The Patient Centred Assessment Method for improving nurse-led biopsychosocial assessment of patients with long-term conditions: a feasibility RCT

Abstract

Background Annual reviews of people living with long-term conditions (LTCs) are mostly conducted by practice nurses (PNs), who focus on the physical needs of patients. The broader mental well-being and social needs of patients are also important if they are to live well. The Patient Centred Assessment Method (PCAM) is a new tool to help PNs conduct biopsychosocial assessments of patients’ needs. Research questions Is it feasible and acceptable to use the PCAM in primary care nurse-led reviews for those with LTCs? Is it feasible and acceptable to run a cluster randomised trial of the PCAM in primary care? Methods Four practitioner and two patient focus groups explored the acceptability and implementation requirements of the PCAM, which was then tested in a feasibility cluster randomised controlled trial aiming to recruit eight general practitioner (GP) practices and 16 nurses. Baseline data collection was conducted with nurses prior to randomisation, with a cohort of 10 patients per nurse, including patient demographics, patient evaluation of consultation, patient-completed outcomes (measured via the Consultation and Relational Empathy, Patient Enablement Instrument, Warwick–Edinburgh Mental Well-Being Scale, General Health Questionnaire and the Short Form questionnaire-12 items) and nurse referrals/signposting to services. Patient follow-up questionnaires were completed at 8 weeks. Practices were then randomised to the PCAM intervention or care as usual (CAU). Data collection was repeated for a second cohort of patients. Fidelity was tested by comparing a sample of recorded consultations before and after PCAM training. Qualitative interviews were conducted with PCAM nurses and a sample of patients. Results Approaches to 159 eligible practices resulted in the recruitment of six practices (10 nurses), with five practices (seven nurses) completing both data collection phases. Nurses collected baseline data on 113 patients, 71 of whom (62.8%) completed follow-up questionnaires. Five practices were randomised: three practices (six nurses) to the PCAM arm and two practices (four nurses) to the CAU arm. In phase 2, seven nurses collected data on 77 patients, of whom 40 (52%) completed follow-up. Only four PCAM nurses agreed to recording consultations, with five pre- and four post-PCAM recordings obtained. Post PCAM training, there was evidence of more attention being given to patients’ mental well-being and social issues. The PCAM was fairly easily integrated into consultation, although some nurses reflected that this benefited from early support. Patients were not always aware of its use, but most were happy to have their needs assessed. Limitations Recruitment of GP practices, and nurse recruitment and retention. Conclusions The PCAM is feasible and acceptable for use by primary care nurses and may have potential for encouraging biopsychosocial assessment of patients. Efforts required to recruit and retain staff indicate that a full trial is not feasible or cost-effective at this time. Future work The PCAM intervention warrants further exploration as an effective mechanism for improving care for people with LTCs; this could be conducted within an implementation study. Trial registration Current Controlled Trials ISRCTN98973169. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research Vol. 6, No. 4. See the NIHR Journals Library website for further project information.

Development and validation of a Japanese version of the Patient Centred Assessment Method and its user guide: a cross-sectional study

“…The exclusion of the latter item presumably resulted from the fact that copayment of medical expenses is at most 30% under the Japanese universal health insurance coverage system and 0% under the welfare system 44 45 ; hence, few patients were likely troubled with financial problems due to healthcare. Moreover, previous research revealed that financial topics are taboo and inappropriate for discussion with healthcare providers 46 ; therefore, this question might not have been answered accurately. In the Japanese version of PCAM, these items were not intentionally excluded in consideration of the fact that the overall Cronbach’s alpha was 0.86, which indicates a high internal consistency without exclusion of these items.…”

Identifying Barriers to Collaboration Between Primary Care and Public Health: Experiences at the Local Level

“…Collaboration between public health professionals (or public health organizations) and primary care providers (or primary care organizations) is a strategy for improving population health in communities. 1 Although primary care focuses on providing care to individuals, interest in addressing population-level health, 2 –5 responding to the social determinants of health, 6,7 and exploring how to build collaborative relationships outside primary care clinics has increased. 8,9 Public health organizations are also considering how to broaden collaboration with clinics to help address the needs of the community.…”

A Multi-sourced Data Analytics Approach to Measuring and Assessing Biopsychosocial Complexity: The Vancouver Community Analytics Tool Complexity Module (VCAT-CM)

“…Complexity scores were perceived to have good discriminatory power, in that they enable differentiation of patients in accordance to their unique contexts. These are similar characteristics to the PCAM and MCAM, which has been validated for use to enable multidisciplinary care planning functions (Pratt et al 2015; Maxwell et al 2011; Maxwell et al 2018).…”