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.
- health policy
- quality in health care
- primary care
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Twitter @LucinaRolewicz, @eiliskeeble, @CAM_Paddison, @SarahScobie2
Contributors LR, EK and SS drafted the initial paper and had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. SS conceived the initial research questions. CP conducted a literature review into previous studies on multimorbidity and unmet need. LR, EK, CP and SS reviewed/edited the manuscript, refined the research questions and contributed to discussion; contributed to the revision of the paper, approved the final version of the manuscript and agreed to be accountable for all aspects of the work. LR and EK completed the statistical analysis.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data may be obtained from a third party and are not publicly available. Patient-level General Practice Patient Survey (GPPS) data are pseudonymised and non-identifiable. Data were shared under a Data Sharing Agreement between the Disclosing Data Controller (NHS England) and the Receiving Data Controller (Nuffield Trust). This agreement covers the use of these data for this analysis only and cannot be processed for any other purpose. The data can be requested through NHS England’s Insight Team at firstname.lastname@example.org.
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