Objectives The increasing prevalence of chronic conditions and multimorbidity places a significant burden on patients and leads to increasing challenges for healthcare systems, especially in primary care. Recognising the multifaceted nature of chronic conditions, the Assessment of Burden of Chronic Conditions (ABCC) tool was developed to support person-centred care, by facilitating shared decision-making and self-management. This study aims to evaluate the cost-effectiveness of the ABCC tool in primary care. Design and setting This cost-effectiveness analysis was conducted over 18 months alongside a clustered, two-arm quasi-experimental study in primary care in the Netherlands. Participants The study included 231 participants diagnosed with chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes mellitus (T2DM) and/or chronic heart failure (CHF). Of these, 173 were assigned to the intervention group and 58 to the control group. Interventions The intervention group was intended to incorporate the ABCC tool into routine consultations, while the control group had to continue care as usual. Outcome measures Outcomes were assessed from a societal perspective, including quality-adjusted life years (QALYs) derived via the EuroQol-5D-5L (EQ-5D-5L) questionnaire. Costs were measured using adapted versions of the Productivity Costs Questionnaire (PCQ) and Medical Consumption Questionnaire (MCQ). Sensitivity analyses (SAs) included a healthcare perspective, per-protocol analysis (to account for disruptions caused by COVID-19) and exclusion of home care costs (to address extreme outliers). Moreover, all analyses were performed for well-being-adjusted life years (WALYs), derived from the ICEpop CAPability measure for Adults (ICECAP-A) questionnaire. Results The ABCC tool was more expensive and effective than usual care, with an incremental cost-effectiveness ratio (ICER) of €64 525 per QALY and a 29% probability of cost-effectiveness. With the exception of the healthcare perspective, the SAs yielded more favourable outcomes in terms of cost-effectiveness, with ICERs (probability of cost-effectiveness) of €41 484 (31%), €8683 (58%) and €23 905 (48%) for a healthcare perspective, per-protocol analysis and exclusion of home care costs, respectively. Outcomes for QALY and WALY were comparable. Conclusion While the primary analysis suggested a relatively low probability of cost-effectiveness, the SAs showed higher probabilities. The per-protocol analysis suggested that the ABCC tool can be cost-effective when actually used. Trial registration number NCT04127383.

Aim: This study aims to assess the perspectives of patients with chronic conditions on the use of the Assessment of Burden of Chronic Conditions (ABCC) tool during consultations with their healthcare providers in primary care. Background: The increasing prevalence of chronic conditions, including multimorbidity, poses major challenges to healthcare systems today, particularly in primary care where most chronic care takes place. Effective management strategies are crucial for improving quality of life (QoL). The ABCC tool offers a unique approach to chronic disease management by facilitating shared decision-making and self-management. Methods: This qualitative phenomenological study involved semi-structured interviews. Fourteen patients with chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes mellitus (T2DM) and/or chronic heart failure (CHF) were recruited from a previously conducted quasi-experimental study on the effectiveness of the ABCC tool. Findings: Participants generally expressed satisfaction with the comprehensive questionnaire, user-friendly design and clear visualisation. They appreciated the opportunity to facilitate discussions with healthcare providers and help with monitoring. However, some confusion around the grey balloons in the tool highlighted the need for clearer explanations. Participants had limited awareness of advanced treatment recommendation functions. Conclusions: This study provides valuable insights into patients’ experiences with the ABCC tool. Despite challenges such as recall bias and limited awareness of certain features, participants generally expressed satisfaction with using the tool. Based on these findings, the tool can be further improved and its use should be further supported. However, the ABCC tool shows promise as a valuable instrument for improving consultations in clinical practice.

Background: Post-COVID syndrome manifests with a diverse array of symptoms for which no standard care plan currently exists. Many questions were raised by patients, which underscored the need for a validated patient-reported outcome measure (PROM). Therefore, a post-COVID module was developed to be included in the Assessment of Burden of Chronic Conditions (ABCC-) tool. The ABCC-tool evaluates and visualises the perceived physical, emotional and social burden of one or multiple chronic disease(s) using a balloon diagram and aims to facilitate person-centred care and structured discussions between patients and healthcare professionals. This study explores the patients’ perspective on the content of the ABCC-tool for post-COVID and the tool’s usability in a home-based setting. Methods: All patients who completed the ABCC-tool for post-COVID were invited for an online semi-structured interview. We selected post-COVID patients who had used the tool in the past three months. Interviews were audio recorded and analysed using a thematic approach with Atlas.ti version 23. Results: Nineteen post-COVID patients (10 males, mean age 56) were interviewed between May and August 2024. The tool was regarded as user-friendly, and patients indicated they would use the tool again in the future. Patients valued the tool’s broad range of topics, some of which are often overlooked in standard healthcare consultations. The tool was comprehensible and relevant according to all patients. The balloon diagram was easy to understand, but a legend explaining the colours of the balloons was preferred. Other suggestions for improvement included adding open-text fields and periodic reminders to increase usability and adding long-term data. Conclusions: The ABCC-tool is a promising instrument for post-COVID patients, offering a structured way to monitor and communicate experienced burden in addition to standard healthcare consultations. Refinements addressing usability and comprehensiveness are recommended to facilitate its integration into clinical practices.

Objective: To develop a chronic heart failure (CHF) module for the Assessment of Burden of Chronic Conditions (ABCC) tool and evaluate its psychometric properties. Design: Mixed methods study. Setting: The study was conducted in the Netherlands. Participants: Healthcare providers (ie, general practitioners (GPs), practice nurses, cardiologists, heart failure nurse practitioners, heart failure specialist nurses) and patients with CHF were involved in the developmental phase. In the psychometric evaluation, patients with CHF were included. Results: The ABCC-CHF module comprised 26 items across CHF-specific domains, accompanied by associated advice. It demonstrated high convergent validity with the Kansas City Cardiomyopathy Questionnaire (KCCQ) (97%) and successfully differentiated most known-groups. Internal consistency yielded a Cronbach’s α of 0.92 for the total scale, while test-retest reliability showed an intraclass correlation coefficient (ICC) of 0.97. Conclusion: The CHF-specific module is developed and validated. It aims to integrate disease burden into routine healthcare, supporting person-centred care for people with CHF and multimorbidity.

The increasing prevalence of chronic conditions has become a major public health issue [1,2]. This rise is expected to continue and is further complicated by multimorbidity, which is defined as the...