‘I wouldn't push that further because I don't want to lose her’: a multiperspective qualitative study of behaviour change for long‐term conditions in primary care

ObjectivesTo develop a taxonomy of interventions and a programme theory explaining how interventions improve physical activity and function in people with long-term conditions managed in primary care. To co-design a prototype intervention informed by the programme theory.DesignRealist synthesis combining evidence from a wide range of rich and relevant literature with stakeholder views. Resulting context, mechanism and outcome statements informed co-design and knowledge mobilisation workshops with stakeholders to develop a primary care service innovation.ResultsA taxonomy was produced, including 13 categories of physical activity interventions for people with long-term conditions.Abridged realist programme theoryRoutinely addressing physical activity within consultations is dependent on a reinforcing practice culture, and targeted resources, with better coordination, will generate more opportunities to address low physical activity. The adaptation of physical activity promotion to individual needs and preferences of people with long-term conditions helps affect positive patient behaviour change. Training can improve knowledge, confidence and capability of practice staff to better promote physical activity. Engagement in any physical activity promotion programme will depend on the degree to which it makes sense to patients and professions, and is seen as trustworthy.Co-designThe programme theory informed the co-design of a prototype intervention to: improve physical literacy among practice staff; describe/develop the role of a physical activity advisor who can encourage the use of local opportunities to be more active; and provide materials to support behaviour change.ConclusionsPrevious physical activity interventions in primary care have had limited effect. This may be because they have only partially addressed factors emerging in our programme theory. The co-designed prototype intervention aims to address all elements of this emergent theory, but needs further development and consideration alongside current schemes and contexts (including implications relevant to COVID-19), and testing in a future study. The integration of realist and co-design methods strengthened this study.

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FRAILTY AND SARCOPAENIA TRIALS IN PRIMARY CARE – IDENTIFYING AND OVERCOMING KEY BARRIERS TO SUCCESSFUL CLINICIAN PARTICIPATION

Journal of Frailty & Aging ◽

10.14283/jfa.2015.62 ◽

2015 ◽

pp. 1-2

Author(s):

A. SINCLAIR

Keyword(s):

Primary Care ◽

Target Population ◽

Population Based ◽

Care Staff ◽

Long Term Conditions ◽

Primary Care Research ◽

Wide Range ◽

Primary Care Practitioners ◽

Primary Care Staff

Primary care research involving older people brings together a wide range of primary care practitioners. Key areas of activity include: health promotion, disease prevention, screening and early diagnosis, as well as the management of common and long-term conditions such as frailty and sarcopaenia which are under-researched domains of health in this setting. Few interventional studies have identified frail or sarcopaenic patients as the target population based on recent definitions of either condition. Several barriers to successful research in the primary care area exist and overcoming such barriers is not straightforward but involves a multidimensional approach that attempts to enhance the confidence and opportunity to engage in research of primary care staff and the consideration of factors that allow external leads of research to coordinate their programme.

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Improving the Care of People with Long-Term Conditions in Primary Care: Protocol for the Enhance Pilot Trial

Journal of Comorbidity ◽

10.15256/joc.2015.5.60 ◽

2015 ◽

Vol 5 (1) ◽

pp. 135-149 ◽

Cited By ~ 3

Author(s):

Emma L. Healey ◽

Clare Jinks ◽

Valerie A. Tan ◽

Carolyn A. Chew-Graham ◽

Sarah A. Lawton ◽

...

Keyword(s):

Primary Care ◽

Controlled Trial ◽

Qualitative Interviews ◽

Pilot Trial ◽

Integrated Approach ◽

Long Term Conditions ◽

Delivery Of Care ◽

Care Protocol ◽

Engagement Assessment

Background Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.

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Identifying the processes of change and engagement from using a social network intervention for people with long‐term conditions. A qualitative study

Health Expectations ◽

10.1111/hex.12839 ◽

2018 ◽

Vol 22 (2) ◽

pp. 173-182 ◽

Cited By ~ 5

Author(s):

Ivaylo Vassilev ◽

Anne Rogers ◽

Anne Kennedy ◽

Chad Oatley ◽

Elizabeth James

Keyword(s):

Social Network ◽

Qualitative Study ◽

Processes Of Change ◽

Long Term Conditions ◽

Social Network Intervention ◽

Network Intervention

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Medication Adherence and Blood Pressure Control Among Hypertensive Patients With Coexisting Long-Term Conditions in Primary Care Settings

Medicine ◽

10.1097/md.0000000000007831 ◽

2017 ◽

Vol 96 (32) ◽

pp. e7831

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Medication Adherence ◽

Blood Pressure Control ◽

Pressure Control ◽

Long Term Conditions ◽

Hypertensive Patients ◽

Primary Care Settings

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Improving communication and patient safety in primary care for people aged 65+ with multiple long-term conditions

http://isrctn.com/ ◽

10.1186/isrctn13196605 ◽

2021 ◽

Author(s):

Rebecca Goulding

Keyword(s):

Primary Care ◽

Patient Safety ◽

Long Term Conditions

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Electronic Patient Records (EPR), Library Services (LS) and Multidisciplinary Team (MDT) Meetings

Health Literacy ◽

10.4018/978-1-5225-1928-7.ch009 ◽

2017 ◽

pp. 179-197

Author(s):

Shahid Muhammad ◽

Malcolm Rigler ◽

Meshia Adams

Keyword(s):

Primary Care ◽

Multidisciplinary Team ◽

Library Services ◽

Patient Records ◽

Electronic Patient Records ◽

Long Term Conditions ◽

Health Records ◽

Care Services ◽

Primary Care Services

Patients with Long-Term Conditions (LTCs) account for around 50% of General Practitioner (GP) appointments, 64% of outpatient appointments and 70% of hospital bed days. There needs to be a wider access to knowledge and understanding such as directories with information leaflets, documents, books on lifestyle, helpful contacts and sources to information that can support patients and the general public on the most important elements their health. This cannot be achieved just through patients accessing their health records in sole. The objective of this paper is to 1) highlight the importance of integrating General Practice (GP), Electronic Patient Records (EPR) with Library Services (LS) and 2) also explore why it would be advantageous to implement patient-centred Multidisciplinary Team (MDT) meetings in primary care for patients with Long-Term Conditions (LTCs). This article provides a UK glance and how primary care services can be improved, integrating for the better. Having access to Electronic Patient Records (EPR) alone will not help or encourage a patient to gain confidence and/ or understanding especially if patients are overwhelmed by their healthcare choices and Health Literacy (HL) complexities. Patients' whose first language is not English for example, approaching more methods to support HL is/ will be challenging. Library and Health Services partnerships should be initiated to allowing access to wider resources. In addition, patient-centred Multidisciplinary Team (MDT) meetings should be arranged at dedicated time points between a doctor and patient/ carer and these can take place in a private section within library setting involving wider participation in care plans. Given that more patients and the public will have opportunity to access their health records, a “Libraries and Health” partnership can help integrate primary healthcare better thus allowing all to access health-related literature, using books, leaflets and digital media in a comfortable environment in a setting that also has staff that can support with HL and technology. An EPR and MDT initiative should be supported with library and health partnerships; this needs to be encouraged.

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