Primary care quality and secondary healthcare utilisation in patients with multimorbidity: a retrospective cohort study

Vollständiger Abstract

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Background High-quality primary care can improve multimorbidity management but little evidence is available to understand its impact on secondary care use over time. Aim To assess the concurrent and lagged associations between quality of primary care and planned and unplanned secondary care use, examining the modifying role of frailty. Design and Setting A retrospective cohort study included 468,172 patients with multimorbidity in England from the Discover research platform (April 2022-March 2024). Method We used principal component analysis to combine a set of quality indicators (QIs) and assessed the impacts of QIs on both planned and unplanned care using regression models. Results Generally, patients with higher QI attainment also had higher likelihood of outpatient visits, emergency admissions and ED visits. There was a lower lagged odds of elective hospital admissions in the following 12 months among those with higher attainment of multimorbidity-specific QIs. In the complex multimorbidity cohort (≥3 conditions), multimorbidity-specific QIs were longitudinally associated with lower odds of elective admissions and outpatient visits, while generic QIs were related to lower odds of outpatient non-attendance. Conclusion Attainment of generic and multimorbidity QIs was generally associated with slightly increased planned and unplanned care. However, patients for whom we identified higher attainment of multimorbidity-specific QIs had lower odds of elective admissions and outpatient visits, especially for those with complex multimorbidity. Our research suggests that the quality of primary care may influence patients’ use of secondary care, with the potential to improve care for people with multimorbidity and warrant further investigation into management strategies.