Differences in patient-reported outcomes across multimorbidity profiles in primary care: evidence from the first cycle of the OECD Patient Reported Indicator Surveys (PaRIS).

Background
Multimorbidity is a growing challenge for healthcare systems worldwide, yet policymakers and healthcare professionals often lack evidence on how distinct multimorbidity profiles (capturing co-occurrence of chronic conditions) relate to patient-reported outcomes and experiences. This study examines how mutually exclusive multimorbidity profiles are associated with physical health, mental health, and well-being and whether these associations are modified by healthcare experiences.

Methods
We analysed data from 102 786 primary care patients aged ≥ 45 years participating in the OECD Patient-Reported Indicator Surveys (PaRIS) across 19 countries (2023–2024). Self‑reported chronic conditions were grouped into five mutually exclusive multimorbidity profiles. Physical and mental health outcomes were assessed using PROMIS® Global Health T-scores, and well-being using WHO-5 Well-being Index. Multilevel mixed-effects models estimated associations between multimorbidity profiles and outcomes, controlling for age, gender, education and number of chronic conditions. Interactions with patient-reported person-centredness and continuity of care were examined.

Results
Multimorbidity profiles showed differences in self-reported health, with profiles including mental health conditions associated with both poorer physical and mental health outcomes. Compared with the cardiometabolic-only reference group, physical health scores were significantly lower among patients with cardiometabolic + mental + other (b=–2.07) and mental and/or other‑only profiles (b=–2.94) (p < 0.05). Profiles including mental health conditions were associated with lower scores on mental health outcomes. Well‑being was similarly poorer, with the largest declines observed in cardiometabolic + mental (b=–12.65) and cardiometabolic + mental + other profiles (b=–12.08). While person‑centredness was positively associated with all health outcomes, it did not meaningfully modify the relationship between the health outcomes and multimorbidity profiles, with only limited interaction effects observed. Continuity of care showed overall limited effects.

Conclusion
Differences in patient-reported outcomes suggest that health systems may need to better adapt to the needs of people with multimorbidity. Profiles involving mental health conditions are associated with poorer patient‑reported outcomes, stressing the importance of implementing person-centred integrated care models within primary care and beyond. Investing in systems that systematically assess patient-reported outcomes among people with multiple chronic conditions in primary care may support policymakers and practitioners in improving care delivery.