Development and evaluation of an integrated multispecialty clinic for people with multiple long-term conditions

Abstract

Introduction: The number of people with multiple long-term conditions (MLTC) is increasing. People with MLTC experience fragmentation of care due to single-disease-orientated healthcare organisation and have increased morbidity and mortality. We developed an innovative clinic model whereby people with MLTC are assessed by a team of specialists together in one appointment to form a consensus management plan in real time. We report the outcomes together with patient and clinician feedback.

Methods: A multispecialty clinic was established to assess adults referred from the community or secondary care with MLTC. Patients were seen together by three or more relevant specialists and a coordinated plan was developed. To evaluate the clinic, we collected patient outcomes and obtained feedback from patients and clinicians in the clinic and from primary care clinicians.

Results: Twenty seven patients were assessed in the multispecialty clinic with a mean age of 64.6 years; 89% had diabetes, 70.4% hypertension, 63% CKD stages 3-5, and 51.9% had heart failure. Patients were taking a mean of 10 medications. Referrals were from primary care (51.9%) and secondary care, with the commonest reason being fluid overload (29.6%). On average, 1.7 medication changes were made per patient. Compared to the 6-month period before the clinic, in the 6 months after the clinic there was a significant reduction in interactions of patients with the acute hospital services (emergency department, same-day emergency care unit and acute inpatient medicine service). In a survey of 11 patients, all reported high satisfaction with the novel clinic format. A survey of seven clinicians, including a pharmacist and trainee doctor, demonstrated positive experiences of the clinic, confidence in the clinical decision making and enhanced learning. Primary care physicians also appreciated the coordinated plan across several specialties.

Discussion: In our pilot multispecialty clinic, people with MLTC were able to develop a real-time consensus plan with a group of specialists. Our approach was associated with fewer unscheduled healthcare interactions after the clinic. Our after-clinic survey showed positive responses from patients and clinicians. Future studies could examine how such a service could be rolled out to a wider group of people effectively and efficiently.