The role of shared medical appointments in the management of chronic disease: utilising international experiences to design an intervention for peripheral arterial disease in the NHS

Abstract

With over 15 million people living with chronic disease in England alone, patients and healthcare systems face significant burden, in terms of symptoms, quality-of-life and resource costs. One such chronic disease is peripheral arterial disease (PAD), with an estimated UK prevalence of 7%. Patients with PAD often have co-morbidities and require risk factor modification, having increased risk of cardiovascular morbidity and mortality. They utilise primary care, community and hospital resources, requiring multi-disciplinary team input, to provide lifestyle, medical and surgical management. With increasing prevalence of chronic disease and in the current economic climate, there is a need to empower patients to take an active role in their care and improve utilisation of existing healthcare resources. Interventions that streamline patient pathways, integrate the multi-disciplinary team and facilitate self-care are likely to benefit patients and the NHS. Shared medical appointments (SMAs) can improve patient education, self-management and clinical outcomes in those with chronic disease, whilst delivering care more efficiently. Whilst their use has increased in countries such as USA across a variety of settings, research or use within the NHS has mainly been within primary care. To date, SMAs have not been used within vascular surgery, in the UK or abroad. Using the example of PAD, this thesis seeks to investigate the role for SMAs in the NHS. Firstly, it identifies scope for improvement within current care. Through international collaboration, it then examines barriers and facilitators to implementing SMAs and the patient experience of this model of care. It details a co-design process, whereby UK patients and healthcare professionals were brought together to work with qualitative data from the preceding chapters. The final data chapters describe a pilot SMA and discuss experiences of staff and patients involved. Finally, the thesis reflects on implications of this work for clinical practice and healthcare policy.Open Acces