Effectiveness and perceptions of using templates in long-term condition reviews: a systematic synthesis of quantitative and qualitative studies

BACKGROUND: Review templates are commonly used in long-term condition (LTC) consultations to standardise care for patients and promote consistent data recording. However, templates may affect interactions during the review and potentially inhibit patient-centred care.

AIM: To systematically review literature on the impact of LTC review templates on process and health outcomes, and the views of healthcare professionals and patients on using review templates in consultations.

DESIGN AND SETTING: Parallel qualitative and quantitative systematic reviews.

METHOD: Following Cochrane methodology, we searched nine databases (1995-2019; updated July 2020) for clinical trials and qualitative studies of LTC templates in healthcare settings. We performed duplicate selection, risk-of-bias assessment and data extraction. The quantitative and qualitative analyses were conducted in parallel and findings synthesised narratively.

RESULTS: We included 12 qualitative and 14 quantitative studies (two studies reported both qualitative and quantitative data and were included in both analyses). Review templates were well used, but the only study to assess health outcomes showed no effect. Templates can improve documentation of key measures, and act as a reminder tool; however, this can restrict the review process, and risks prioritising healthcare professional agendas over patients. Templates may also limit opportunities to discuss individuals' concerns about living with their condition, and act as a barrier to providing patient-centred care.

CONCLUSION: Future research should evaluate health as well as process outcomes. The potential benefits of templates in improving documentation should be balanced against concerns that 'tick boxes' may override patient agendas unless templates are designed to promote patient-centred care.