The impact of quality of primary care on secondary healthcare utilisation for patients with multiple long-term conditions

Objectives To assess the concurrent and lagged associations between quality of primary care and planned and unplanned secondary care use for patients with multimorbidity, examining the modifying role of frailty. Design A retrospective cohort study Setting This population-level analysis included 468,172 patients with multimorbidity in England from the Discover research platform (April 2022-March 2024). Participants Patients with multimorbidity Main outcome measures 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. Results Generally, patients with higher QI attainment also had higher likelihood of planned (outpatient visits) and unplanned care (emergency admissions and ED visits) utilisation. There was a lower lagged odds of elective hospital admissions in the following 12 months among those with higher attainment of multimorbidity-specific QIs (OR=0.94, 95%CI 0.93-0.95). In the complex multimorbidity cohort ([≥]3 conditions), multimorbidity-specific QIs were longitudinally associated with lower odds of elective admissions (OR=0.94, 95%CI 0.92-0.95) and outpatient visits (OR=0.96, 95%CI 0.95-0.98), while generic QIs were related to lower odds of outpatient non-attendance (OR=0.95, 95%CI 0.91-0.99). In non-frail patients with multimorbidity, multimorbidity-specific QIs were longitudinally associated with reduced odds of outpatient visits (OR=0.98, 95%CI 0.97-0.99), elective admissions (OR=0.92, 95%CI 0.90-0.94) and prolonged elective hospital stay (IRR=0.94, 95%CI 0.89-0.99). Conclusions 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.