Mapping quality of primary care among 0.5 million people with multiple long-term conditions in England, 2015-2024: a retrospective cohort study using electronic health records.

backgroundAs the number of people with multimorbidity continues to increase, the traditional medical care model - based on single disease models - has become increasingly unsuitable to meet current challenges, leading to concerns about the quality of primary care for patients with multimorbidity. This study aimed to evaluate the quality of care for people with multimorbidity in primary care, using quality indicators identified in Electronic Health Records (EHR) data.

methodsThis study used EHR from the Discover-NOW Hub for April 2015-2024, covering 95% of northwest London's population. Through review of literature and clinical guidelines, we identified eight generic and six multimorbidity-specific quality indicators (QIs) for primary care, with consideration of the availability of indicators within EHR data. The final list was derived following discussion with people with lived experience of multimorbidity and clinicians. We used heat maps to report the QI attainment levels and conducted Ordinary Least Squares and logistic regression analyses to assess sociodemographic and health-related inequalities in relation to generic and multimorbidity-specific QI.

resultsThis study included 509,782 adult patients with multimorbidity. Attainment on generic QIs (range 23.5%-79.8%) was generally higher than multimorbidity-specific indicators (< 30%). QIs were generally stable over the past decade, but significantly reduced during the COVID-19 pandemic and fluctuated across individual QIs. Compared with healthier multimorbidity groups, those living with more comorbidities, polypharmacy and more severe frailty had higher levels of QI scores and had higher odds of uptake of individual QIs. Notably, we found socioeconomic inequalities, especially regarding ethnicity and neighbourhood deprivation, though this varied by QI.

conclusionsThis study provides real-world evidence of the quality of primary care among multimorbidity patients. There was lower attainment on multimorbidity-specific QI than general indicators, with less affluent and some minority ethnic groups less likely to receive good care. Policymakers should focus on approaches to improve the support of primary care clinicians in the delivery of person-centred care for individuals with multimorbidity. Further research is needed to explore the underlying mechanisms for differential QI attainment and support primary care teams to improve the quality of care for people with multimorbidity.