Extrait

Background and study aims Patients with long-term conditions are often managed in general practice by inviting them to practice-based clinics for each of their specific conditions (e.g. diabetes clinics), where they see a nurse who follows a checklist for that condition. However, increasing numbers of people have several long-term conditions, which is known as multimorbidity. These patients with multimorbidity often have to see different nurses and doctors at different clinics, sometimes get conflicting advice, often have to take lots of medication and can feel that no-one treats them as a whole person or takes their views into account. They also have high rates of depression which may be unrecognised. The aim of this study is to develop and test a new way for GP practices to manage people with multiple long-term conditions. Who can participate? Male or female, aged 18 years and over and have at least three of the following conditions: cardiovascular disease or chronic kidney disease (including coronary heart disease, hypertension, heart failure, peripheral arterial disease, CKD), stroke, diabetes, chronic obstructive pulmonary disease (COPD) or asthma, epilepsy, atrial fibrillation, severe mental health problems (e.g. schizophrenia, psychotic illnesses), depression, dementia, learning disability, rheumatoid arthritis. What does the study involve? The general practices are randomly allocated to either use the new way of managing patients with multimorbidity (intervention group) or to use the current management practice of treating each condition separately (usual care group). Patients in general practices allocated to the intervention group are identified and given a named nurse and doctor to manage their care. These patients are offered longer appointment times when they have to see a GP, as far as possible with their named GP. Patients are also invited for a comprehensive health review every 6 months which is designed to cover all of their health issues, focussing on the patients' concerns and priorities, as well as including a medication review to try to simplify their drug treatment and to check that their drugs are being correctly prescribed and taken, and checking for and treating symptoms of depression. The practice also has a linked general physician at the local hospital whom they can contact easily for advice about patients with complex problems. Training, feedback, financial incentives and regular meetings of practice champions are used to try to ensure that the intervention is delivered in practices as intended. Patients with general practices allocated to the usual care group continue having their care managed by their GP using current management practices of multiple appointments and clinics for their separate conditions. Before the study starts, and at 9 and 15 months into the study, participants from both groups are asked to fill in questionnaires about their wellbeing, illnesses and treatments, their experience of their care, and what health resources they used. A small sample of patients (about 30 participants) from GP practices in the intervention group are invited to take part in qualitative interviews. Following a semi-structured interview format, participants are asked for their perspectives and experiences of changes to their care. Interviews and observation of practice staff from about five intervention practices also inform the process evaluation. What are the possible benefits and risks of participating? This study will help to establish what works best in planning services to manage people with multiple long-term conditions in general practice, so this will be of benefit to future patients. Using a new service or changing an established routine comes with risks. Some participants may not want to change how they are being managed. However, study participants will receive a more intensive level of monitoring and have extra points of contact (research team) in addition to what they would normally receive in primary care. Patients in intervention practices could benefit by having fewer but longer appointments and having to take less drugs. Patients may also benefit from diagnosis and treatment of depression, or being encouraged to highlight their priorities. Participants in the study would have to give up some of their time to fill out questionnaires, which may be an inconvenience. Researchers will require access to patients' medical records, which participants may be uncomfortable with. All patient information will be treated in strict confidence and in compliance of the Data Protection Act. Where is the study run from? The study is led by the University of Bristol, in collaboration with the Universities of Glasgow, Manchester and Dundee, the Royal College of General Practitioners and Bristol Clinical Commissioning Group. About 32 practices across England and Scotland are participating. When is the study starting and how long is it expected to run for? March 2014 to September 2017 Who is funding the study? National Institute of Health Research (NIHR) (UK) Who is the main contact? Dr Mei-See Man [email protected]

Critère d'inclusion

• Topic: Primary Care Research Network for England; Subtopic: Not Assigned; Disease: All Diseases

Liens

• ictrp
• isrctn