The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socio-economic deprivation

Stewart Mercer , Rosaleen O'Brien, Bridie Fitzpatrick , Maria Higgins , Bruce Guthrie , Graham Watt , Sally Wyke

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The aim of this study was to develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas. Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients.
Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients.
Original languageEnglish
Number of pages17
JournalChronic Illness
Early online date16 Apr 2016
Publication statusPublished - Apr 2016



  • Primary care, multimorbidity, deprivation, complex intervention, quality of life

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