Impact of a comprehensive review template on personalised care in general practice for patients with multiple long-term conditions: a mixed-methods evaluation.

Abstract

Background: Primary care is in urgent need of more effective and efficient ways of managing the care of people living with multiple long-term conditions (multimorbidity). Personalised care organised around an individual's needs and conditions, taking account of individual context and priorities and supporting self-management, may offer an improved approach.

Aim: Explore the impact of a computerised template to support personalised care for patients with multiple long-term conditions within the context of routinely applied general practice.

Design & setting: A convergent mixed-methods evaluation design. General practices were recruited from three areas of England: Bristol, Southampton and Staffordshire.

Method: A computerised template for the review of multiple long-term conditions was made available to all general practices subscribing to a commercial template supplier. Implementation practices were supported to conduct personalised multimorbidity reviews. We used routine clinical data from implementation and control practices, a before-and-after patient questionnaire and qualitative interviews with general practice staff and patients to evaluate the impact of the intervention.

Results: Thirty-two general practices were recruited of which half were implementation practices. Using the multimorbidity template has potential to improve quality of care and patient benefit with no increase in consultation numbers. Patients received a more complete assessment of their needs with a clearer focus on the problems that matter most to them. Conducting multimorbidity reviews can increase burden on nursing staff and consideration is required to the organisation of reviews and appropriate training for nursing staff.

Conclusion: Use of the multimorbidity template needs to be supported by staff training, adequate practice capacity, support for system reorganisation, and attention to incentives to facilitate its benefits.