SP 6.06 Co-Designing a Complex Intervention to Improve Outcomes for People with Multiple Long-Term Conditions Undergoing Elective Surgery: A Theory-Informed Mixed-Methods Study
Sivesh Kathir Kamarajah, Jugdeep Dhesi, Dion Morton, Shalini AhujaAbstract
Background
People with multiple long-term conditions (MLTC) are common in elective surgery, yet current pathways remain poorly equipped to meet their complex needs. These pathways presents a unique, time-sensitive opportunity to act. This study aimed to co-design a feasible intervention that integrates MLTC care into surgical pathways.
Methods
We conducted a mixed-methods theory-informed co-design study (NIHR / MRC Complex Intervention framework): Phase I was a contextual analysis of current UK pathways: pathway mapping, policy scan, national survey; and phase II, a multidisciplinary stakeholder workshops to develop a Theory of Change.
Results
In phase 1, pathway mapping identified variation and delayed pre-assessment, resulting in limited window to optimise chronic diseases. The scoping review found no UK guidance integrating MLTC into surgical pathways. In the survey (73 responses, 51 NHS Trusts), few services screened at listing and structured pathways were uncommon. Only one-in-ten hospitals had a MLTC-specific care pathway for elective surgical patients, primarily focussing on diabetes or anaemia management. In phase 2, stakeholders (n=21) agreed a pragmatic intervention prioritised on four domains, diabetes, hypertension, weight management and smoking cessation, with five intervention components: (i) surgeon-led checklist-based early identification at listing; (ii) automated referral to primary care/specialist services; (iii) patient-activation materials; (iv) optimisation during waiting time; and (v) structured discharge communication.
Conclusions
This study presents a co-designed model shifting MLTC care upstream to point of listing. Although this model offers the potential to improve short- and long-term health, closing knowledge gap on its clinical effectiveness is required before broader implementation into the NHS.