Multiple long-term conditions within households and use of health and social care: a retrospective cohort study

Abstract

Background: The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multimorbidity is understudied. Aim: To test whether co-residence with a multimorbid person (compared with a non-multimorbid co-resident) is associated with utilisation and cost of primary, community and secondary health care and formal social care. Design and Setting: Linked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged 50+ in two-person households in 2016-2018. Methods: Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health and social care by multimorbidity status of individuals and co-residents, adjusted for age, gender and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink. Results: Over 45% of multimorbid people in two-person households were co-resident with another multimorbid person. They were 1.14 (95% CI 1.00, 1.30) times as likely to have community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar. Conclusions: Care utilisation for people with multimorbidity varies by household context. There may be potential for connecting health and community service input across household members.

Association between household context and emergency hospital use in older people: a retrospective cohort study on indicators for people living alone or living with somebody with frailty, developed from routine healthcare data in England

“…To our knowledge, there are no statistical studies on living with someone with frailty, although results are broadly consistent with the literature on informal carers. A study on multimorbidity within households found inconsistent results of cohabitees’ multimorbidity status on emergency hospital use 16…”

“…A study on multimorbidity within households found inconsistent results of cohabitees’ multimorbidity status on emergency hospital use. 16 …”

“…Living with someone with frailty may imply having informal care responsibilities. Informally caring for somebody else can have a detrimental effect on a person’s own physical and mental health 15–17. Informal carers may not only feel socially isolated,11 but may also suffer from lack of sleep and neglect their own health and personal well-being,18 19 or have difficulty accessing care 20.…”

Understanding social care need through primary care big data: a rapid scoping review

“…The review found a relatively limited sample of studies containing data variables or coding lists from UK primary care database studies (14)(15)(16)(17). These are shown in Appendix 1.…”

One year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity

“…Multimorbidity, the presence of more than one chronic medical condition in the same individual, is the number one challenge in primary health care. 1 , 2 It is associated with poorer quality of life, 3 , 4 functional decline, 5 , 6 increased health care utilisation 7 , 8 and complex management with drugs which often leads to polypharmacy. 9 , 10 Fragmentation of care due to the involvement of both primary care and multiple specialists, who may not be effectively communicating with each other, is a problem frequently faced by these patients.…”