Patient-Perceived Chronic Illness Care and Its Association with Health-Related Quality of Life Among Community-Dwelling Older Adults with Multimorbidity

Abstract

Objective: This study aims to assess how community-dwelling older adults with multimorbidity perceive chronic illness care, examine its association with health-related quality of life (HRQoL), and identify the management dimensions most closely associated with HRQoL. These findings may provide evidence for optimizing patient-centered multimorbidity management in primary care settings. Methods: This cross-sectional study involved 263 older adults with multimorbidity managed by primary healthcare institutions within a division of the Xinjiang Production and Construction Corps, China, from July to November 2024. The Patient Assessment of Chronic Illness Care (PACIC), which includes five care-process dimensions, was used to evaluate patient-perceived chronic illness care. HRQoL was measured using the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L). Multiple linear regression identified factors associated with PACIC scores, while Spearman correlation and two-limit Tobit regression models examined the associations between PACIC scores and health utility values. Results: The mean overall PACIC score was 2.24 ± 0.27, and follow-up/coordination had the lowest dimension score (1.95 ± 0.48). Rural residence, living alone, polypharmacy, and activities of daily living impairment were independently associated with lower PACIC scores. After adjustment for prespecified covariates, a one-point higher overall PACIC score was associated with an estimated 0.232 higher EQ-5D-5L health utility value (95% CI: 0.123, 0.342, p < 0.001). Among the five PACIC dimensions, only problem solving/contextual counseling (AME = 0.084, p = 0.005) and follow-up/coordination (AME = 0.094, p = 0.017) remained independently associated with health utility values. Conclusions: Community-dwelling older adults with multimorbidity reported relatively low levels of chronic illness care, particularly in follow-up and coordination. Patient-perceived chronic illness care was positively associated with HRQoL. Specifically, problem solving/contextual counseling and follow-up/coordination were the two dimensions that remained independently associated with health utility values. These findings offer empirical evidence for primary healthcare institutions to identify patient-perceived service gaps, prioritize patient-centered multimorbidity care, and enhance health-service responsiveness.