1. Patient –Centred Consultations
for Patients with Multiple Long-Term Conditions
Sharon Steel

2. Aims
To understand the change of practice required to identify, assess and care for patients with multimorbidity effectively.
To help you to develop the skills for conducting patient-centred consultations for patients with multiple long-term conditions.

3. Objectives
By the end of the workshop, you should be able to:
explain why multimorbidity will become increasingly important in general practice
develop some phrases and techniques for conducting patient-centred consultations taking account of their goals, values and priorities
devise a plan to develop patient-centred consultations in practice. 

4. During this workshop
Why do we need patient-centred consultations for patients with multiple long-term conditions?
A chance to practice.
Evaluation and action planning.

5. Principles of Medicines Optimisation (RPS)
Aim to understand the patient’s experience
Evidence based choice of medicines
Ensure medicines use is as safe as possible
Make medicines optimisation part of routine practice
I am sure you are all familiar with the 4 principles of medicines optimisation developed by the Royal Pharmaceutical Society
Today we will be concentrating on principle 1 – aiming to understand the patient's experience

6. Multimorbidity: clinical assessment and management
NICE Clinical Guideline 56
Step 0
Develop criteria to identify patients
Step 1
Explain purpose of this approach
Step 2
Establish disease and treatment burden
Step 3
Establish patient goals, values & priorities
Step 4
Review Treatment
Step 5
Agree individualised management plan
NICE Clinical Guideline 56 on multimorbidity suggests a series of 5 steps to assess and manage multimorbidity
You will know from your programme that two colleagues from NICE are running a workshop today that will discuss the guideline in detail and all the resources available from NICE to help you understand and implement the guideline.
I want to suggest an extra initial step:
Identifying which patients may benefit for enhanced care for their multimorbidity
We’ll come back to that at the end of the worskshop when we consider action planning.

7. In practice it is a cyclical process
That preparation step to identify priority patients
Then a cycle as shown here
But once an individualised management plan has been agreed and enacted
then the cycle begins again at Step 2

8. The “work of being a patient”
Step 0
Develop criteria to identify patients
Step 1
Explain purpose of this approach
Step 2
Establish disease and treatment burden
Step 3
Establish patient goals, values & priorities
Step 4
Review Treatment
Step 5
Agree individualised management plan
The plan for today’s workshop is to concentrate on these two steps:
Understanding the disease and treatment burden – literally “the work of being a patient”
and understanding the goals, values, and priorities of an individual patient
To do this we need a truly patient-centred consultation style
So there will be a chance to practice this during the workshop.
I am sure all your consultations aim to work with your patients
But today we want to work at really understanding the “patient’s agenda” and helping them to know we want to develop a partnership and a consensus as we try to address it.

9. “ICE” Consultations I = Ideas “Why do you think this has happened?”
“Have you any ideas about it yourself?”
C = Concerns
“What has been going through your mind?”
“Is there anything in particular that is worrying you?”
E = Expectations
“What do you think might be the best approach?”
“What were you hoping we could do about this?”
ICE is one mnemonic to help you develop some suitable questions to gather information from your patients to help you understand what matters to them.

10. How the role plays work
Please split into groups of 3 Decide who will be the pharmacist the patient the observer You have 5 minutes to read your brief and prepare 5 minutes to start the consultation then 5 minutes to discuss it together
This is how the role plays will work,
You will repeat this cycle twice with 2 different cases
You have details of your patients and a brief for each role in your handouts
So 5 minutes to prepare;
5 minutes to begin the consultation;
and 5 minutes for the observer to feed back and to discuss the

11. Support your colleagues Keep to your role Follow Pendleton Rules
Ground Rules
Support your colleagues
Keep to your role
Follow Pendleton Rules
Keep it real, have fun
Permission to stop at any time
There is a reminder of Pendleton Rules in your handout in the section “Information for the Observer”

12. Role Play

13. Move on to Case 2
Make sure that everyone in the group has a chance to be either the patient or the pharmacist

14. Role Play

15. Next steps
Develop a definition of multimorbidity for use across the practice
Identify which patients with multimorbidity are a priority
eg, those who are frail or prone to falls;
those who need frequent emergency care;
or those prescribed a specific number of regular medicines
Develop a “multimorbidity clinic”
So now I want you to consider how to take this forward back in your practice
Write on the Post-It note one action you are going to take to improve the care of your patients with multiple long term conditions

16. Please can you take a few minutes to complete your evaluation form and leave it on your tables/chairs

18. www.cppe.ac.uk info@cppe.ac.uk 0161 778 4000
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