Reviews for multimorbidity risk in people with inflammatory conditions: a qualitative study

Background: People with inflammatory rheumatological conditions (IRCs) are at high risk of developing other conditions including cardiovascular disease (CVD) and mood disorders. Aim: To explore perspectives of people with IRCs and healthcare practitioners (HCPs) on the content and delivery of a review consultation aimed at identification and management of multiple long- term conditions (mLTCs). Design & setting: Semi- structured interviews and focus groups with people with IRCs and HCPs in primary and secondary care. Method: People with IRCs participated in individual semi- structured interviews by telephone or online platform. HCPs (including primary and secondary care clinicians) participated in online focus groups. Data were transcribed verbatim and analysed using inductive thematic analysis. Results: Fifteen people with IRCs were interviewed; three focus groups with HCPs were conducted. The following two main themes were identified: reflecting on the value of review consultations; and what would a new review look like? Overall, people with IRCs and HCPs reflected that access to reviews is inequitable, leading to duplication of reviews and fragmentation in care. People with IRCs, at times, had difficulty conceptualising reviews, especially when discussing their future risk of conditions. People suggested that preparation before the healthcare review could align patient and HCP agendas as part of a flexible and person- centred discussion. Conclusion: Any review introduced for people with IRCs must move beyond a 'tick- box' exercise. To gain maximum value from a review, preparation from both patient and HCP may be required alongside a person- centred approach while ensuring they are targeted at people most likely to benefit.