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New questionnaire will help researchers measure the ‘burden’ of treatment for patients with multiple health problems in primary care

18 April 2018

Patients with multiple health problems, known as multimorbidity, have many things to think about and do to take care of their health. Experts from the Centre of Academic Primary Care at the University of Bristol have developed a questionnaire to help researchers measure this treatment ‘burden’, so that they can understand the impact that interventions to improve care might have on patients’ daily lives.

Treatment burden describes the things patients might need to do to look after their health. It includes having to take different medicines at different times, attending appointments with different health professionals at the GP surgery or in hospital, arranging transport for appointments and monitoring medical conditions, such as checking blood pressure or blood sugar levels.

The research team developed the Multmorbidity Treatment Burden Questionnaire (MTBQ) as part of the 3D Study, funded by the National Institute for Health Research, which looked at ways of improving the care of patients with multimorbidity in general practice. The 10-item questionnaire was developed with patients and tested on over 1,500 mostly elderly patients wth three or more long-term conditions using international standards for validating questionnaires. It was found to be a good measure of treatment burden according to the results published in BMJ Open today.

Dr Polly Duncan, a GP and lead author, said: “With an ageing population, multimorbidity has become the norm, affecting over two-thirds of adults attending general practice. Current health policy is pushing for greater support for patients to self-manage their chronic medical conditions. However, the time and energy this takes for patients can be overwhelming, especially for those with multiple health problems.

“We see our questionnaire as an important tool in ensuring that new interventions that are being trialled in health care take into account the impacts on treatment burden because these will affect how well, or not, patients are able to self-manage their conditions in future.

“And the impacts can be great. For example, one patient we interviewed talked about having to give up work because of their health conditions.”

Professor Chris Salisbury, who supervised the development of the questionnaire, said: “People with more than one long-term condition are particularly vulnerable to high treatment burden. We reviewed existing questionnaires before developing our own and found that none was quite right for this particular patient group or for use in general practice.

“There has been much interest in the MTBQ and it is already being used in a number of research trials in the UK. It has also been translated into Danish for use in a large population survey.

"We welcome feedback from users and are interested in hearing from researchers who have new ideas for how it might be used. We are also looking at the possibility of testing the questionnaire for use by GPs themselves to help them in their clinical practice.”

To find out more and to register to use the MTBQ see

Paper: Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ) by Polly Duncan, Mairead Murphy, Mei-See Man, Katherine Chaplin, Daisy Gaunt and Chris Salisbury. Published in BMJ Open. April 2018. DOI: 10.1136/bmjopen-2017-019413

Further information

About the Centre for Academic Primary Care

The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.

About the NIHR

The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research.

Established by the Department of Health and Social Care, the NIHR:

  • funds high quality research to improve health
  • trains and supports health researchers
  • provides world-class research facilities
  • works with the life sciences industry and charities to benefit all
  • involves patients and the public at every step.

For further information, visit the NIHR website

This research was funded by the NIHR Health Services and Delivery Research programme.

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