Typical doctor surgeries arrange consultations for ten minutes which enable patients and practitioners to focus on one, typically medical, problem. However, it is common, particularly in areas of high deprivation, for people to have multiple physical health problems in addition to mental illnesses and they may also be managing social problems, like poverty. We described, in our first qualitative paper published, the “endless struggle” GPs and Practice Nurses working in the most deprived areas had, in terms of adequately getting to the bottom of complex issues in a short amount of time http://10.1177/1742395310382461.
A research team from the Universities of Glasgow and Dundee, led by Professor Stewart Mercer, University of Edinburgh, developed the CARE (Connect, Assess, Respond, Empower) Plus study. Qualitative work conducted over four years by Rosaleen O’Brien (2009-2013), overseen by Co-Investigator Professor Sally Wyke, was used to develop, test and evaluate a different approach to care. We sought to establish if longer (30-60 minute) consultations changed the way doctors thought about the illnesses they were presented with and the treatments they offered, and whether this would improve outcomes for their patients.
Eight practices in deprived parts of Glasgow took part in the study, of which four health centres offered an enhanced care programme. During the extended consultations, GPs dealt with all the patients’ issues, agreed a care plan with them and goals to aim for that might improve quality of life, as well as follow-up sessions. Patients who received this extra attention were found to be comparatively better a year later than a group of similar patients, who declined in health, having received a standard service from their GP.
My view of the main outcomes of the feasibility trial, reported by the media at the time, was that standard trial measures used might have underplayed the benefits of the intervention to the CARE Plus group:
“Qualitative interviews produced more nuanced, and positive, findings about the benefits of CARE Plus. Most patients and practitioners interviewed had noticed marked improvements to wellbeing. When noticeable change to quality of life had not yet been experienced by patients, some felt that the extra support they had received had set them on the right path to health improvements. The act of giving patients extra time seemed to have particular significance in this social setting of high deprivation; to many patients extra time indicated they were being valued and this boosted their sense of self-worth. In the longer term, this could have real benefits and primary care providers should be encouraged to think creatively about how they could reconfigure their services to give more time to those who would benefit most.”
The study was funded by the Chief Scientist Office, Scotland, UK.
Dr Rosaleen O'Brien 