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Background: treatment burden represents the work patients undertake because of their healthcare, and the impact of that effort on the patient. Most research has focused on older adults (65+) with multiple long-term conditions (MLTC-M) but there are more younger adults (18-65) living with MLTC-M and they may experience treatment burden differently. Understanding experiences of treatment burden, and identifying those most at risk of high treatment burden, are important for designing primary care services to meet their needs.Aim: to understand the treatment burden associated with MLTC-M, for people aged 18–65 years, and how primary care services affect this burden.Design & setting: mixed-methods study in 20–33 primary care practices in two UK regions.Method: i. In-depth qualitative interviews with adults living with MLTC-M (approximately 40 participants) to understand their experiences of treatment burden and the impact of primary care; with a think-aloud aspect to explore face validity of a novel short treatment burden questionnaire for routine clinical use (STBQ) in the initial 15 interviews. ii. Cross-sectional patient survey (approximately 1,000 participants) with linked routine medical record data to examine the factors associated with treatment burden for people living with MLTC-M, and to test the validity of STBQ.Conclusion: this study will generate in-depth understanding of the treatment burden experienced by people aged 18–65 years living with MLTC-M, and how primary care services affect this burden. This will inform further development and testing of interventions to reduce treatment burden, and potentially influence MLTC-M trajectories and improve health outcomes.

Additional file 2 Exploratory factor analysis: Scree plot for German MTBQ.

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Additional file 1. Results of cognitive interviews.

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Background: Medication reviews may improve the safety of prescribing and NICE highlights the importance of involving patients in this process.Aim: To explore GP and pharmacist perspectives on how medication reviews are conducted in UK General Practice.Design and setting: Semi-structured interviews with 13 GPs and 10 pharmacists working in UK primary care sampled for heterogeneity.Methods: Interviews focused on experience of medication review. Data saturation was achieved with no new insights arising from later interviews. Interviews were analysed thematically.Results: GPs and pharmacists perceived medication review as an opportunity to improve prescribing safety. Whilst interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPs, a medication review was done ‘in the quickest way possible to say that it was done’. Pharmacists were perceived by both professions as being more thorough but less time-efficient than GPs and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work. Conclusion: Practices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance.