Development of a patient-centred electronic review template to support self-management in primary care: a mixed-methods study.

Abstract

Electronic templates are frequently used in long-term condition (LTC) reviews (for example, asthma) to act as reminders and improve documentation; however, they can restrict patient-centred care and opportunities for patients to discuss concerns and self-management. The IMPlementing IMProved Asthma self-management as RouTine (IMP²ART) programme aimed to develop a patient-centred asthma review template that encourages supported self-management. This was a mixed-methods study, which integrated qualitative and systematic review data, primary care Professional Advisory Group feedback, and qualitative data from clinician interviews. Aligned with the Medical Research Council complex intervention framework, a template was developed in the following three phases: (1) development phase, which consisted of a qualitative exploration with clinicians and patients, a systematic review, and prototype template development; (2) feasibility pilot phase, which involved feedback from clinicians (<i>n</i> = 7); and (3) pre-piloting phase, which consisted of delivering the template within the IMP²ART implementation strategy (incorporating the template with patient and professional resources) and eliciting clinician feedback (<i>n</i> = 6). Template development was guided by the preliminary qualitative work and the systematic review. A prototype template was developed with an opening question to establish patient agendas, and a closing prompt to confirm agendas have been addressed and an asthma action plan provided. The feasibility pilot identified refinements needed, including focusing the opening question on asthma. Pre-piloting ensured integration with the IMP²ART strategy. Following the multi-stage development process, the implementation strategy, including the asthma review template, is now being tested in a cluster randomised controlled trial.