Relationship between health-related quality of life, perceived family support and unmet health needs in adult patients with multimorbidity attending primary care in Portugal: a multicentre cross-sectional study

Abstract

BackgroundMultimorbidity has a high prevalence in the primary care context and it is frequently associated with worse health-related quality of life (HRQoL). Few studies evaluated the variables that could have a potential effect on HRQoL of primary care patients with multimorbidity. The purpose of this study, the first of its kind ever undertaken in Portugal, is to analyse the relationship between multimorbidity, health-related quality of life, perceived family support and unmet health needs in adult patients attending primary care.MethodsMulticentre, cross-sectional survey conducted among primary care patients with multimorbidity. It included 521 participants (64.1 % females) who met the inclusion criteria. HRQoL was evaluated using the Portuguese Short Form-12 Health Status Questionnaire. The Portuguese Family APGAR was used to measure the perceived family support. A patients’ unmet health needs questionnaire was used. The unmet needs for medical, surgical and dental care; prescription medications; mental healthcare or counselling; and eyeglasses or other technical aid was assessed. Descriptive and multivariate analyses were performed.ResultsThe sample had an overall average of 4.5 chronic health problems. Increased multimorbidity levels were linked to worse health-related quality of life, particularly the physical health. Some variables were confirmed as playing a role on health-related quality of life. Male patients with high monthly incomes and highly functional families had better physical and mental health. High levels of education and the presence of asthma were also associated with better physical health. Contrariwise, elderly patients with high levels of multimorbidity and with osteoarthritis had lower physical health. The majority of the patients did not have unmet health needs. When health needs were stated they were mostly for generalist medical care, dental care, and eyeglasses/other technical aid. Financial insufficiency was the primary reason for not fulfilling their health needs.ConclusionTo improve the quality of life of multimorbid patients, within primary care practices and health delivery systems, one should take into special account the sex of the patient, the perceived family support and the self-perceived economic status because of their relationship with both physical and mental health. Limitations and recommendations are discussed.

The Knowledge, Awareness, and Practices of Portuguese General Practitioners Regarding Multimorbidity and its Management: Qualitative Perspectives from Open-Ended Questions

“…the Portuguese translation [22] was provided to participants immediately before this question); (4) “How useful is the EGPRN concept of multimorbidity (Portuguese translation) [22]?” (extremely/very/moderately/slightly/not at all); (5) “Give your comments, ideas or suggestions regarding the previously presented definition of multimorbidity” (open-ended); (6) “In your opinion, what is the importance of multimorbidity in your day as a GP?” (open-ended); (7) “In clinical practice, what are the difficulties and challenges that you find in the consultations with patients with multimorbidity?” (open-ended); (8) “In clinical practice, how do you manage the difficulties and challenges found in consultations with patients with multimorbidity?” (open-ended). The third section briefly itemized the available results from the previous phases of the MM-PT project [10,25,33] (Figure 1) and questioned the respondents if after reading the information provided they would change their former ideas regarding the (1) concept of multimorbidity (no/yes; justify your choice: open-ended); (2) importance of multimorbidity (open-ended); (3) primary care physicians’ clinical practice (open-ended). The last section also allowed respondents to manifest comments, ideas, or suggestions regarding the MM-PT project’s results.…”

Health-related quality of life variations by sociodemographic factors and chronic conditions in three metropolitan cities of South Asia: the CARRS study

“…17 Other potential contributing factors that are known to influence health status are living conditions, gross domestic product per capita, inequities in income distributions and access to healthcare. [56][57][58][59][60][61] Therefore, public health initiatives should focus on intersectoral approaches to address issues of education, generating more avenues for employment and improving the quality and access of primary healthcare.…”

Validez de constructo y confiabilidad de la APGAR familiar en pacientes odontológicos adultos de Cartagena, Colombia

“…Estos hallazgos a pesar de reportarse en población adulta sugieren un comportamiento similar de la escala en estudiantes de secundaria como lo reportaron Forero, et al en Bucaramanga, Colombia, aunque con valores de alpha de Cronbach inferiores (0,79) a los reportados aquí en este estudio (0,90) 17 . Asimismo, los valores de consistencia interna de la escala del presente estudio corresponden a valores superiores a los encontrados en la validación en inglés (0,86) 7 , español en Perú (0,72) 8,24 , portugués en Brasil (0,73-0,78) 9 y Portugal (0,86) 25 ; pero no todos los estudios reportan resultados de análisis factorial tanto exploratorio (AFE) como confirmatorio (AFC) para dar cuenta de sus propiedades psicométricas, específicamente validez de constructo 12 . Es importante advertir que los anteriores estudios que se reportan para discutir los resultados de la presente investigación, no corresponden a estudios realizados en pacientes Odontológicos dado que no hay evidencia científica sobre el desempeño psicométrico de la APGAR en este tipo de pacientes.…”