Goal-setting in care planning for people with multimorbidity

INTERVENTION: This is a six practice cluster randomised controlled mixed‐methods feasibility trial, to test the feasibility of goal‐setting as part of the care planning process in 60 patients with multimorbidity and at risk of unplanned hospital admission. Three practices will be randomly allocated to the intervention and three to the control group using simple block randomisation by Norwich Clinical Trials Unit. Intervention group: Participants receive a goal‐setting intervention, comprising two care planning appointments with a GP from their general practice. The first of these appointments will involve goal‐setting, and the second will be to review the goals agreed and any progress made with them. Intervention group participants may also be invited to attend a focus group to discuss their experiences of goal‐setting. Control group: Participants receive treatment as usual for patients included in the care planning process. The duration of participation for patients from practices in both groups will be 10 months, including consent, baseline data collection, up to two care planning consultations, and follow‐up data collection at 6 months post‐baseline. For those patients and GPs that opt to take part in subsequent focus groups, the overall duration will be approximately 18 months. The quantitative, qualitative and health economic data gathered during the study will be triangulated and emerging findings discussed with patients and GPs at a workshop to refine the intervention if required, and estimate the key parameters for a subsequent definitive randomised controlled trial of goal‐setting within care planning consultations. CONDITION: Specialty: Primary Care, Primary sub‐specialty: Primary care; UKCRC code/ Disease: Other/ General symptoms and signs ; Not Applicable ; Care planning PRIMARY OUTCOME: 1. Recruitment rate (practice level) is measured as the number of general practices that consent to participate at 3 months; 2. Recruitment rate (patient level) is measured as the number of eligible patients that consent to participate in the study by 6 months; 3. Quality of life is measured using the EQ‐5D questionnaire and the ICECAP‐O questionnaire at baseline and 6 months; 4. GAS‐Light goal achievement is measured for intervention group patients after the second care plan consultation; 5. Patient involvement with care planning and goal‐setting is measured using the Dyadic OPTION and CollaboRATE scales after the initial care plan consultation, and the Patient Assessment of Care for Chronic Conditions (PACIC) 20‐item questionnaire at baseline and 6 months; 6. Cognition is measured using the General Practitioner Assessment of Cognition (GPCOG) Score at baseline and 6 months; 7. Healthcare resource use is measured by the number of hospital admissions, A&E and outpatient contacts, and primary care staff contacts at 6 months, by reviewing patient notes; 8. Number and type of prescribed medications will be measured at 6 months, by reviewing patient notes; 9. Mortality will be measured at 6 months by reviewing patient notes SECONDARY OUTCOME: No secondary outcome measures INCLUSION CRITERIA: 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 dis