Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial

IntroductionGoal-setting is recommended for patients with multimorbidity, but there is little evidence to support its use in general practice.ObjectiveTo assess the feasibility of goal-setting for patients with multimorbidity, before undertaking a definitive trial.Design and settingCluster-randomise...

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Bibliographic Details
Published in:BMJ open 2019-06, Vol.9 (6), p.e025332-e025332
Main Authors: Ford, John A, Lenaghan, Elizabeth, Salter, Charlotte, Turner, David, Shiner, Alice, Clark, Allan B, Murdoch, Jamie, Green, Carole, James, Sarah, Koopmans, Imogen, Lipp, Alistair, Moseley, Annie, Wade, Tom, Winterburn, Sandra, Steel, Nicholas
Format: Article
Language:English
Subjects:
Adult
Chronic illnesses
Clinical decision making
Comorbidity
Continuity of care
Decision making
Dementia
Evidence-based medicine
Feasibility Studies
Female
Focus Groups
Goals
Humans
Male
Medical personnel
Multimorbidity
Objectives
Patient assessment
Patient-centered care
Patients - psychology
Physician-Patient Relations
Planning
Primary care
Primary Health Care
Public Health
Quality Improvement
Quality of Life
Quantitative psychology
Referral and Consultation
Systematic review
United Kingdom
Verbal communication
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Summary:IntroductionGoal-setting is recommended for patients with multimorbidity, but there is little evidence to support its use in general practice.ObjectiveTo assess the feasibility of goal-setting for patients with multimorbidity, before undertaking a definitive trial.Design and settingCluster-randomised controlled feasibility trial of goal-setting compared with control in six general practices.ParticipantsAdults with two or more long term health conditions and at risk of unplanned hospital admission.InterventionsGeneral practitioners (GPs) underwent training and patients were asked to consider goals before an initial goal-setting consultation and a follow-up consultation 6 months later. The control group received usual care planning.Outcome measuresHealth-related quality of life (EQ-5D-5L), capability (ICEpop CAPability measure for Older people), Patient Assessment of Chronic Illness Care and healthcare use. All consultations were video-recorded or audio-recorded, and focus groups were held with participating GPs and patients.ResultsFifty-two participants were recruited with a response rate of 12%. Full follow-up data were available for 41. In the goal-setting group, mean age was 80.4 years, 54% were female and the median number of prescribed medications was 13, compared with 77.2 years, 39% female and 11.5 medications in the control group. The mean initial consultation time was 23.0 min in the goal-setting group and 19.2 in the control group. Overall 28% of patient participants had no cognitive impairment. Participants set between one and three goals on a wide range of subjects, such as chronic disease management, walking, maintaining social and leisure interests, and weight management. Patient participants found goal-setting acceptable and would have liked more frequent follow-up. GPs unanimously liked goal-setting and felt it delivered more patient-centred care, and they highlighted the importance of training.ConclusionsThis goal-setting intervention was feasible to deliver in general practice. A larger, definitive study is needed to test its effectiveness.Trial registration number ISRCTN13248305; Post-results.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2018-025332