RT Journal Article
SR Electronic
T1 A consultation-level intervention to improve care of frequently attending patients: a cluster randomised controlled feasibility trial
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP bjgpopen18X101623
DO 10.3399/bjgpopen18X101623
A1 Rebecca K Barnes
A1 Helen Cramer
A1 Clare Thomas
A1 Emily Sanderson
A1 Sandra Hollinghurst
A1 Chris Metcalfe
A1 Sue Jackson
A1 Charlie Record
A1 Helen Thorley
A1 David Kessler
YR 2019
UL http://bjgpopen.org/content/early/2019/02/07/bjgpopen18X101623.abstract
AB Background Frequent attenders (FAs) to primary care receive considerable NHS resources without necessarily gaining benefit, and may even be harmed.Aim To assess the feasibility of a consultation-level intervention to improve care and address service use of FAs.Design & setting A cluster randomised controlled feasibility trial was undertaken. The study used a mixed-methods process evaluation and took place in six practices in England.Method All practices screened the top 3% of all attending patients over the previous 12 months for eligibility. Following randomisation, intervention patients were matched with named GPs, trained to use the Background, Affect, Trouble, Handling, Empathy (BATHE) technique during consultations. Telephone consultations were encouraged. Feasibility outcomes assessed were recruitment, retention, data collection and completeness, implementation fidelity, and acceptabilityResults A total of 599/1328 (45.1%) FAs were eligible. Four practices were randomised to the intervention (n = 451) and two to usual care (n = 148). A total of 96 (23.7%) patients were recruited to complete questionnaires. Retention and completeness of data were good; for example, 76% of those agreeing to complete questionnaires did so at the 12-month assessment point. Thirty-four GPs were trained and delivered BATHE ≥1 times to 50.1% of patients (n = 577 consultations). There were minimal increases in continuity and telephone consultations. Patients were positive about the intervention, but noticed little change in their care. Despite valuing BATHE, low adherence to training was indicated and GPs used it less than anticipated.Conclusion It was feasible to identify FAs and collect trial data. GPs were keen to engage and there was evidence that the BATHE technique was taken into practice. Optimising training is likely to improve fidelity. The intervention was low cost and low risk.