A Computer Template to Enhance Patient-centredness in Multimorbidity Reviews: a Qualitative Evaluation in Primary Care

Overview

Journal Br J Gen Pract

Specialty Public Health

Date 2018 May 23

PMID 29784866

Citations 10

Authors

Cindy Mann

Alison Shaw

Lesley Wye

Chris Salisbury

Bruce Guthrie

Affiliations

Soon will be listed here.

Abstract

Background: Computer templates for review of single long-term conditions are commonly used to record care processes, but they may inhibit communication and prevent patients from discussing their wider concerns.

Aim: To evaluate the effect on patient-centredness of a novel computer template used in multimorbidity reviews.

Design And Setting: A qualitative process evaluation of a randomised controlled trial in 33 GP practices in England and Scotland examining the implementation of a patient-centred complex intervention intended to improve management of multimorbidity. A purpose-designed computer template combining long-term condition reviews was used to support the patient-centred intervention.

Method: Twenty-eight reviews using the intervention computer template and nine usual-care reviews were observed and recorded. Sixteen patient interviews, four patient focus groups, and 23 clinician interviews were also conducted in eight of the 12 intervention practices. Transcripts were thematically analysed based on predefined core components of patient-centredness and template use.

Results: Disrupted communication was more evident in intervention reviews because the template was unfamiliar, but the first template question about patients' important health issues successfully elicited wide-ranging health concerns. Patients welcomed the more holistic, comprehensive reviews, and some unmet healthcare needs were identified. Most clinicians valued identifying patients' agendas, but some felt it diverted attention from care of long-term conditions. Goal-setting was GP-led rather than collaborative.

Conclusion: Including patient-centred questions in long-term condition review templates appears to improve patients' perceptions about the patient-centredness of reviews, despite template demands on a clinician's attention. Adding an initial question in standardised reviews about the patient's main concerns should be considered.

Citing Articles

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Birtwistle J, Millares-Martin P, Evans C, Foy R, Relton S, Richards S PLoS One. 2022; 17(10):e0275991.

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Ethnic Inequalities in Healthcare Use and Care Quality among People with Multiple Long-Term Health Conditions Living in the United Kingdom: A Systematic Review and Narrative Synthesis.

Hayanga B, Stafford M, Becares L Int J Environ Res Public Health. 2021; 18(23).

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Health information technology to improve care for people with multiple chronic conditions.

Samal L, Fu H, Camara D, Wang J, Bierman A, Dorr D Health Serv Res. 2021; 56 Suppl 1:1006-1036.

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