.63%) Heart failure (0.73%) Learning difficulty (0.46%) Osteoporosis (0.06%) Palliative care (0.32%) Cancer (2.22%) Rheumatoid arthritis (0.61%) Obesity (7.61%) | Coronary Heart Disease Peripheral arterial disease Stroke or TIA Hypertension Diabetes Chronic Obstructive Pulmonary Disease Chronic Kidney Disease Asthma Schizophrenia & bipolar affective disorder | Dementia or Alzheimer’s Angina or long term heart condition Arthritis or long term joint condition Asthma or long term chest condition Blindness or severe visual impairment Cancer in last 5 years Deafness or severe hearing impairment Diabetes Epilepsy Hypertension Kidney or liver disease Learning difficulty Long term back problem Long term mental health problem Long term neurological problem |
Statistical analysis
Results
Sample characteristics
Practice or population characteristic | Mean (SD), or n |
---|---|
GP training practice | n = 1911 |
QOF clinical domain score | 411 (31.5) |
Practice list size | 7355 (4370) |
Practice list size per full-time equivalent GP | 1805 (686) |
Registered patients aged 45–64 years (%) | 25.4 (4.3) |
Registered patients aged 65–74 years (%) | 9.2 (3.4) |
Registered patients aged 75–84 years (%) | 5.4 (2.1) |
Registered patients aged ≥85 years (%) | 2.2 (1.1) |
Index of Multiple Deprivation score (IMD-2010) | 26.2 (17.4) |
Population Ethnicity: South Asian (%) | 8 (13) |
Population Ethnicity: African or Caribbean (%) | 4 (6) |
Long Term Condition morbidity prevalence values in general practices
Morbidity measure 1: number of QOF LTCs per 100 registered patients | Morbidity measure 2: % of patients with one or more QOF LTCs | Morbidity measure 3: % of patients with one or more GPPS LTCs | |
---|---|---|---|
Mean value (5th–95th centiles) | 56.7 (35.1–76.7) | 22.6% (14.3–29.5) | 63.5% (51.8–73.8) |
Predictor variables: Beta coefficients for variables that were significantly associated with higher morbidity burden (P < 0.05); n/s denotes not significant | |||
---|---|---|---|
Morbidity measure 1: | Morbidity measure 2: | Morbidity measure 3: | |
Registered patients aged 45–64 years (%) | 0.17 | 0.23 | 0.15 |
Registered patients aged 65–74 years (%) | 0.34 | 0.43 | 0.15 |
Registered patients aged 75–84 years (%) | 0.27 | 0.38 | 0.33 |
Registered patients aged ≥85 years (%) | 0.22 | 0.02 | n/s |
IMD score | 0.51 | 0.35 | 0.62 |
QOF points (clinical domain indicators) | 0.11 | 0.04 | n/s |
Training Practice status | n/s | −0.16 | n/s |
Proportion of population of African/Caribbean ethnicity | −0.13 | −0.03 | −0.15 |
Proportion of population of South Asian ethnicity | −0.04 | 0.04 | −0.10 |
List size per FTE GP | n/s | n/s | −0.03 |
LTC morbidity burden as a predictor of health service utilization
Beta coefficient (all p <0.05) | |||
---|---|---|---|
Morbidity measure 1 | Morbidity measure 2 | Morbidity measure 3 | |
Emergency admissions per 1000 (crude rate) | 0.28 | 0.35 | 0.21 |
A + E attendance per 1000 (crude rate) | 0.30 | 0.38 | 0.21 |
Outpatients attendance per 1000 (crude rate) | 0.27 | 0.47 | 0.14 |
LTC morbidity burden as a predictor of patient satisfaction
GPPS question | Morbidity measure 1 | Morbidity measure 2 | Morbidity measure 3 |
---|---|---|---|
B coefficients (P < 0.05) ; N/S denotes non-significant | |||
Access (q3) | −0.08 | −0.29 | −0.21 |
Access (q18) | −0.05 | −0.19 | −0.12 |
Continuity of care (q9) | −0.17 | −0.37 | −0.10 |
Communication (Reception) (q4) | n/s | n/s | n/s |
Communication (Doctor) (q21a-e) | n/s | n/s | n/s |
Communication (Nurse) (q23a-e) | 0.14 | 0.40 | 0.13 |
Overall experience (q28) | n/s | n/s | −0.04 |