The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

Mercer, S. W., O'Brien, R., Fitzpatrick, B., Higgins, M., Guthrie, B., Watt, G. and Wyke, S. (2016) The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation. Chronic Illness, 12(3), pp. 165-181. (doi:10.1177/1742395316644304) (PMID:27068113) (PMCID:PMC4995497)

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Abstract

OBJECTIVES To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. METHODS Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients. RESULTS Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients. DISCUSSION We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial.

Item Type:Articles
Additional Information:This work was funded by the Chief Scientist Office of Scottish Government Health Directorates (Applied Research Programme Grant ARPG/07/1).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wyke, Professor Sally and O'Brien, Dr Rosaleen and Watt, Professor Graham and Higgins, Ms Maria and Fitzpatrick, Dr Bridie and Mercer, Professor Stewart
Authors: Mercer, S. W., O'Brien, R., Fitzpatrick, B., Higgins, M., Guthrie, B., Watt, G., and Wyke, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:Chronic Illness
Publisher:SAGE Publications
ISSN:1742-3953
ISSN (Online):1745-9206
Published Online:10 April 2016
Copyright Holders:Copyright © 2016 The Authors
First Published:First published in Chronic Illness 12(3): 165-181
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
477971Living Well with Multiple MorbidityStewart MercerScottish Executive Health Department (SEHHD-CSO)ARPG/07/01IHW - GENERAL PRACTICE & PRIMARY CARE