The CARE Plus study – a whole-system intervention to improve quality of life of primary care patients with multimorbidity in areas of high socioeconomic deprivation: exploratory cluster randomised controlled trial and cost-utility analysis

Stewart Mercer , Bridie Fitzpatrick , Bruce Guthrie , Elisabeth Fenwick, Eleanor Grieve , Kenny Lawson , Nicki Boyer , Alex McConnachie, Suzanne Lloyd , Rosaleen O'Brien, Graham Watt , Sally Wyke

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Abstract

Multimorbidity is common in deprived communities and reduces quality of life. Our aim was to evaluate a whole-system primary care-based complex intervention, called CARE Plus, to improve quality of life in multimorbid patients living in areas of very high deprivation. We used a phase 2 exploratory cluster randomised controlled trial with eight general practices in Glasgow in very deprived areas that involved multimorbid patients aged 30–65 years. The intervention comprised structured longer consultations, relationship continuity, practitioner support, and self-management support. Control practices continued treatment as usual. Primary outcomes were quality of life (EQ-5D-5L utility scores) and well-being (W-BQ12; 3 domains). Cost-effectiveness from a health service perspective, engagement, and retention were assessed. Recruitment and baseline measurements occurred prior to randomisation. Blinding post-randomisation was not possible but outcome measurement and analysis were masked. Analyses were by intention to treat.
Original languageEnglish
JournalBMC Medicine
Volume14
Issue number88
Early online date22 Jun 2016
DOIs
Publication statusPublished - Jun 2016

Keywords

  • multimorbidity
  • complex intervention
  • General Practice
  • care plan
  • primary care
  • deprivation
  • socioeconomic status
  • consultation time
  • mindfulness
  • empathy

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