Patient Centred Assessment Method (PCAM): improving nurse led biopsychosocial assessment of patients with long term conditions and co-morbid mental health needs

Living with a chronic illness can impact on many aspects of people's lives such as mental, social and financial wellbeing GP practices were encouraged to look for depression in people with long term conditions, but new research casts doubts on its effectiveness in addressing mental health needs For many people their surrounding life circumstances, alongside their physical health problems both impact on their mental well-being, which in turn can further impact on their physical health and their ability to self care Addressing peoples physical, mental and social care needs might help people to take better care of themselves and improve overall health and wellbeing Annual reviews of people with long term conditions are mostly conducted by nurses who often struggle with patient needs that go beyond physical care This study will use a new tool, the Patient Centred Assessment Method (PCAM), to see if it can help nurses do better in addressing the physical, mental and social needs of patients We need to know whether the tool can be used by nurses, whether it is acceptable to them and to patients, and how best to implement it We would also need to see if it leads to better patient care and outcomes before it could be rolled out across the NHS To do this we need to run a feasibility trial which will let us know if it is possible to run a full trial before committing valuable research and NHS resources This initial study will involve GPs and nurses and patient groups discussing the practical aspects of using the tool in primary care nurse reviews for people with long term conditions We will ask patients what they feel about healthcare practitioners assessing and helping them with their broader health social needs We will then do a feasibility study to see whether it is feasible and worthwhile conducting a full-size trial of the impact of nurses using the PCAM We will randomly allocate practices to a group using the PCAM and a group delivering care as usual Eight Nurses from 4 GP practices will be trained to use the tool in a small group of their patients, and 8 nurses from 4 other practices will just provide care as usual We will collect information from 160 patients (10 per nurse) both before and after implementing the tool, as we would for a full scale trial This will test the outcome measures we would use in a future trial We will ask what patients thought of the care they received, and measure their health and wellbeing We would hope that this would improve if nurses were using the PCAM well We will study how the nurses actually use the PCAM and see if it changes the way they conduct annual reviews We will do this by recording a sample of their consultations before and after Finally, we will seek nurses and patients' views after having used the tool It may be difficult to let all patients know in advance that that they may be asked to complete questionnaires following their review the surgery often fills appointments at short notice We will allow people the chance to take forms away and post back to us A small number of people being asked to have their consultation audio recorded will be given information in advance The current team have experience of developing tools to assess quality of care in primary care We have already tested this tool in another healthcare setting The NHS costs of this study are small and the research could ensure future trial costs are efficient or not wasted