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Open Access Highly Accessed Research article

Experiences of care planning in England: interviews with patients with long term conditions

Jenny Newbould1, Jenni Burt1*, Peter Bower2, Tom Blakeman2, Anne Kennedy2, Anne Rogers2 and Martin Roland2

Author Affiliations

1 Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK

2 Health Sciences Research Group, University of Manchester, Manchester, UK

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BMC Family Practice 2012, 13:71  doi:10.1186/1471-2296-13-71

Published: 25 July 2012

Abstract

Background

The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority in England for chronic disease management. However, it is not clear how care planning is currently understood, translated and implemented in primary care. This study explores experience of care planning in patients with long term conditions in three areas in England.

Methods

We conducted semi-structured interviews with 23 predominantly elderly patients with multiple long term conditions. The interviews were designed to explore variations in and emergent experiences of care planning. Qualitative analysis of interview transcripts involved reflexively coding and re-coding data into categories and themes.

Results

No participants reported experiencing explicit care planning discussions or receiving written documentation setting out a negotiated care plan and they were unfamiliar with the term ‘care planning’. However, most described some components of care planning which occurred over a number of contacts with health care professionals which we term”reactive” care planning. Here, key elements of care planning including goal setting and action planning were rare. Additionally, poor continuity and coordination of care, lack of time in consultations, and patient concerns about what was legitimate to discuss with the doctor were described.

Conclusions

Amongst this population, elements of care planning were present in their accounts, but a structured, comprehensive process and consequent written record (as outlined in English Department of Health policy) was not evident. Further research needs to explore the advantages and disadvantages of different approaches to care planning for different patient groups.

Keywords:
Aged; Chronic disease; Chronic illness; Patient care planning; Primary health care