Multimorbidity in primary care
Funding
BNSSCG CCG Research Capability Funding (Local development)
What is the research question?
Is the Maximising Wellbeing in Everyday Life with Long-term conditions (MaxWELL) intervention effective and cost-effective?
What is the problem?
The majority of long-term condition management takes place in primary care. GPs and individuals with multimorbidity (more than one health condition) highlight the challenges of addressing multiple complex health problems within typical 10-minute consultations, and while long-term condition review appointments are typically longer, these often take place with practice nurses who may feel ill-equipped to discuss concerns beyond the single disease monitoring remit. The costs to the NHS of supporting and caring for people with multimorbidity are considerable and account for a large part of NHS resource use. Also, people with multimorbidity report poorly co-ordinated care that fails to treat them as a ‘whole person’, to consider their main concerns, or provide a clear care plan, and they generally receive worse continuity of care, despite continuity having greater importance for them. An intervention that could be shown to lessen the burden on individuals with multimorbidity and the NHS by addressing at least some of these problems and optimising resource use would be of huge benefit.
What is the aim of the research?
This study will develop a detailed practical intervention (MaxWELL) for GP practices to use with patients with multimorbidity. MaxWELL will be evaluated to see if it demonstrates cost-effectiveness and other benefits to the health economy, with improved well-being and value to people with multi-morbidity. The intervention will include clinician training and facilitation of organisational set-up, to help GP practices and Primary Care Networks to implement the requirements of the NHS plan around personalised care, shared decision-making and collaborative plans and avoid having to ‘re-invent the wheel’ in each practice.
How will this be achieved?
The study will recruit GP practices who will each identify adults with 3+ long term conditions from their list of registered patients. The patients will be offered a comprehensive annual review in 3 stages: 1) the collection of clinical information and tests with a healthcare assistant, 2) the sharing of the results of stage 1 with the patient and clinicians, then 3) a person centred and collaborative meeting between the patient and an appropriate clinician with the skills to address any clinical issues identified. Patient reported outcome measures will be collected, alongside anonymised practice level data that is routinely collected to monitor service delivery. Video-recordings of consultations and observations of MaxWELL will analysed, and patients, clinicians and other practice staff will be interviewed to assess the impact of the intervention.
Who is leading the research?
Dr Cindy Mann, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol.
Further information:
For more information or to get involved in this project, please contact bnssg.research@nhs.net.