Goal-setting in care planning for people with multimorbidity: Feasibility study and intervention refinement

HS South Norfolk CCG0 个研究点目标入组 52 人开始时间: 2016年12月21日最近更新: 2019年7月29日

试验速览

2019 results in: https://www.ncbi.nlm.nih.gov/pubmed/31164362 (added 05/07/2019) 2019 qualitative analysis results in: https://www.ncbi.nlm.nih.gov/pubmed/31160370 (added 05/07/2019)

•Inclusion criteria for practices:
•1. In the ‘Avoiding Unplanned Admissions Enhanced Service (ES): proactive case finding and care review for vulnerable people for general practice’ (over 90% of practices in England), or similarly using risk stratification to identify patients at high risk of unplanned admission
•2. At least one GCP trained GP (to be site Principal Investigator) and one GCP trained nurse for data collection
•3. GPs must be available to attend pre-arranged goal-setting training in the event that their practice is randomised to the intervention group
•Inclusion criteria for patients:
•1. Age 18 or over
•2. In the top 2% for risk of unplanned admission, e.g. on the practice register for ‘Avoiding Unplanned Admissions’ ES or similar, and so eligible for a new or review case planning consultation during the data collection period
•3. Diagnosed with at least 2 of 40 morbidities in Barnett’s analysis of multimorbidity, which includes diseases in the Quality and Outcomes Framework

•Exclusion criteria for practices:
•1. Single handed practice
•Exclusion criteria for patients:
•1. Not able to participate in goal-setting in GP’s professional opinion (e.g. advanced dementia or acute psychosis)
•2. Received care planning consultation in previous three months
•3. Require translation services to communicate verbally

发起方

HS South Norfolk CCG