Patient Centred Assessment Method (PCAM): Experiences of adding the Psychosocial to the Clinical in Annual Reviews for patients with Long Term Conditions in Primary Care: A Process Evaluation of a Feasibility Randomised Controlled Trial.
Annual reviews for people with long term conditions (LTCs) are mostly conducted by Practice Nurses who focus on patients’ physical needs. However, evidence indicates that broader psychosocial support could lead to improved self-care and well-being, with reduced morbidity.
The Patient Centred Assessment Method (PCAM) is a new tool to help Practice Nurses conduct biopsychosocial needs’ assessments. It aims to: guide conversational assessment across four domains; identify needs and resources; and prioritise actions including use of wider statutory and third sector services. Implementing PCAM requires nurse training, Practice engagement and development of relationships with support services. We ran a feasibility, cluster randomised controlled trial of PCAM in primary care to determine its feasibility and acceptability in nurse-led, annual LTC reviews. Pre-trial, we conducted six focus groups with patients (n=17) and Practice staff (n=16). These informed PCAM implementation during the trial. Post-trial, we ran semi-structured interviews with patients (n=5) and staff (n=6) who had received and implemented (respectively) PCAM.
Focus groups: Patients described diverse experiences around living with and managing health conditions. Care experiences were both positive and negative. Some described the “transformative” results of broader support services. Patients largely found PCAM aims acceptable and valuable; most concerns related to potential burdens upon nurses. Practices were diverse in context, but most staff expressed frustration with, currently, limited impact upon patient self-care. PCAM was consistent with staff aspirations, some feeling they already achieved broader care, others that barriers prevented from doing so. The main feasibility concern was time and their ability to address broader issues raised.Interviews:Patients described and welcomed talking with nurses about their lives and broader concerns during PCAM reviews. PCAM use appeared to be seamlessly integrated from patients’ perspectives. Nurses appreciated supported, experiential training pre-trial. For nurses the PCAM was fairly easily integrated into consultations, although some reflected that initial integration took time and support. Nurses reported that PCAM appeared to help support a positive patient-nurse relationship through increasing the quality and openness of communication, and the understanding of patients’ lives. Nurses found the resource pack useful and actively signposted patients to various supports. This was complemented by an approach of helping patients to identify priorities and access support independently, rather than focusing solely on clinical issues. Long term adoption of PCAM appears likely for some of the Practices in this research, beyond the research project itself and there appeared to be scope to broaden use of the approach out to other Practice staff, including GPs.
PCAM appears acceptable and feasible for Practice Nurses and patients with LTCs, with potential to support broader psychosocial care and well-being. Nurse training and support is required to underpin this approach.