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Public health
Research
Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial
  1. John A Ford1,
  2. Elizabeth Lenaghan1,
  3. Charlotte Salter1,
  4. David Turner1,
  5. Alice Shiner1,
  6. Allan B Clark1,
  7. Jamie Murdoch1,
  8. Carole Green2,
  9. Sarah James1,
  10. Imogen Koopmans1,
  11. Alistair Lipp3,
  12. Annie Moseley2,
  13. Tom Wade1,
  14. Sandra Winterburn1,
  15. Nicholas Steel1
  1. 1 Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
  2. 2 Patient and public involvement representative, Norwich, UK
  3. 3 NHS England Midlands & East (East), Fulbourn, UK
  1. Correspondence to Dr Nicholas Steel; n.steel{at}uea.ac.uk

Abstract

Introduction Goal-setting is recommended for patients with multimorbidity, but there is little evidence to support its use in general practice.

Objective To assess the feasibility of goal-setting for patients with multimorbidity, before undertaking a definitive trial.

Design and setting Cluster-randomised controlled feasibility trial of goal-setting compared with control in six general practices.

Participants Adults with two or more long term health conditions and at risk of unplanned hospital admission.

Interventions General 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 measures Health-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.

Results Fifty-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.

Conclusions This 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.

  • primary care
  • social medicine

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/bmjopen-2018-025332

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    Footnotes

    • Contributors NS, JAF, CS and AS conceived the idea. All authors contributed to the design of the study. EL led the data collection which was supported by TW, IK and SJ. CS, JM and AS led the analysis of the qualitative data which was supported by SW. ABC undertook the statistical analysis. DT undertook the economic analysis. CG and AM provided a patient and public perspective and helped with qualitative analysis. AL led the partnership with NHS England and contributed to handling of adverse events. All authors contributed to the interpretation of the results. JAF drafted the initial manuscript. All authors revised the manuscript and approved the final version. NS is the guarantor.

    • Funding This paper presents independent research supported by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0215-36079) and by the NIHR Collaboration for Leadership in Applied Health Research and Care East of England Programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funders did not have any role in the design, collection, analysis or interpretation of data or in writing the manuscript.

    • Competing interests None declared.

    • Ethics approval Research ethics approval was obtained from the NHS Research Ethics Committee (16/EM/0411).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Dataset of quantitative data and statistical code is available from the corresponding author.

    • Patient consent for publication Not required.