TOPLINE

Among patients with multimorbidity in England, higher attainment of primary care quality indicators was associated with an increased likelihood of outpatient visits and emergency admissions. However, patients with higher attainment of multimorbidity-specific checks — such as medication reviews, care plan reviews, and frailty assessments — had lower odds of elective hospital admissions.

METHODOLOGY

• Researchers conducted a retrospective, longitudinal cohort study using a database covering data for a range of primary care and secondary care services in northwest London (April 2022 to March 2024) to assess the link between the quality of primary care and subsequent secondary healthcare use.
• A total of 468,172 adults (mean age, 56.5 years; 54.6% women; 46.5% White individuals) with multimorbidity (two or more long-term conditions) were included; of these, 54.4% had mild-to-severe frailty.
• The quality of primary care was assessed using clinically curated quality indicators, including blood pressure monitoring, BMI measurements, medication reviews, care plan reviews, frailty and functional assessments, and mental health screening.
• Principal component analysis identified two components: generic quality indicators (such as more blood pressure monitoring, BMI measurements, and blood sugar level measurements) and multimorbidity-specific quality indicators.
• The use of planned care (outpatient visits, non-attendance, elective admissions, and hospital length of stay) and unplanned care (emergency admissions, emergency department visits, and length of emergency stays in the hospital) was assessed within the year of attainment of the quality indicators and in the subsequent year.

TAKEAWAY

• Higher attainment of both generic and multimorbidity-specific quality indicators was associated with increased odds of outpatient visits and emergency admissions in the following year.
• Patients with higher attainment of multimorbidity-specific quality indicators had lower odds of elective hospital admissions (odds ratio [OR], 0.94; 95% CI, 0.93-0.95), with this association persisting among those with frailty (OR, 0.94; 95% CI, 0.93-0.94) and those without frailty (OR, 0.92; 95% CI, 0.90-0.94).
• Among patients with complex multimorbidity (four or more conditions), those who attained multimorbidity-specific quality indicators had slightly lower odds of outpatient visits and elective hospital admissions.

IN PRACTICE

"Our findings highlight the potential associations between multimorbidity-specific QIs [quality indicators] and reduced elective hospital admissions for patients with multimorbidity. A comprehensive management strategy, as reflected by multimorbidity-specific QIs, which involve more detailed and in-depth checks, could potentially better support disease management and prevent serious outcomes that lead to hospitalisation," the authors wrote.

SOURCE

The study was led by Qian Gao, PhD, Faculty of Population Health Sciences, University College London, London, England. It was published online on September 03, 2026, in the British Journal of General Practice.

LIMITATIONS

The study period coincided with post-pandemic recovery, potentially introducing residual confounding or measurement variation due to healthcare system disruption. The possibility of bias from mortality could not be eliminated. Delays or incomplete entries in the electronic health records may have led to the misclassification of some conditions, leading to potential bias.

DISCLOSURES

This study was supported by the National Institute for Health and Care Research (NIHR) Imperial Biomedical Research Centre and the NIHR Applied Research Collaboration Northwest London. Two authors received funding from the NIHR North West London Patient Safety Research Collaboration. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.