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

• Published in: Chronic illness 2016-09, Vol.12 (3), p.165-181
• Main Authors: Mercer, Stewart William, O'Brien, Rosaleen, Fitzpatrick, Bridie, Higgins, Maria, Guthrie, Bruce, Watt, Graham, Wyke, Sally
• Format: Article
• Language: English
• Subjects: Adult; Aged; Appointments and Schedules; Comorbidity; Continuity of Patient Care; Female; Focus Groups; General Practitioners; Holistic Health; Humans; Male; Middle Aged; Nurses; Patients; Physician-Patient Relations; Pilot Projects; Poverty Areas; Primary Health Care - methods; Primary Health Care - organization & administration; Quality of Life; Residence Characteristics; Time Factors
• ISSN: 1742-3953; 1745-9206
• DOI: 10.1177/1742395316644304

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.