Enhancing wellbeing in patients with multimorbidity in areas of high deprivation: development of a primary care-based complex intervention

Context: The Scottish prevalence of multimorbidity (the co-existence of more than one chronic morbidity) is nearly 25%, increases with age and occurs 10-15 years earlier in the most deprived neighbourhoods. A recent Cochrane Review found few interventions specifically for multimorbidity. Objective: To describe the development of a complex intervention to enhance wellbeing in people with multimorbidity in areas of high deprivation. Design: The MRC framework guided intervention development. The intervention was based on existing models of self-management and self-determination theory and refined using qualitative data in two stages. Setting: Primary Care in deprived areas of Glasgow, Scotland. Participants: Multimorbid patients, primary care staff, and voluntary sector workers took part in 5 focus group discussions (stage 1) and a scoping study in which the intervention was tried with patients and feedback gathered from 6 staff meetings and 6 individual interviews (stage 2). Intervention: A whole system approach incorporating: a) more time and personal continuity; b) a ‘CARE’ approach to consultations (i) ‘Connect’ with the patient, ii) ‘Assess’ holistically, iii) ‘Respond’ in an empathic, validating way, and iv) Empower patients to take control); c) support/training for professionals; d) resources for patients. Results: Practitioners invested considerably in time and relationships to participate in the study and support holistic management. Patients talked of using extra time to make connections (e.g. between social and medical problems), gain insight (e.g. knowledge of conditions), and set goals to improve quality of life. Both talked of the emotional burden of multimorbidity. The intervention was improved by providing guidance on use of time and selecting patients, on using small steps towards goals, and on use of stress management. Conclusion: A whole system intervention to enhance wellbeing is feasible in general practices serving deprived areas and is valued by staff and patients. It is being assessed in a pilot RCT.