How did we make GP-MATE (a communication tool to improve post-discharge care) using experience based co-design?

Problem

The post-discharge period is a time of risk for older people, especially those with frailty and multi-morbidity.[1] There has been extensive study of the discharge problem for older people from a secondary care and hospitalist perspective [2,3] but very little attention in primary care at the ‘receiving end’ despite clear safety issues[4]. The overarching aim of GP-MATE is to empower patients and their carers through co-designing a tool (GP-MATE) for older patients and their carers to improve communication with their general practice after discharge from hospital.

Approach

Experience Based Co-Design (EBCD) was used to co-design the GP-MATE patient held tool and the general practice staff toolkit. Three co-design groups corresponding to three loose geographic areas were set up, and a total of 19 older people/carers recruited. General Practice staff were also recruited with the assistance of the Clinical Research Network in three regions. A total of 17 staff members participated. The co-design meetings took place over 4 months (Spring/summer 2023). All meetings were half-day in length and were audio-recorded. The trigger film was presented to participants in the first meeting, after which priorities for GP-MATE were assigned. The GP-MATE tool was built on these priorities and underwent further development and refinement. A final joint event across the three areas took place with both staff and lay participants where implementation barriers and facilitators were identified.

Findings

The GP-MATE patient held tool has four key priority areas, with an overarching aim to overcome barriers in access to general practice following discharge. Participants identified the importance of continuity of care, specifically episodic continuity, to improve the quality of care received from general practice. Carers and caring was a key priority area, exploring important topics post discharge including the issue of loneliness and identification of sources of support. The medication safety section was designed to help assess patients and their carers understanding of medication changes, while the information power section contains questions to help better understand the discharge summary. The GP-MATE staff toolkit is currently a 20-page manual with training advice for a range of staff roles in relation to GP-MATE appointment set up, systems surrounding high quality post-discharge care and information on how to conduct a GP-MATE consultation.

Consequences

The use of EBCD to create GP-MATE provided an adaptable approach where patients and caregivers were involved throughout all stages of intervention development. GP-MATE is a low-cost intervention, empowering patients and carers and making care safer in the post discharge space. GP-MATE will be tested in a feasibility study in a General Practice setting. This will help to determine the real-world acceptability and usability of GP-MATE for both patients and primary care staff and how it will lead to measurable improvements in patient safety.