Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey
Open accessAbstract
Objectives: To investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England. Design: Cross-sectional study using data from 199 150 survey responses. Setting: Primary care and community-based services. Participants: Respondents to the 2018 English General Practice Patient Survey with at least one long-term condition. Primary and secondary outcome measures: The primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors. Results: There was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need. Conclusions: Levels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.
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Tudor Hart's inverse care law states that people most in need of health care are least likely to seek it or receive it; the law reflects two mutually-reinforcing phenomena-worse health in deprived localities and barriers to accessing healthcare in those same localities.
“Tudor Hart's (71) inverse care law states that people most in need of health care are least likely to seek it or receive it; the law reflects two mutually-reinforcing phenomena—worse health in deprived localities and barriers to accessing healthcare in those same localities (47, 48, 72, 73).”
From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [73]
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“Tudor Hart’s (71) inverse care law states that people most in need of health care are least likely to seek it or receive it; the law reflects two mutually-reinforcing phenomena—worse health in deprived localities and barriers to accessing healthcare in those same localities (47, 48, 72, 73).”
Background
- Authors
- Rolewicz, L., Keeble, E., Paddison, C., & Scobie, S.
- Affiliations
- Nuffield Trust (GB)
- Corresponding author
- Rolewicz, Lucina
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2020-11
- Volume
- 10
- Issue
- 11
- Pages
- e041569
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC7668368
- OpenAlex
- W3103314577
- Cited by
- 25
- References
- 21
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 6 · 2023: 2 · 2022: 5 · 2021: 1
- FWCI
- 1.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
- Keywords
- multimorbidity, unmet needs, general practice, primary care, community-based services, patient-reported outcomes, social isolation, frailty, ethnic differences, young patients, care coordination, individualized care, health disparities
- MeSH terms
- Activities of Daily Living, Adolescent, Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, England, Female, Health Services Needs and Demand, Humans, Male, Middle Aged, Surveys and Questionnaires, Young Adult, General Practice
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