Living well with multiple morbidity: the development and evaluation of a primary care-based complex intervention to support patients with multiple morbidities

Grant Holders:

• Professor Stewart Mercer (PI),
• Professor Graham Watt, Dr Elisabeth Fenwick, Dr Alex McConnachie (University of Glasgow)
• Professor Sally Wyke (University of Stirling),
• Professor Bruce Guthrie (University of Dundee)
• Mr Alex McKenzie (NHS Greater Glasgow and Clyde)

Funded by CSO NHS Applied Research Programme for 4 years (£825,153)

Start date 1 January 2009 (Research Secretary in post), other researchers to be appointed on 30 January 2009

Background

Multiple morbidity (currently defined as the co-existence of two or more long-term conditions in an individual) is an increasingly common problem, exacerbated by socio-economic deprivation and affecting psychological as well as physical well-being. Multiple morbidity cuts across current NHS priorities. Such patients stand to gain not only from improvements in the quantity, co-ordination and continuity of personalised care, but also from primary care-led support for self-management

Aims and Objectives

Our overall aim is to develop and evaluate a primary care-led whole-system intervention that helps people to live well with multiple morbidity

Our research objectives are:

1. To describe the nature, extent and experience of multiple morbidity in the most deprived areas of Scotland (compared with the least deprived) within different types of patient and practice populations and the impact on use of services, and from this to identify the target group for the intervention more precisely;
2. To develop a ‘whole system’ intervention (in accordance with MRC guidelines for the development and evaluation of complex interventions) that acts at system, and professional-patient levels to support self-care in targeted patients with multiple morbidity in deprived areas with the objective of improving patient-defined outcomes, well-being, and health-related quality of life;
3. To carry out a pragmatic exploratory randomised controlled trial to assess the feasibility and likely cost-effectiveness of the intervention in preparation for a large scale definitive RCT.

Overview of Research Programme

The programme will consist of five inter-linked workstreams. Workstream 1 will investigate the prevalence of multiple morbidity in Scotland, comparing patients living in more deprived and more affluent areas, and examining the age at which multi-morbidity manifests at different ages. It will additionally establish the best ways of identifying the target population for the complex intervention.

Workstream 2 will develop the first iteration of the complex intervention through literature review, and the contribution of an expert Advisory Group with professional, patient and voluntary sector membership. Workstream 3 will evaluate the feasibility of the delivery of the intervention in relation to the system changes, training and delivery of support and in relation to the feasibility of data collection in intervention practices. Workstream 4 will evaluate the likely effectiveness and cost-effectiveness of the intervention, as well as inform and focus the evaluation of the intervention in terms of effectiveness and value for money as it evolves throughout the programme. Workstream 5 will determine the likely cost-effectiveness of the intervention in an exploratory trial to determine best outcomes and likely effect-sizes in a full, UK-wide, trial.