Hibberd C (2017) SP31 Can Primary Care Nurses Improve Integrated Care and Self-Management for Long-Term Conditions? A Feasibility Trial and Process Evaluation of the Person Centered Assessment Method (PCAM). 2017 NAPCRG Annual Meeting, Montreal, Canada, 17.11.2017-21.11.2017.
Abstract Context: Long-term conditions (LTC) and multimorbidity are the greatest challenges facing healthcare systems in the 21st century. Improving broader biopsychosocial health and self-care are key to addressing complex health problems. But, primary care and patients have been largely unable to optimise self-care. Objective: to assess the feasibility and acceptability of the Person Centred Assessment Method (PCAM) and conduct a feasibility trial. Design: Feasibility/pilot cluster RCT with practices randomised to nurses delivering Usual-care (UC) or PCAM; a process evaluation assessed feasibility, acceptability, and barriers and facilitators to use. Setting: Primary care settings in Scotland. Patients: with LTC's attending nurse reviews. Intervention: The Person Centred Assessment Method (PCAM) aims to encourage biopsychosocial needs assessment alongside person-centred action planning which links patients with broader statutory and third sector services. Outcomes: Recruitment and retention rates for nurses and patients, fidelity to intervention via an audit of consultation recordings pre and post use, and nurse advice or referrals to other services. Results: Five practices were randomised: with three practices (six nurses) to the PCAM arm and two practices (four nurses) to the UC arm. Data was obtained for 113 patients at baseline and 77 patients post intervention. For nurses the PCAM was easily integrated into the consultation, although some reflected that 'experiential learning' was required. Most nurses reported they would continue to use PCAM which helped support a positive nurse/patient relationship. Analysis of consultation recordings showed increased discussion of broader social issues. PCAM nurses made increased use of signposting to social supports (18% PCAM v 4%UC) which were also more likely to be taken up by patients (8% PCAM v 2% UC). Conclusions: The PCAM has potential to be implemented and valued by nurses in a range of practices and to improve patient access to social supports. Time for embedding into practice should be appreciated.