Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial

Ford, John; Lenaghan, Elizabeth; Salter, Charlotte; Turner, David; Shiner, Alice; Clark, Allan; Murdoch, Jamie; Green, Carole; James, Sarah; Koopmans, Imogen; Lipp, Alistair; Moseley, Annie; Wade, T.; Winterburn, Sandra; Steel, Nicholas

doi:10.1136/bmjopen-2018-025332

Cited by 26 publications

(48 citation statements)

References 28 publications

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“…Their sociodemographic characteristics were similar to the population that attended each site. The magnitude of the change pre-post implementation was high, and greater than those reported by previous studies on guided care [26] or goal-setting interventions [27] for older adults with multimorbidity. Patients showed the lowest degree of satisfaction with care in the arrange dimension and the highest in the advise one.…”

Section: Discussionmentioning

confidence: 52%

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS

Rodríguez‐Blázquez

Forjaz

Gimeno-Miguel

et al. 2020

IJERPH

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Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle (CHRODIS) to ensure the continuity of care for patients with multimorbidity. The IMCM was implemented in five European pilot sites in Spain, Italy, and Lithuania, within the Joint Action CHRODIS-PLUS. The effect of these pilot interventions was assessed pre- and post-implementation by 17 healthcare managers, using the Assessment of Chronic Illness Care (ACIC) measure, and by 226 patients with the Patient Assessment of Care for Chronic Conditions (PACIC+) survey. The ACIC total score significantly increased (5.23 to 6.71, p = 0.022) after the intervention, with differences across sites. A significant increase in the PACIC+ summary score was found ranging from 3.25 at baseline to 4.03 after the intervention (p < 0.001), and 58% of the sample perceived an improvement in care. Higher PACIC+ scores after the intervention were associated to lower baseline values in the respective PACIC+ dimension and to greater changes in ACIC Part 1 (delivery system organization). The IMCM implementation can help improve the quality of care for patients with multimorbidity.

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Section: Discussionmentioning

confidence: 52%

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS

Rodríguez‐Blázquez

Forjaz

Gimeno-Miguel

et al. 2020

IJERPH

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“…Thus, patients should be equipped with the right skillsets for self-care. Various studies identified the need to facilitate self-management and provide adequate support, for example, through community programmes [59][60][61][62][63][64][65][66]. Although healthcare providers might have provided self-management guidelines and support to polyclinic patients, our study found that patients' practices were still affected by their daily activities involving work and the community, as well as their beliefs and physical condition.…”

Section: Key Findings and Recommendationsmentioning

confidence: 65%

Facilitators and barriers of managing patients with multiple chronic conditions in the community: a qualitative study

Foo

Sundram²,

Legido‐Quigley

2020

BMC Public Health

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Background: Approximately one-third of all adults worldwide are diagnosed with multiple chronic conditions (MCCs). The literature has identified several challenges facing providers and patients coping with managing MCCs in the community, yet few studies have considered their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. Methods: This study involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provide subsidised primary care services. Topic guides were developed with reference to the literature review, Chronic Care Model (CCM) and framework for patient-centred access to healthcare. Results: Despite the perceived affordability and availability of the support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nationwide medical savings scheme to cover outpatient treatment and medications. Half of healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those who did not visit the clinics might not receive timely care. Furthermore, patients reported long consultation waiting time. Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges to delivering safe and quality care with limited consultation duration due to the need to manage high patient load and waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients. Although providers could equip patients with self-management and lifestyle-related guidelines, patients' actions are influenced by multiple factors, including work requirements, beliefs and environment. Conclusions: There were barriers on care access, delivery and self-management. It is crucial to adopt a whole-ofsociety approach involving individuals, community, institutions and policymakers to improve and support MCC management. This study has also highlighted the importance of considering the different viewpoints of healthcare providers and users in policy formulation and community care planning.

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“…As such, patients should be equipped with the right skillset for self-care. Various studies identified the need to facilitate self-management and provide adequate support, for example through community programmes (55)(56)(57)(58)(59)(60)(61)(62). Even though healthcare providers might have provided self-management guidelines to polyclinic patients, our study found that patients' practices were also affected by their daily activities involving work and the community, as well as their beliefs and physical condition.…”

Section: Key Findings and Recommendationsmentioning

confidence: 65%

Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study

Foo¹,

Sundram²,

Legido‐Quigley

2019

Preprint

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Background About one-third of all adults worldwide were diagnosed with multiple chronic conditions (MCCs). Literature had found several challenges of providers and patients coping with managing MCCs in the community, urging the need for further study. A qualitative study was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. Methods This involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provides subsidised primary care services. Topic guides were developed with reference from literature review, Chronic Care Model (CCM) and Framework for patient-centred access to healthcare. Results Despite perceived affordable charges and availability of support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of the healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those that did not turn up might not receive timely care. Furthermore, patients reported long consultation waiting time. Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges of delivering safe and quality care with limited consultation duration due to the need to manage waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients. Although providers could equip patients with self-management and lifestyle related guidelines, patients’ actions are influenced by multiple factors including work nature, beliefs and environment. Conclusions There were barriers on care access, delivery and self-management as reported. It is crucial to adopt whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCCs management. This study has also highlighted the importance to consider different viewpoints of healthcare providers and users in policy formulation and community care planning.

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Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial

Cited by 26 publications

References 28 publications

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS

Facilitators and barriers of managing patients with multiple chronic conditions in the community: a qualitative study

Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study

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