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Addressing the treatment burden of multimorbidity

Treatment burden is defined as the effort required of patients to look after their health and the impact this has on their wellbeing and day-to-day life (Eton et al., 2012). This can include having to order, collect and take complex medicine regimens; to co-ordinate, arrange transport for and attend multiple healthcare appointments; to make lifestyle changes; and to self-monitor conditions such as blood pressure. A useful way to conceptualise treatment burden is to think about the ‘workload’ of being the patient (e.g. the work of coordinating appointments and taking multiple medicines) and the ‘capacity’ to do the work (e.g. the social support networks and resilience a patient has to cope with the workload) (Shippee et al., 2012). Some patients may experience minimal treatment burden despite having a high workload, as they have good strategies, support and, therefore, high capacity to manage the workload. Other patients with a relatively low workload may experience high treatment burden, due to poor social support and, therefore, poor capacity to manage the work. In the case study example, Max has both high workload and poor capacity to manage the workload and is, therefore, at particular risk of high treatment burden. Some patients can feel overwhelmed by treatment burden (May et al., 2014) and this can have a significant impact on their quality of life (see Box 1) (Duncan et al., 2018).