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Half of primary care consultations involve more than one condition

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More than a half of patients presenting in primary care now have two or more long-term conditions, which may lead longer consultations with practice nurses and GPs, a new study has indicated.

Researchers found more than a quarter of patients registered with practices in England had so-called “multi-morbidity” and that these patients accounted for over half of consultations in their study.

“More than half of GP consultations are for patients living with two or more long-term conditions”

Helen Stokes-Lampard

High blood pressure, mental health problems and pain were the most common conditions found by the researchers from Cambridge University, Bristol University and the University of Utah in the US.

Writing in the British Journal of General Practice, they noted: “Multi-morbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available.”

As a result, the researchers looked at a sample of 403,985 adult patients registered with a general practice and assessed, conditions, consultations, prescriptions, and admissions over four years.

Multi-morbidity was defined by the researchers as having two or more from a list of 36 long-term conditions recorded in patients’ medical records.

In total, 27.2% of the patients involved in the study had multi-morbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%).

The prevalence of multi-morbidity was higher in females than males – 30% versus 24.4%, respectively – and among those with lower socioeconomic status.

Physical-mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients, aged 18-44 years, and those patients with a lower socioeconomic status.

Multimorbidity was “strongly associated” with the use of health services, highlighted the researchers. Patients with multi-morbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions, they said.

They stated: “Multi-morbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.” 

helen stokes lampard blog image

helen stokes lampard blog image

Helen Stokes-Lampard

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “As this research shows, more than half of GP consultations are for patients living with two or more long-term conditions.”

She said the large-scale study was “further evidence of the increasing complexity of cases” that practice teams were dealing with and the “inadequacy of the standard 10-minute consultation”.

Professor Stokes-Lampard added: “Today’s research also highlights the rising number of cases of physical and mental comorbidity, particularly in young people.

She said it highlighted an “urgent need” for enhanced community mental health services, including more staff and more treatment options – and for practice teams to have better access to them.

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