NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England.
Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England.
BMC Prim Care. 2024 Jan 5;25(1):12. doi: 10.1186/s12875-023-02221-3.
Older people with multiple long-term conditions (multimorbidity) (MLTC-M) experience difficulties accessing and interacting with health and care services. Breakdowns in communication between patients and staff can threaten patient safety. To improve communication and reduce risks to patient safety in primary care, we developed an intervention: Safer Patients Empowered to Engage and Communicate about Health (SPEECH). SPEECH comprises a booklet for patients and an associated guide for staff. The booklet is designed to provide patients with information about staff and services, skills to prepare and explain, and confidence to speak up and ask.
A single-arm mixed methods feasibility study with embedded process evaluation. General practices in the North West of England were recruited. Participating practices invited patients aged 65+ with MLTC-M who had an appointment scheduled during the study period. Patients were asked to complete questionnaires at baseline and follow-up (four to eight weeks after being sent the patient booklet), including the Consultation and Relational Empathy measure, Empowerment Scale, Multimorbidity Treatment Burden Questionnaire, and Primary Care Patient Measure of Safety. Staff completed questionnaires at the end of the study period. A sub-sample of patients and staff were interviewed about the study processes and intervention. Patients and the public were involved in all aspects of the study, from generation of the initial idea to interpretation of findings.
Our target of four general practices were recruited within 50 days of the study information being sent out. A fifth practice was recruited later to boost patient recruitment. We received expressions of interest from 55 patients (approx. 12% of those invited). Our target of 40 patient participants completed baseline questionnaires and were sent the SPEECH booklet. Of these, 38 (95%) completed follow-up. Patients found the intervention and study processes acceptable, and staff found the intervention acceptable and feasible to deliver.
Our findings suggest the intervention is acceptable, and it would be feasible to deliver a trial to assess effectiveness. Prior to further evaluation, study processes and the intervention will be updated to incorporate suggestions from participants.
The study was registered on the ISRCTN registry (ISRCTN13196605: https://doi.org/10.1186/ISRCTN13196605 ).
患有多种长期疾病（多病共存）（MLTC-M）的老年人在获取和与医疗和保健服务互动方面存在困难。患者和医务人员之间沟通不畅可能会威胁到患者安全。为了改善初级保健中的沟通并降低患者安全风险，我们开发了一种干预措施：使患者能够安全参与并交流健康状况（SPEECH）。SPEECH 包括一本供患者使用的手册和一份配套的员工指南。该手册旨在为患者提供有关员工和服务的信息、准备和解释的技能，以及提高他们发言和提问的信心。
一项具有嵌入式过程评估的单臂混合方法可行性研究。英格兰西北部的全科医生诊所被招募参与。参与的诊所邀请了在研究期间有预约的 65 岁以上患有 MLTC-M 的患者。患者被要求在基线和随访时（在收到患者手册后四到八周）完成问卷，包括咨询和关系同理心量表、赋权量表、多病共存治疗负担问卷和初级保健患者安全量表。员工在研究结束时完成问卷。对患者和员工的一小部分进行了有关研究过程和干预措施的访谈。患者和公众参与了研究的各个方面，从最初想法的产生到研究结果的解释。
我们在发送研究信息后的 50 天内招募了四个目标全科医生诊所。后来又招募了第五个诊所以增加患者招募数量。我们收到了 55 名患者（约占受邀人数的 12%）的意向表达。我们的 40 名患者目标参与者完成了基线问卷并收到了 SPEECH 手册。其中 38 名（95%）完成了随访。患者认为干预和研究过程是可以接受的，而员工则认为干预是可以接受的，并且可以实施。
我们的研究结果表明该干预措施是可以接受的，并且进行有效性评估的临床试验是可行的。在进一步评估之前，将更新研究过程和干预措施，以纳入参与者的建议。
该研究在 ISRCTN 注册中心注册（ISRCTN13196605：https://doi.org/10.1186/ISRCTN13196605）。
