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Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study

Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study
Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study
Background
In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits.

Aim
To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care.

Design and setting
A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning.

Method
Implementation of care plans and care planning in general practice was assessed using the 2009–2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling.

Results
The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time.

Conclusion
The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning.
uk, care planning, care plans, general practice, long-term conditions
0960-1643
e568-e575
Reeves, David
4d9f4b50-445c-4257-81fe-4d6fa73a9891
Hann, Mark
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Rick, Jo
b6b84866-38a3-4af1-a86d-6bfbbd4e8702
Rowe, Kelly
ad964ae1-89e9-4201-bdc0-32d5d7f13e1e
Small, Nicola
d7558988-49a2-4fce-9782-d07a86127657
Burt, Jenni
af1903e7-2bb8-464d-8e82-ec1076fdbb2e
Roland, Martin
a938cadd-11c8-4f18-8b74-5da81c1a6a27
Protheroe, Joanne
ef666365-4f77-4c8c-9471-967b084dff81
Blakeman, Tom
805f6f85-5cf2-4c4b-b6b6-c94ee0e46a8e
Richardson, Gerry
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Kennedy, Anne
e059c1c7-d6d0-41c8-95e1-95e5273b07f8
Bower, Peter
ec553157-a170-4219-8b55-2df813846e44
Reeves, David
4d9f4b50-445c-4257-81fe-4d6fa73a9891
Hann, Mark
0438c864-9e6d-4808-974f-4d8755cfe2bb
Rick, Jo
b6b84866-38a3-4af1-a86d-6bfbbd4e8702
Rowe, Kelly
ad964ae1-89e9-4201-bdc0-32d5d7f13e1e
Small, Nicola
d7558988-49a2-4fce-9782-d07a86127657
Burt, Jenni
af1903e7-2bb8-464d-8e82-ec1076fdbb2e
Roland, Martin
a938cadd-11c8-4f18-8b74-5da81c1a6a27
Protheroe, Joanne
ef666365-4f77-4c8c-9471-967b084dff81
Blakeman, Tom
805f6f85-5cf2-4c4b-b6b6-c94ee0e46a8e
Richardson, Gerry
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Kennedy, Anne
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Bower, Peter
ec553157-a170-4219-8b55-2df813846e44

Reeves, David, Hann, Mark, Rick, Jo, Rowe, Kelly, Small, Nicola, Burt, Jenni, Roland, Martin, Protheroe, Joanne, Blakeman, Tom, Richardson, Gerry, Kennedy, Anne and Bower, Peter (2014) Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study. British Journal of General Practice, 64 (626), e568-e575. (doi:10.3399/bjgp14X681385). (PMID:25179071)

Record type: Article

Abstract

Background
In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits.

Aim
To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care.

Design and setting
A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning.

Method
Implementation of care plans and care planning in general practice was assessed using the 2009–2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling.

Results
The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time.

Conclusion
The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning.

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More information

Accepted/In Press date: 11 April 2014
e-pub ahead of print date: 1 September 2014
Published date: September 2014
Keywords: uk, care planning, care plans, general practice, long-term conditions
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 372985
URI: http://eprints.soton.ac.uk/id/eprint/372985
ISSN: 0960-1643
PURE UUID: c98ef6a8-2662-4535-ab54-5024ff76d1e7
ORCID for Anne Kennedy: ORCID iD orcid.org/0000-0003-4570-9104

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Date deposited: 05 Jan 2015 16:47
Last modified: 14 Mar 2024 18:46

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Contributors

Author: David Reeves
Author: Mark Hann
Author: Jo Rick
Author: Kelly Rowe
Author: Nicola Small
Author: Jenni Burt
Author: Martin Roland
Author: Joanne Protheroe
Author: Tom Blakeman
Author: Gerry Richardson
Author: Anne Kennedy ORCID iD
Author: Peter Bower

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