Long-term condition (LTC) review templates in clinical consultations: A mixed-methods systematic review

Abstract

Introduction: Electronic templates are used in consultations to promote guideline-driven management for LTCs. We wanted to develop a template to facilitate a patient-centred asthma review. Our mixed-studies systematic review aimed to investigate the effectiveness of templates in improving asthma/LTC care, and to explore healthcare professional (HCP) and patient views of using templates in consultations.

Methods: Following Cochrane methodology, we searched nine databases for relevant quantitative and qualitative literature. We assessed quality using Cochrane risk-of-bias and ROBINS-I tools (quantitative), and the Critical Appraisal Skills Programme checklist (qualitative). Quantitative/qualitative syntheses were combined in a narrative synthesis.

Results: We included 13 quantitative studies from 10,795 records; and 11 qualitative studies from 5,982 records. Templates can improve documentation (e.g. symptom history), and promote guideline adherence (e.g. to treatment). HCPs appreciated that templates provide structure to consultations, and act as reminders. However, they were viewed as ‘tick boxes’, which prioritised the clinical over the patient’s agenda. An opening ‘box’ ‘What does the patient want to discuss?’ might overcome concerns that templates were a barrier to providing patient-centred care and self-management support.

Conclusion: Review templates improve documentation and guideline adherence, however may impact on patient-centred care and risk overriding the patient agenda. There is a need to develop review templates which address these issues to support LTC care.

Method: NIHR PGfAR (RP-PG-1016-20008).