Wrong kind of care plans?

Doctors are pretty sceptical about care plans. No less so since the government started providing incentives for patients with long term conditions to have care plans. Yet a published Cochrane Review suggests that care plans can improve physical and mental health and improve people’s confidence in managing their own conditions [1]. So what’s the reason for the disconnect?

Angela Coulter was fairly clear about this at a recent meeting held by the Nuffield Trust and Commonwealth Fund. Government targets encourage a tick box approach with little engagement of the patient (and this was one of the problems identified in our work on care planning – see below for publications). A ‘plan’ devised by the doctor and handed out to the patient is going to do little to help anyone. Coulter has herself described a ‘House of Care’ model in which patients are closely involved in developing plans for their own care [2] and this is very different from what goes on in most GP consultations. That’s what Coulter thinks will make a difference – much more than ticking a box on an electronic record to say the patient’s been given a care plan. Not rocket science really.

However, even so, we shouldn’t expect too much of care plans. For example, the meta-analyses in the Cochrane review showed small but clinically significant improvements in HbA1, systolic blood pressure , depression and self-efficacy, but no significant change in general or condition specific health status or reported physical activity. More worryingly, most of the trials in the Cochrane Review focused on particular clinical conditions (most commonly diabetes) and many doctors struggle to know what a care plan should look like for their patient with six, eight or ten conditions. The ‘House of Care’ model goes some way to addressing what care planning should mean for more complex patients, and it involves a fundamentally different starting point in engaging the patient in the consultation. Not something doctors and nurses are necessarily trained in or skilled at. And certainly not ticking boxes.

1. Coulter A et al. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Library 2015

2. Coulter A et al. Delivering better services for people with long term conditions. Building the house of care. Kings Fund 2013.

CCHSR work on care planning

Reeves D, Hann M, Rick J, Rowe K, Small N, Burt J, Roland M, Protheroe J, Blakeman T, Richardson G, Kennedy A, Bower P. Care plans and care planning in the management of long-term conditions in the United Kingdom: a controlled prospective cohort study. BJGP 2014. 64(626):e568-75. doi: 10.3399/bjgp14X681385

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 English National Health Service: baseline data from a cohort study. J Health Serv Res Policy2013, 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

Burt J, Roland M, Paddison C, Reeves D, Campbell J, Abel G, Bower P. Prevalence and benefits of care plans and care planning for people with long-term conditions in England. Journal Health Serv Res Policy 2012 17(Suppl 1): 64–71

 

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  • The Cambridge Centre for Health Services Research (CCHSR) is a thriving collaboration between the University of Cambridge and RAND Europe. We aim to inform health policy and practice by conducting research and evaluation studies of organisation and delivery of healthcare, including safety, effectiveness, efficiency and patient experience.