Improving Primary Care after Stroke: A qualitative evaluation of the Patient Concerns Inventory (PCI) as a tool to identify unmet health needs

Conference: 
SAPC ASM 2018 - London
Talk Code: 
P1.37
Presenter: 
Dr Aaron Poppleton
Twitter: 
@aaronpoppleton
Co-authors: 
Dr Liz Lightbody(1), Prof. Dame Caroline Watkins(1), Prof. Umesh Chauhan(2).
Author institutions: 
1. University of Central Lancashire - Faculty of Health and Wellbeing, 2. University of Central Lancashire - Faculty of Clinical and Biomedical Sciences

Problem

Having a stroke can result in a range of physical, cognitive, and social impairments. After initial inpatient care, the GP become the chief care-coordinator and gatekeeper to healthcare. Individuals after stroke have been shown to have a higher and disability-weighted number of primary care encounters compared with an age matched general population. Despite this, multiple unmet health and social needs have been reported after stroke. While assessment of stroke patients’ health needs is proposed by NICE, no formal needs assessment tool is currently promoted within primary care. The ‘Patient Concerns Inventory’ (PCI) tool is in development as a means of individuals highlighting unmet health needs after stroke to secondary care clinicians within an outpatient setting. The current “Well-being after stroke: how General Practice can help” study aims to assess the perceived viability and acceptability of the PCI tool by individuals after stroke within primary care.

Approach

A qualitative grounded theory study involving 10-15 participants diagnosed with stroke or TIA three months to three years prior to December 2017. Individuals meeting inclusion criteria were identified from the electronic care record of five GP practices in East Lancashire. Invitation to participate is via a letter and subsequent follow-up phone call. A purposive sample of respondents will be selected to maximise variation based on age, gender, stroke/TIA, and ethnicity. Participants will complete a ‘Patient Concerns Inventory’ (PCI) on unmet health and social needs after stroke. A subsequent one-on-one semi-structured interview will explore perceived viability and acceptability of the PCI tool in addition to other themes relating to well-being after stroke. Video recording and communication aids will be offered to participants to facilitate interview responses. Analysis will be undertaken using a grounded theory methodology employing constant comparison within the Framework approach. The assessments, interviews, and transcript analysis will be undertaken by an academic GP clinical fellow within one of the practices. Rigor and trustworthiness will be ensured through cross-checking of interpretations and themes generated by two senior researchers within the stroke research team. Depth of knowledge generated will be increased through comparison of PCI and interview responses with the participant care record, interview video recordings (in mild-moderate communication difficulties) and interview field notes.

Findings

Data collection is ongoing. Study conclusion is expected by July 2018. Themes generated will be explored in the context varying participant socioeconomic status, ethnicity, and level of disability after stroke.

Consequences

Findings will inform PCI development and potential for implementation in primary care to improve identification of unmet health needs after stroke in an increasingly diverse UK population.

Submitted by: 
Aaron Poppleton
Funding acknowledgement: 
We declare no competing interests. AP gratefully acknowledges the support and funding of the National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast. AP is also funded by the NHS CCG for East Lancashire.