A computer template to enhance patient-centredness in multimorbidity reviews: a qualitative evaluation in primary care

Cindy Mann (Lead / Corresponding author), Alison Shaw, Lesley Wye, Chris Salisbury, Bruce Guthrie

Research output: Contribution to journalArticle

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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.

LanguageEnglish
Pagese495-e504
Number of pages10
JournalBritish Journal of General Practice
Volume68
Issue number672
Early online date22 May 2018
DOIs
Publication statusPublished - Jul 2018

Fingerprint

Comorbidity
Primary Health Care
Communication
Interviews
Health
Scotland
Long-Term Care
Focus Groups
England
Randomized Controlled Trials
Delivery of Health Care

Keywords

  • Delivery of health care
  • Electronic health records
  • Multiple chronic conditions
  • Patient-centred care
  • Primary health care
  • Quality of life

Cite this

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title = "A computer template to enhance patient-centredness in multimorbidity reviews: a qualitative evaluation in primary care",
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.",
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A computer template to enhance patient-centredness in multimorbidity reviews : a qualitative evaluation in primary care. / Mann, Cindy (Lead / Corresponding author); Shaw, Alison; Wye, Lesley; Salisbury, Chris; Guthrie, Bruce.

In: British Journal of General Practice, Vol. 68, No. 672, 07.2018, p. e495-e504.

Research output: Contribution to journalArticle

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AU - Mann, Cindy

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AU - Wye, Lesley

AU - Salisbury, Chris

AU - Guthrie, Bruce

N1 - This project was funded by the National Institute for Health Research, Health Services and Delivery Research (NIHR) Programme (project number 12/130/15). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the above funder, NIHR, NHS, or the Department of Health.

PY - 2018/7

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N2 - 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.

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KW - Primary health care

KW - Quality of life

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