چکیده (انگلیسی):

Background:General practices in the United Kingdom are encouraged to have a protocol for the identification of
carers and a mechanism for social care referral. However, a minority of carers are identified and those caring for
someone with a terminal illness often cope until the situation becomes overwhelming. Earlier identification could
enable more timely support.
The aim of this project was to model and pilot a systematic approach to identify, assess and support carers of
people with supportive and palliative care needs in primary care.
Method:The intervention was modelled on the Medical Research Council complex intervention framework with a
preliminary theoretical phase, which has been reported elsewhere. In this study, which lasted 12 months, four
general practices were recruited. Each practice identified a‘carer liaison’ person to take the lead in identifying
carers, followed by assessment and support using a toolkit modelled from the earlier phase. Qualitative evaluation
interviews were conducted with carers who had received the intervention and the carer liaisons and general
practitioners in the pilot practices. A stakeholder event was held to disseminate and deliberate the findings.
Results:The practices’ populations ranged from 5840 to 10832 patients and across the four practices, 83 carers
were identified. Thirty six carers were identified from practice registers (disease - 16; palliative care - 9; carer - 11;
advanced care plan - 12), whilst 28 were identified opportunistically by practice staff at appointments or at home.
Seven carers self-identified. Overall, 81 carers received the carer pack and 25 returned the Carer Support Needs
Assessment Tool (CSNAT) form. Eleven carers received a follow up call from the practice to discuss support and 12
were also referred/signposted for support. Qualitative interviews suggest carers valued connection with their
practices but the paperwork in the toolkit was onerous.
Conclusion:This approach to identifying and supporting carers was acceptable, but success was dependent on
engagement within the whole practice. Carers did not tend to self-identify, nor ask for help. Practices need to
proactively identify carers using existing opportunities, resources and computer systems, and also adopt a public
health approach to raise carer awareness and perceived support within their communities.