Care plans and care planning: a rare event?

Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study  BJGP September 1, 2014: 64(626): e568-e575 doi: 10.3399/bjgp14X681385

Those of you with more than a passing interest in the management of long-term conditions will be well acquainted with current policy enthusiasm for the use of written “care plans” and the process of “care planning”. ‘Care planning’ means discussions with patients about care for their long-term conditions, making agreements about roles and responsibilities, supporting patients to manage their own health, and promoting shared decision-making consistent with evidence and patient preferences. A ‘care plan’ summarises the results of those discussions and provides a blueprint for care. And, the Government hope, these things should be an integral part of day-to-day care for pretty much everyone with a long-term condition.

However, work we have published today in collaboration with the Universities of Manchester, Keele and York suggests that the current use of written care plans in the management of patients with long-term conditions by GPs in the UK is rather rare.  To explore the adoption of care plans and care planning, and the relationships with patient outcomes, we recruited 38 practices, 17 of which reported relatively high levels of ‘care plans’, and 21 of which showed lower levels (based on data from the General Practice Patient Survey). We then recruited 2439 patients with long-term conditions in those practices and followed them over 12 months. One warning note: this was done before the usual inevitable policy changes, and thus before the contractual obligation to offer care plans to the most vulnerable 2% of patients came into operation.

And what did we find? Very few patients in the cohort reported having access to a written ‘care plan’. Patients in practices that had higher levels of ‘care plans’ did report more experience of ‘care planning’ (based on the validated Patient Assessment of Chronic Illness Care scale), but the differences were small. We found no relationship between ‘care plans’, ‘care planning’ and patient outcomes. Our interviews with patients who volunteered that they did indeed have care plans (you’ll have to wait for the full details, we haven’t quite written that bit up yet) found that, with a few notable exceptions, patients didn’t necessarily actually have one, didn’t really understand what a care plan was, and weren’t always that enthusiastic about them if they did.

So, it seems we need (as is often the case) rather more thought given to effective methods of implementation to allow the potential benefits of care planning to be demonstrated: and rather more understanding about what individual patients actually want.

If you are feeling enthusiastic, you can read the whole report here.

Other publications arising from this work so far are:

Bower P, Hann M, Rick J, Rowe K, Burt J, Roland M, Protheroe J, Richardson G, Reeves D. Multimorbidity and delivery of care for long-term conditions in the Englsih National Health Service: baselines data from a cohort study. Journal of Health Services Research and Policy 2013; 18: 29-37, doi:10.1177/1355819613492148

Burt J, Rick J, Blakeman T, Protheroe J, Roland M, Bower P. Care plans and care planning in long term conditions: a conceptual model. Primary Health Care Research and Development 2013. doi:10.1017/S1463423613000327

Newbould J, Burt J, Bower P, Blakeman T, Kennedy A, Rogers A, Roland M. Experiences of care planning in England: interviews with patients with long term conditions. BMC Family Practice 2012, 13:71

The study was part of a programme of work funded by the UK Department of Health Policy Research Programme (Health Reform Evaluation Programme 077/0016).


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