title: The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation.
abstract: To develop and optimise a primary care-based complex intervention (CARE Plus) to enhance the quality of life of patients with multimorbidity in the deprived areas.
  
  
  
  Six co-design discussion groups involving 32 participants were held separately with multimorbid patients from the deprived areas, voluntary organisations, general practitioners and practice nurses working in the deprived areas. This was followed by piloting in two practices and further optimisation based on interviews with 11 general practitioners, 2 practice nurses and 6 participating multimorbid patients.
  
  
  
  Participants endorsed the need for longer consultations, relational continuity and a holistic approach. All felt that training and support of the health care staff was important. Most participants welcomed the idea of additional self-management support, though some practitioners were dubious about whether patients would use it. The pilot study led to changes including a revised care plan, the inclusion of mindfulness-based stress reduction techniques in the support of practitioners and patients, and the stream-lining of the written self-management support material for patients.
  
  
  
  We have co-designed and optimised an augmented primary care intervention involving a whole-system approach to enhance quality of life in multimorbid patients living in the deprived areas. CARE Plus will next be tested in a phase 2 cluster randomised controlled trial.
authors.affiliation: General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland stewart.mercer@glasgow.ac.uk.
authors.forename: Stewart William
authors.initials: SW
authors.lastname: Mercer
authors.affiliation: General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Rosaleen
authors.initials: R
authors.lastname: O'Brien
authors.affiliation: General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Bridie
authors.initials: B
authors.lastname: Fitzpatrick
authors.affiliation: General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Maria
authors.initials: M
authors.lastname: Higgins
authors.affiliation: General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
authors.affiliation: General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Graham
authors.initials: G
authors.lastname: Watt
authors.affiliation: General Practice and Primary Care, University of Glasgow, United Kingdom of Great Britain and Northern Ireland.
authors.forename: Sally
authors.initials: S
authors.lastname: Wyke
mesh_terms: D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D015897:Comorbidity; D003266:Continuity of Patient Care; D005260:Female; D017144:Focus Groups; D058005:General Practitioners; D006694:Holistic Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010361:Patients; D010817:Physician-Patient Relations; D010865:Pilot Projects; D011204:Poverty Areas; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration*; D011788:Quality of Life; D012111:Residence Characteristics; D013997:Time Factors
keywords: Primary care; complex intervention; deprivation; multimorbidity; quality of life