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Ford, John, Lenaghan, Elizabeth, Salter, Charlotte, Turner, David 
ORCID: https://orcid.org/0000-0002-1689-4147, Shiner, Alice ORCID: https://orcid.org/0000-0002-0016-5759, Clark, Allan B. ORCID: https://orcid.org/0000-0003-2965-8941, Murdoch, Jamie, Green, Carole, James, Sarah, Koopmans, Imogen, Lipp, Alistair, Moseley, Annie, Wade, Tom, Winterburn, Sandra and Steel, Nicholas ORCID: https://orcid.org/0000-0003-1528-140X
(2019)
Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial.
BMJ Open, 9 (6).
ISSN 2044-6055
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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 to control in six general practices. Participants: Adults with 2 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 six months later. The control group received usual care planning. Outcome measures: Health-related quality of life (EQ5D5L), capability (ICEpop CAPability measure for Older people (ICECAP-O)), patient assessment of chronic illness care (PACIC) and health care use. All consultations were video 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 to 77.2 years, 39% female and 11.5 medications in the control group. The mean initial consultation time was 23.0 minutes 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, felt it delivered more patient-centred care and 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.
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