Primary care chaplaincy: an intervention for complex presentation

Abstract

Aim To determine the responsiveness of primary care chaplaincy (PCC) to the current variety of presenting symptoms seen in primary care. This was done with a focus on complex and undifferentiated illness. Background Current presentations to primary care are often complex, undifferentiated and display risk factors for social isolation and loneliness. These are frequently associated with loss of well-being and spiritual issues. PCC provides holistic care for such patients but its efficacy is unknown in presentations representative of such issues. There is therefore a need to assess the characteristics of those attending PCC. The effectiveness of PCC relative to the type and number of presenting symptoms should also be analysed whilst evaluating impact on GP workload. Methods This was a retrospective observational study based on routinely collected data. In total, 164 patients attended PCC; 75 were co-prescribed antidepressants (AD) and 89 were not (No-AD). Pre- and post-PCC well-being was assessed by the Warwick–Edinburgh mental well-being score. Presenting issue(s) data were collected on a separate questionnaire. GP appointment utilisation was measured for three months pre- and post-PCC. Findings Those displaying undifferentiated illness and risk factors for social isolation and loneliness accessed PCC. PCC (No-AD) was associated with a clinically meaningful and statistically significant improvement in well-being in all presenting issues. This effect was maintained in those with multiple presenting issues. PCC was associated with a reduction in GP appointment utilisation in those not co-prescribed AD.

Spiritual care is stagnating in general practice

“…3 Research has shown that such chaplaincy provision improves spiritual wellbeing to a similar extent as antidepressants while reducing GP consultation rates. 4,5 These results justify the place of chaplaincy within our MDTs at this time of workload realignment.…”

“…Chaplaincy has also been shown to be responsive to multimorbidity and undifferentiated illness, both of which are core presentations that the expert medical generalist encounters. 5 Such generalists are ideally placed to refer on to the specialist chaplain within the MDT.…”

Spiritual needs assessment: the LOADS SHARED mnemonic

“…Some expressions of PCC have been based on a fusion of Maslow's hierarchy of needs and Hanlon's modern maladies. 4,5 Maslow describes a hierarchy of ascending needs: from the physiological to the transcendent. 10 He suggests that those who are ultimately fulfilled move beyond their personal needs for significance, security, and self-esteem towards transcendence.…”

“…Community Chaplaincy Listening (CCL) and Primary Care Chaplaincy (PCC) have been more recently described in the UK. [4][5][6] PCC, for example, seeks to help patients address their deepest inner needs and find meaning, purpose, and orientation towards the transcendent. The emerging evidence base for PCC is gaining momentum, specifically in terms of its efficacy, relevance as a talking therapy, ability to respond to varied and complex presentations, and reduction in GP workload.…”

“…The emerging evidence base for PCC is gaining momentum, specifically in terms of its efficacy, relevance as a talking therapy, ability to respond to varied and complex presentations, and reduction in GP workload. 4,5…”