Table 1 Recommendations for multimorbidity intervention and planned approach to operationalising the recommendations in the development of a new intervention

Clinical focus elements

 Patient identified priority areas

Amer Ger Soc (2012)^a

Muth et al. (2014)^b

Naylor et al. (2016)^c

Smith et al. (2012)^d

• Provide clinicians with information about the patient’s priority areas based on survey response prior to initial appointment.

• Priorities to be discussed, affirmed or altered collaboratively at the initial appointment

• Planning at initial assessment and follow-up sessions to directly address patient priority areas, and this approach to be supported by documentation templates providing space for priority areas, as well as template to include helpful questions in establishing priority areas

 Mental health focus

Muth et al. (2014)^b

Naylor et al. (2016)^c

• Intervention materials to include evidence-based behavioural targets for improving mood and well-being in people experiencing depression

• Evidence-based priority areas to include: mood, anxiety, concentration, self-image, thoughts of death and concentration, health, appetite, interest, sleep, energy

 Support for lifestyle behaviour change

Naylor et al. (2016)^c

Smith et al. (2012)^d

• Specific priority areas relevant to lifestyle behaviour change include: health, appetite, interest, sleep, energy

• Intervention to include collaborative planning with patient to identify planned changes to behaviour and ongoing monitoring, review of progress and revised planning

• MI communication strategies to focus on and strengthen the patient’s reasons for making changes.

 Emphasis on clinical consultation skills

Amer Ger Soc (2012)^a

Naylor et al. (2016)^c

• All nurses participate in 2 days of training, including 1 day focused on motivational interviewing skills.

• Development of support materials to reinforce MI skills.

• Intervention summary plans to incorporate open questions in the templates; and intervention manual to include examples of patient-centred clinical notes to support implementation

Organisation of delivery elements

 Integrated into routine care

Naylor et al. (2016)^c

Smith et al. (2013)^d

• Program to be co-located in existing GP practices. Patients to have option of face-to-face or phone follow up sessions to promote flexibility and minimize treatment burden.

 Appointments longer than GP consultation

Naylor et al. (2016)^c

• Initial appointments planned to be up to 1-h duration, with follow up appointments up to 30 min duration.

• Intervention to be delivered by primary care nurses to enable longer consultations

 Scheduled review appointments

Amer Ger Soc (2012)^a

Muth et al. (2014)^b

• Intervention to consist of 8 sessions over approximately 12 weeks. All sessions to be scheduled collaboratively with the patient.

 Enhanced communication between care providers

Muth et al. (2014)^b

Naylor et al. (2016)^c

• With patient consent, nurses to liaise with and share plans with GPs and other health professionals involved in the patient’s care.