title: Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study.
abstract: BACKGROUND
  In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits.
  
  
  OBJECTIVE
  To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care.
  
  
  METHODS
  A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning.
  
  
  METHODS
  Implementation of care plans and care planning in general practice was assessed using the 2009-2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling.
  
  
  RESULTS
  The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time.
  
  
  CONCLUSIONS
  The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning.
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester.
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester.
authors.forename: Mark
authors.initials: M
authors.lastname: Hann
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester.
authors.forename: Jo
authors.initials: J
authors.lastname: Rick
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester.
authors.forename: Kelly
authors.initials: K
authors.lastname: Rowe
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester.
authors.forename: Nicola
authors.initials: N
authors.lastname: Small
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge.
authors.forename: Jenni
authors.initials: J
authors.lastname: Burt
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge.
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.affiliation: Institute of Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele.
authors.forename: Joanne
authors.initials: J
authors.lastname: Protheroe
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester.
authors.forename: Tom
authors.initials: T
authors.lastname: Blakeman
authors.affiliation: Centre for Health Economics, University of York, York.
authors.forename: Gerry
authors.initials: G
authors.lastname: Richardson
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton.
authors.forename: Anne
authors.initials: A
authors.lastname: Kennedy
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
mesh_terms: D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D010347:Patient Care Planning / Q000458:organization & administration*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D012648:Self Care / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
keywords: UK; care planning; care plans; general practice; long-term conditions