The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation

Chronic Illn. 2016 Sep;12(3):165-81. doi: 10.1177/1742395316644304. Epub 2016 Apr 10.


Objectives: To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas.

Methods: Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients.

Results: Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients.

Discussion: We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial.

Keywords: Primary care; complex intervention; deprivation; multimorbidity; quality of life.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Appointments and Schedules
  • Comorbidity*
  • Continuity of Patient Care*
  • Female
  • Focus Groups
  • General Practitioners
  • Holistic Health
  • Humans
  • Male
  • Middle Aged
  • Nurses
  • Patients
  • Physician-Patient Relations
  • Pilot Projects
  • Poverty Areas*
  • Primary Health Care / methods*
  • Primary Health Care / organization & administration*
  • Quality of Life
  • Residence Characteristics
  • Time Factors