From protocolized to person-centered chronic care in general practice: study protocol of an action-based research project (COPILOT).
action-based research
chronic diseases
general practice
multimorbidity
person-centered care
primary care
quadruple aim
Journal
Primary health care research & development
ISSN: 1477-1128
Titre abrégé: Prim Health Care Res Dev
Pays: England
ID NLM: 100897390
Informations de publication
Date de publication:
24 09 2019
24 09 2019
Historique:
entrez:
25
9
2019
pubmed:
25
9
2019
medline:
21
3
2020
Statut:
epublish
Résumé
To develop a proactive person-centered care approach for persons with (multiple) chronic diseases in general practice, and to explore the impact on 'Quadruple aims': experiences of patients and professionals, patient outcomes and costs of resources use. The management of people with multiple chronic diseases challenges health care systems designed around single disease. Patients with multimorbidity often receive highly fragmented care that may lead to inefficient, ineffective and potentially harmful treatments and neglect of essential health needs. A more comprehensive, person-centered approach is advocated for persons with multiple morbidities. However, examples on how to provide more person-centered care and evidence of its impact are scarce. A group of Dutch general practitioners (GPs) took the initiative to develop such a care approach. Mixed methods with a development and pilot-testing phase. The proactive person-centered approach will be developed using an action-based research design consisting of multiple plan-act-observe-reflect-adjust cycles. In each cycle, experiences of patients and primary care professionals from 13 practices will be collected via interviews, observations and focus groups. Starting point for the first cycle is a 'person-centered consultation' of up to 1 h in which the GP discusses the health status and health care needs of the patient. Furthermore, shared decisions between GP and patient are made on treatment goals and follow-up. In the pilot-test phase, a nested case cohort study allows to explore the impact of the new approach on 'Quadruple aim' outcomes comparing persons with and without exposure to the new care approach. This study will provide a proactive person-centered approach for persons with multimorbidity in primary care and estimate its potential impact on quadruple outcomes.
Sections du résumé
AIM
To develop a proactive person-centered care approach for persons with (multiple) chronic diseases in general practice, and to explore the impact on 'Quadruple aims': experiences of patients and professionals, patient outcomes and costs of resources use.
BACKGROUND
The management of people with multiple chronic diseases challenges health care systems designed around single disease. Patients with multimorbidity often receive highly fragmented care that may lead to inefficient, ineffective and potentially harmful treatments and neglect of essential health needs. A more comprehensive, person-centered approach is advocated for persons with multiple morbidities. However, examples on how to provide more person-centered care and evidence of its impact are scarce. A group of Dutch general practitioners (GPs) took the initiative to develop such a care approach.
METHODS/DESIGN
Mixed methods with a development and pilot-testing phase. The proactive person-centered approach will be developed using an action-based research design consisting of multiple plan-act-observe-reflect-adjust cycles. In each cycle, experiences of patients and primary care professionals from 13 practices will be collected via interviews, observations and focus groups. Starting point for the first cycle is a 'person-centered consultation' of up to 1 h in which the GP discusses the health status and health care needs of the patient. Furthermore, shared decisions between GP and patient are made on treatment goals and follow-up. In the pilot-test phase, a nested case cohort study allows to explore the impact of the new approach on 'Quadruple aim' outcomes comparing persons with and without exposure to the new care approach.
DISCUSSION
This study will provide a proactive person-centered approach for persons with multimorbidity in primary care and estimate its potential impact on quadruple outcomes.
Identifiants
pubmed: 31547898
pii: S1463423619000550
doi: 10.1017/S1463423619000550
pmc: PMC6764186
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e134Références
Eur J Intern Med. 2015 Apr;26(3):190-6
pubmed: 25704328
Fam Pract. 2004 Aug;21(4):381-6
pubmed: 15249526
Bone Joint J. 2014 May;96-B(5):622-8
pubmed: 24788496
Health Qual Life Outcomes. 2015 May 13;13:56
pubmed: 25963944
J Comorb. 2018 Mar 8;8(1):9-15
pubmed: 29651408
Health Policy. 2016 Jul;120(7):818-32
pubmed: 27114104
Med Care. 2005 May;43(5):436-44
pubmed: 15838407
Health Aff (Millwood). 2001 Nov-Dec;20(6):64-78
pubmed: 11816692
JAMA. 2005 Aug 10;294(6):716-24
pubmed: 16091574
Eur J Intern Med. 2015 Apr;26(3):157-9
pubmed: 25797840
Qual Life Res. 2011 Dec;20(10):1727-36
pubmed: 21479777
JBI Database System Rev Implement Rep. 2015 Sep 16;13(8):70-8
pubmed: 26455936
Pain. 1983 May;16(1):87-101
pubmed: 6602967
Age Ageing. 2000 Mar;29(2):173-8
pubmed: 10791453
Health Qual Life Outcomes. 2012 Feb 10;10:21
pubmed: 22325334
Health Policy. 2018 Jan;122(1):36-43
pubmed: 29129270
BMJ. 2012 Sep 03;345:e5205
pubmed: 22945950
J Epidemiol Community Health. 2016 Oct;70(10):1032-8
pubmed: 27116951
Ann Fam Med. 2014 Nov-Dec;12(6):573-6
pubmed: 25384822
Value Health. 2016 Jun;19(4):343-52
pubmed: 27325326
Clin Rehabil. 2009 Apr;23(4):362-70
pubmed: 19179355
Lancet. 2018 Jul 7;392(10141):41-50
pubmed: 29961638
Health Policy. 2018 Jan;122(1):4-11
pubmed: 28967492
BMC Health Serv Res. 2018 Jul 24;18(1):576
pubmed: 30041653
N Engl J Med. 2012 Mar 1;366(9):777-9
pubmed: 22375966