Using codesign to involve patients and professionals in developing new interventions for patients with multimorbidity
Multimorbidity, defined as the presence of two or more long-term conditions, is increasingly common in primary care. This often involves taking several different medications; managing mutliple conditions and medications can lead to increased safety risks for patients. This study, led by Dr Sarah Knowles at the University of Manchester, aimed to involve patients in designing new interventions to improve safety in primary care, using different types of design materials. These were based on research into the patient experience of safety and multimorbidity in primary care, and included a 'trigger film' of real patients talking (drawing on the accelerated experience-based co-design approach) and personas and scenarios from the 'future workshop' approach, which use stories from real people to synthesise a range of archetypal experiences and situations. Both types of material are designed to enable patients, carers, and primary health-care professionals to think through the issues and propose interventions to improve care. Two workshops were held initially - one with public contributors only and one with health professionals - at which the trigger film and a persona description were used to stimulate discussion. The suggestions from workshops 1 and 2 were synthesized into three prototype interventions:
1. Scenario 1 “In The Practice”: describing a targeted database review, which calls in patients with multimorbidity to discuss their medications, paying specific attention to ensuring health information is understood and patient priorities are sought.
2. Scenario 2 “In The Pharmacy”: describing a pharmacist offering additional support for medication management (such as dosette boxes) by calling in patients who have not collected prescriptions and asking about support available from family or friends.
3. Scenario 3 “In The Home”: describing a “Medication Diary” that can be used to organize medication schedules and provide prompts to attend reviews, and could be shared with health professionals.
A third joint workshop was held to discuss these scenarios and develop agreed intervention recommendations.
Both patients and professionals prioritized polypharmacy as a threat to safety and identified a need for services to proactively offer support to reduce the burden of managing complex treatment regimes. Final recommendations include the need for accessible reminders to support medication adherence and medication reviews for particularly vulnerable patients conducted with pharmacists within GP practices.
Louise Locock, co-investigator on the study, says: "This was the first study to combine these two approaches to codesign. Participants found the process acceptable and interesting, and we found the scenarios were particularly useful in helping people explore practical service provision issues and move to possible solutions relatively quickly. Finding ways to ensure direct patient involvement but in a timely and efficient manner is a continuing priority."
For more information click here to read the paper http://dx.doi.org/10.1111/hex.12648