Holistic primary health care for patients with multimorbidity: impact on treatment burden, quality of life and urban–rural inequalities

Background. Multimorbidity and the associated treatment burden are a growing challenge for primary health care (PHC). Patients with multiple chronic conditions frequently experience fragmented care, high self-management demands, and poorer health-related quality of life (HRQoL), particularly in rural and socially deprived areas. This study assessed the impact of a holistic care model for patients with multimorbidity in PHC in Lithuania on treatment burden, HRQoL, and mental health, and explored urban–rural differences.

Methods. We conducted a 15-month pragmatic controlled trial in urban and rural PHC centres (n = 796 enrolled) as part of the EUFIAP “TELELISPA” project. Adults aged 40–85 years with ≥2 chronic conditions were allocated to usual care or to a complex intervention that included case management, multidisciplinary team support (family physician, nurse, psychologist, physiotherapist, lifestyle specialist), structured use of patient-reported outcome measures (PROMs), and proactive follow-up. Data were analysed using multivariable models and pre-specified subgroup analyses by age, multimorbidity level, polypharmacy, and place of residence.

Results. Compared with usual care, the intervention produced small-to-moderate improvements in mental health (PHQ-9, GAD-7) and HRQoL (EQ-5D-5L index, EQ-VAS, selected SF-36 domains). The greatest benefits were observed among younger (<65 years) patients, those with higher multimorbidity or polypharmacy, and in urban PHC settings. In rural areas and among older adults, anxiety and depression scores improved, but logistical and organisational aspects of care increased perceived treatment burden (MTBQ), especially medication management, transport, and visit coordination.

Conclusions. A holistic care model in PHC can improve quality of life and mental health in multimorbid patients with complex needs, but may simultaneously shift or increase treatment burden in contexts with persistent access barriers. To avoid overloading vulnerable groups, integrated care should reduce logistical barriers and be tailored to patients’ capacity, particularly in rural and socially deprived areas.