Use of templates in long-term condition reviews act as reminder tools but can restrict patient-centred care, study suggests

A systematic review explored the impact of long-term condition review templates on process and health outcomes, and views around their use in consultations

A study published by the British Journal of General Practice has reviewed the effectiveness and perceptions of using templates in long-term condition consultations.

The researchers, from the National Institute for Health Research-funded IMP²ART (IMPlementing IMProved Asthma self-management as RouTine) programme of work, wanted to:

• investigate the effectiveness of review templates in long-term condition consultations in terms of improving process and health outcomes
• explore the experiences of health professionals and patients  when review templates are used

This is the first systematic review to explore both the effectiveness of using templates with the views and experiences of healthcare professionals and patients about how the template affects the consultation.

The review

The review synthesised data from 12 qualitative and 14 quantitative studies published between 1999 and 2019. The studies were conducted in multiple countries and in various settings: primary care practices, community health centres, paediatric hospitals, ambulatory care clinics, and mobile clinics.

The studies covered many long-term conditions, including asthma, diabetes and hypertension. They evaluated existing templates, and templates that were developed for research to be embedded in routine practice, or that were embedded in practice after being used in a study.

Findings

Using a template improved the likelihood of recommended tasks being undertaken in the review, though only one study reported on health outcomes after using a template – and that did not improve patient-related outcomes.   

Healthcare professionals perceived templates as a useful reminder tool in consultations and could aid how they structure their reviews of long-term conditions, establishing clear priority tasks.

However, healthcare professionals and patients were concerned that the templates restricted the review process to ‘ticking boxes’, and could prioritise the healthcare professional’s tasks over what the patient wanted to discuss. Using templates may also limit the opportunities for patients and healthcare professionals to discuss self-management and restrict delivery of patient-centred care.

Implications for practice

This study shows that templates are effective if their aim is to improve or record processes. However, there was little evidence to support their effectiveness in improving clinical outcomes.

The researchers suggest that in order to improve patient-centredness, templates should start with questions to establish the patient’s agenda and should include questions that ask patients about their main health concerns. This could allow discourse between patients and healthcare professionals. They also recommend including questions near the end of the consultation where patients can reflect on whether their concerns were addressed.

To avoid the perception of inflexibility, the researchers recommend using open-ended questions or flexible options to help balance patient and healthcare professional agendas. This would also help to document patient concerns and multiple conditions.

A further suggestion was the incorporation of more self-management questions and education to help healthcare professionals encourage and educate patients in self-management practices.

The researchers conducting this review are involved in the IMP²ART programme of work, a flagship programme for the Asthma UK Centre for Applied Research. IMP²ART is developing and testing a strategy for implementing supported asthma self-management in primary care.

Professor Hilary Pinnock, the Principal Investigator of the IMP²ART programme, said the findings have informed the development of an asthma review template as part of IMP²ART.

These are important practical findings. As clinicians, we want to do the right things for our patients – and a template can be a useful reminder of what guidelines tell us we should do. However, we must be sure that this efficiency does not override what the patients want from the consultation. In the IMP2ART programme, we have used these findings to develop a patient-centred asthma template for use in primary care asthma reviews. We are now testing the template as part of the IMP2ART strategy in a UK-wide cluster randomised controlled trial.

Read the paper

This publication is available from the British Journal of General Practice

Cite as

Effectiveness and perceptions of using templates in long-term condition reviews: a systematic synthesis of quantitative and qualitative studies.

Mary Morrissey, Elizabeth Shepherd, Emma Kinley, Kirstie McClatchey, Hilary Pinnock

British Journal of General Practice 26 July 2021; BJGP.2020.0963. DOI: 10.3399/BJGP.2020.0963

IMP²ART

Find out more about the IMP²ART programme of work.

Project: IMP²ART

Image credit: Courtney Hale via Getty Images