Intended for healthcare professionals


Thinking about the burden of treatment

BMJ 2014; 349 doi: (Published 10 November 2014) Cite this as: BMJ 2014;349:g6680
  1. Frances S Mair, professor of primary care research1,
  2. Carl R May, professor of healthcare innovation2
  1. 1Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 9LX, UK
  2. 2NIHR CLAHRC, Faculty of Health Sciences, University of Southampton, UK
  1. Correspondence to: F S Mair frances.mair{at}

Should it be regarded as an indicator of the quality of care?

Across the world healthcare systems are struggling to cope with increasing demands and costs. Rising life expectancy has been accompanied by an explosion in the prevalence of long term conditions and multimorbidity.1

Clinicians are working within legacy systems that were developed to deal with 19th century problems—they provide specialised responses to acute illness and infection. At the same time daily practice is strongly influenced by an ever expanding array of disease centred guidelines that don’t map neatly to the realities of clinical practice, in particular the ubiquity of multimorbidity.2 The result is fragmented, poorly coordinated health services for those most in need—vulnerable patients with multimorbidity.3 Today’s healthcare professionals are faced not only with rising disease-disease, drug-drug, and disease-drug interactions in multimorbid populations but with the increasingly evident consequences of socioeconomic disadvantage.

Meanwhile, patients, their families, and their extended social networks experience not only the burden of symptoms but the burden of treatment.4 This is an emerging but underinvestigated phenomenon. It has received increasing attention recently, and interest has been growing in how to define and better understand the concept.

Some of the key components of treatment …

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