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Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility

John A Ford¹, Elizabeth Lenaghan¹, Charlotte Salter¹

¹Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.

|June 6, 2019

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.

Keywords:

primary care social medicine

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