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Background <p>The aim of this study was to assess acceptance, feasibility and further need of development of the intervention <i>Health and Life in Balance (HLB)</i> for improving patient capacity for older people with multimorbidity.</p> Methods <p>A convergent mixed-methods non-randomised pilot study in one intervention (IU) and one control primary care unit (CU) in Region Stockholm, Sweden. General practitioners (GPs) in both units recruited individuals fulfilling eligibility criteria: ≥ 65 years of age, ≥ 2 chronic diseases, and an increased care need. The intervention involved: creating a care plan with a district nurse (DN); DN follow-ups over 6 months; improved communication between DN and GP. The control group received usual care. Quantitative data on preliminary primary, Illness Intrusiveness Rating Scale (IIRS), and secondary outcomes were collected from patient reported outcome measures and medical charts and analysed using statistical analysis. Qualitative data came from patient and healthcare provider interviews and medical charts, analysed using inductive thematic analysis. The mixed-methods analysis used joint display.</p> Results <p>Between February and June 2022, 24 and 29 participants were recruited from the intervention and control units respectively. Participants had mean age 79&#xa0;years and mean number of 18 diagnoses and 10 medications. 56.6% were female. There were no significant differences in preliminary primary (IIRS within group change IU <i>p</i> = 1.0, CU <i>p</i> = 0.43) or secondary quantitative outcomes. Two themes were identified in the qualitative analysis: <i>Vulnerable patients need the intervention most</i> and <i>Relational continuity and (w)holism are positive and satisfactory but threatened by lack of time and priority.</i> The joint interpretation identified scheduled holistic nurse follow-ups being acceptable and feasible for individuals in need. However, HLB requires further development to better target individuals with the greatest care needs and to improve the delivery of person-centred care, particularly in terms of aligning with patient priorities and enhancing teamwork.</p> Conclusions <p>This mixed-methods pilot study indicates partial acceptance and feasibility of <i>HLB,</i> but the intervention should be further developed to target at-need individuals and to raise priority, assess patient-centredness practically and improve teamwork to improve patient centeredness.</p> Trial registration <p>The trial was registered in ClinicalTrials.gov on the 24th of January 2025 (clinicaltrials.gov/study/NCT06791135).</p>

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The Health and Life in Balance intervention to improve patient capacity for older people with multimorbidity: a pragmatic mixed methods non-randomised pilot study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月8日

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  • Caroline Kappelin,
  • Klas Ytterbrink Nordenskiöld,
  • Elisabeth Bos Sparén,
  • Annica Lagerin,
  • Caroline Wachtler

摘要

Background

The aim of this study was to assess acceptance, feasibility and further need of development of the intervention Health and Life in Balance (HLB) for improving patient capacity for older people with multimorbidity.

Methods

A convergent mixed-methods non-randomised pilot study in one intervention (IU) and one control primary care unit (CU) in Region Stockholm, Sweden. General practitioners (GPs) in both units recruited individuals fulfilling eligibility criteria: ≥ 65 years of age, ≥ 2 chronic diseases, and an increased care need. The intervention involved: creating a care plan with a district nurse (DN); DN follow-ups over 6 months; improved communication between DN and GP. The control group received usual care. Quantitative data on preliminary primary, Illness Intrusiveness Rating Scale (IIRS), and secondary outcomes were collected from patient reported outcome measures and medical charts and analysed using statistical analysis. Qualitative data came from patient and healthcare provider interviews and medical charts, analysed using inductive thematic analysis. The mixed-methods analysis used joint display.

Results

Between February and June 2022, 24 and 29 participants were recruited from the intervention and control units respectively. Participants had mean age 79 years and mean number of 18 diagnoses and 10 medications. 56.6% were female. There were no significant differences in preliminary primary (IIRS within group change IU p = 1.0, CU p = 0.43) or secondary quantitative outcomes. Two themes were identified in the qualitative analysis: Vulnerable patients need the intervention most and Relational continuity and (w)holism are positive and satisfactory but threatened by lack of time and priority. The joint interpretation identified scheduled holistic nurse follow-ups being acceptable and feasible for individuals in need. However, HLB requires further development to better target individuals with the greatest care needs and to improve the delivery of person-centred care, particularly in terms of aligning with patient priorities and enhancing teamwork.

Conclusions

This mixed-methods pilot study indicates partial acceptance and feasibility of HLB, but the intervention should be further developed to target at-need individuals and to raise priority, assess patient-centredness practically and improve teamwork to improve patient centeredness.

Trial registration

The trial was registered in ClinicalTrials.gov on the 24th of January 2025 (clinicaltrials.gov/study/NCT06791135).