STUDY PROTOCOL: Improving social and clinical outcomes for socio-economically disadvantaged adults with mixed mental and physical multimorbidity: Development of an intervention based on relational continuity of primary healthcare.

Problem

More than 15.4 million people in England live with a chronic condition, of which 30% also have a mental health disorder. A greater mix of mental and physical health problems (mixed mental and physical multimorbidity or ‘mixed multimorbidity’) is seen as economic deprivation increases. These patients die up to 20years younger; have poorer quality of life, and increased healthcare utilisation. Their care is often fragmented though they would most benefit from care continuity. Organisations are therefore encouraged to provide more opportunities to see the same clinician when appropriate. However, there is a need for more evidence that improving relational continuity would improve overall patient care, especially where a combination of socioeconomic disadvantage and complex co-morbidities can challenge effective engagement with health and social services. AIM  This study aims to build further understanding of the meaning, measurement, and importance of relational continuity for socio-economically disadvantaged adults with mixed multimorbidity, whilst exploring key aspects of an intervention to enhance it in general practice. OBJECTIVES: Identify factors that may facilitate or prevent the provision of relational continuity to this patient group, as well as key aspects of an intervention to improve this. Identify and further test the application of key definitions and measures of relational continuity in primary care Understand interactions between predictors and effects of relational continuity for this patient group. Determine factors that might allow for a definition of minimum necessary (‘adequate’) relational continuity within NHS services for this group. Develop and further refine a complex intervention to improve relational continuity in primary care.

Approach

METHOD The study will address our objectives in 2stages: Stage1 (gathering data and building theory) addresses Objectives1 to 4 by undertaking: a) A systematic review of interventions to improve relational continuity in primary care. b) Semi-structured interviews and focus groups with patients, carers and health professionals respectively, and c) A secondary analysis of the Clinical Practice Research Datalink (CPRD). I will summarise evidence from Stage1 using Integrative Mixed Methods research. This will yield a programme theory for the intervention. Stage2 will use a Delphi study to further develop and refine the intervention, which we called i-CONTEXT (improving CONTinuity of care for Economically disadvantaged adults with miXed multimorbidity). We will test the intervention in a future feasibility study. Patient and public involvement (PPI) The group PPIRes will facilitate PPI in this project. Their lay members have contributed to the proposal and will remain involved throughout the fellowship. Core activities may include contributing to lay perspectives and summaries, ethics approval, leaflets and forms, and dissemination.

Findings

Findings will pave the way to a feasibility study of the developed intervention

Consequences

Expected Outcomes Improving relational continuity may lead to better patient outcomes, whilst increasing patient engagement with health services