title: Experiences of care planning in England: interviews with patients with long term conditions.
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.
authors: Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
authors: Jenny
authors: J
authors: Newbould
authors: Jenni
authors: J
authors: Burt
authors: Peter
authors: P
authors: Bower
authors: Tom
authors: T
authors: Blakeman
authors: Anne
authors: A
authors: Kennedy
authors: Anne
authors: A
authors: Rogers
authors: Martin
authors: M
authors: Roland
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D004739:England; D005260:Female; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010347:Patient Care Planning / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D036301:Qualitative Research; D012648:Self Care