Lessons from a feasibility study testing an anticipatory care planning intervention for older adults at risk of functional decline: feedback from implementing stakeholders

Dagmar Anna S Corry,Kieran Mcglade,Gillian Carter,Peter O’Halloran,Emma Wallace,Kevin Brazil,Frank Doyle

doi:10.1186/s40814-022-00973-w

Abstract

BackgroundAnticipatory care is becoming increasingly important in effectively managing complex multimorbidity in aging populations, preventing further functional decline, and avoiding hospital admissions. This study aimed to elicit the feedback of participating general practitioners, practice managers, nurses and an adjunct pharmacist on the implementation strengths and limitations of a nurse-led, person-centered anticipatory care planning (ACP) intervention for older people at risk of functional decline in a primary care setting. The findings have implications for a full trial and intervention design.MethodsAs part of a feasibility cluster randomized controlled trial (cRCT) testing the ACP intervention, we sought feedback from implementing stakeholders: general practitioners (N = 3), practice staff (N = 3), research nurses (N = 5), and adjunct pharmacist (N = 1) in both the Republic of Ireland (ROI) and Northern Ireland (NI), UK. Following written, informed consent, they were interviewed to investigate their experience of participating in the implementation of the ACP intervention as part of the feasibility trial, and elicit any recommendations for a full trial. Using the Consolidated Framework for Implementation Research, thematic analysis was employed to analyze data. The intervention consisted of home visits by specially trained nurses who assessed participants’ health, discussed with them their health goals and plans, and devised an anticipatory care plan following consultation with participants’ General Practitioners and the adjunct clinical pharmacist.ResultsParticipating stakeholders indicated that the strengths of the implementation process included the training provided to the nurses, constructive collaboration of the research team, and structure of implementation process. Perceived limitations included the selection process and screening tool, communication between the research team and the nurses, the assessment questionnaire, and the final document left with the patient, as well as lack of access to medical records for the adjunct pharmacist. Recommendations include better communication and team-wide consensus on alterations to procedure and documents, and standardized protocols for patient selection, data collection, and reporting for research nurses.ConclusionsThe findings have identified strengths of the implementation process on which to build, and recognized limitations which can now be addressed to ensure improved efficiency and effectiveness in future trials.Trial registrationClinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019.

Highlights

Anticipatory care is becoming increasingly important in effectively managing complex multimorbidity in aging populations, preventing further functional decline, and avoiding hospital admissions
Management of multimorbidity is challenging as clinical guidelines tend to be single condition-oriented rather than person-oriented [2, 3] and patients with multimorbidity are under-represented in clinical trials
This paper focuses on the evaluation of the implementation process using interview data from the implementing stakeholders

Summary

Introduction

Anticipatory care is becoming increasingly important in effectively managing complex multimorbidity in aging populations, preventing further functional decline, and avoiding hospital admissions. Management of multimorbidity is challenging as clinical guidelines tend to be single condition-oriented rather than person-oriented [2, 3] and patients with multimorbidity are under-represented in clinical trials This can often lead to fragmented care and polypharmacy, with a detrimental effect on patients’ quality of life, increased treatment burden and increased use of health services [4]. With these patients making up around one third of general practice consultations, anticipatory care planning (ACP) interventions are increasingly important to improve quality of life, avoid hospital admissions, and to reduce polypharmacy and multiple healthcare appointments [5,6,7,8]. Handley et al [12] discuss how these gaps are often due to a lack of effort in identifying the factors for successful implementation of a particular intervention

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