Table 2 Study characteristics

Davis et al. 2020, USA [26]

To design a telehealth intervention programme for a rural population with multiple chronic conditions through an iterative process

Multimorbidity, unspecified conditions

• Needs assessment (n = N/R)

• Ideation (n = N/R)

• Prototype (n = N/R)

Telehealth experts, patient advocates, health policy faculty members, programme managers, medical directors, and healthcare professionals

A complex intervention based on the Model for Developing Complex Interventions in Nursing for patients with long-term conditions to minimise re-institutionalisation by using synchronous and asynchronous telehealth approaches to promote intervention effectiveness: remote autonomous monitoring, remote nursing assessment and treatment and care coordination

The Model for Developing Complex Interventions in Nursing provided a simple, structured process for designing a multifaceted telehealth intervention to minimise re-institutionalisation of participants with multiple chronic conditions

Easton et al. 2019, UK [27]

To develop a platform to support self-management for patients with an exemplary long-term condition (LTC; chronic pulmonary obstructive disease [COPD])

COPD with mental health conditions

• Needs assessment (n = 11)

• Ideation (n = 19)

• Prototype (n = 8)

Patients with COPD and healthcare professionals

An autonomous virtual agent supporting self-management for patients with COPD and potential mental health comorbidities using artificial intelligence during four scenarios: at the time of diagnosis, during acute exacerbations, during periods of low mood, and for general self-management

Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs

Ekstedt et al. 2021, Sweden [28]

To develop a user-centred design approach to identify and address the needs of older adults and healthcare professionals in the collaborative management of multiple chronic conditions,

Multimorbidity, unspecified conditions

• Needs assessment (n = 23)

• Ideation (n = 10)

• Prototype (n = 17)

• Pilot (n = 7)

Patients with heart failure, COPD, or diabetes, carers, healthcare professionals, managers, administrators, quality developers, researchers and service designers

An e-health web-based application—ePATH (electronic Patient Activation in Treatment at Home)—with separate user interfaces for patients and healthcare professionals catering to the four essential pillars of self-management support

The feasibility study highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organisations when implementing new services and processes in chronic care management

Gagnon et al. 2020, Canada [29]

To design and develop a user-centred patient portal for chronic disease management in primary care

Multimorbidity, unspecified conditions

• Ideation (n = N/R)

• Prototype (n = 19)

• Pilot (n = 18)

Patients with chronic illnesses, carers, healthcare professionals, designers, IT developers, and researchers

A patient portal (CONCERTO +) to promote patient engagement by improving patient care experiences, including personalising follow-ups, health education and communication between patients, caregivers and primary healthcare providers

Users generally found CONCERTO + intuitive and easy to navigate. Chronic patients and their informal caregivers are willing to use CONCERTO + to communicate with their primary healthcare team

Heim et al. 2016, Netherlands [30]

To report on the development, implementation and evaluation of a regional transitional care programme, aimed at improving the recovery rate of frail hospitalised older patients

Frailty with multimorbidity

• Needs assessment (n = N/R)

• Ideation (n = N/R)

• Real-world health and well-being evaluation n = 1933 (3-month follow-up)

Healthcare providers, older adults and knowledge institutes

A transitional care programme that improves integrated care for frail older patients reduces the risk of adverse outcomes after hospitalisation but has little effect on long-term care costs

By involving stakeholders in designing and developing the transitional care programme, the commitment of healthcare providers was secured and led to the development of an innovative and feasible programme. The collective improvement of integrated care for frail older patients reduced the risk for adverse outcomes after hospitalisation but has little impact on long-term care expenses

Horrell 2017, UK [31]

Through an iterative development process, create a patient-centred coordinated care (P3C) tool based on principles of promoting person-centred relationships with service users and practitioners

Multimorbidity, unspecified conditions

• Needs assessment (n = N/R)

• Ideation (n = N/R)

• Prototype (n = N/R)

• Pilot (n = N/R)

Patients, carers, healthcare professionals, commissioners, and policy-makers

An organisational change tool (P3C-OCT) for assessing and monitoring an organisation’s and practitioners’ ability to provide personalised and coordinated care for people with multimorbidity, based on the principles of promoting person-centred relationships

The P3C-OCT provides a coherent approach to monitoring progress and supporting practice development towards P3C. It can be used to generate a shared understanding of the core domains of P3C at a service delivery level, and support re- organisation of care for those with complex needs. The tool can reliably detect change over time, as demonstrated in a sample of 40 UK general practices

Jinks et al. 2015, UK [32,33,34]

To develop and test the feasibility and acceptability of a practice nurse-led “enhanced” review for identifying, assessing and supporting management of joint pain, anxiety, and/or depression in patients attending routine long-term care reviews

Multimorbidity, unspecified conditions

• Needs assessment (n = N/R)

• Ideation (n = N/R)

• Prototype (n = N/R)

• Real-world health and well-being evaluation

Patient and practice nurse advisory groups, practice nurses

A co-designed intervention of integrating joint pain and anxiety and/or depression into long-term care reviews by comprising tools for case-finding and initial patient assessment, evidence-based treatment options and signposting options to other services

The approach enabled the co-design of a new complex intervention of integrating joint pain and anxiety and/or depression into long-term care reviews in primary care consultations, and identification of training needs

Knowles et al. 2018, UK [12]

To generate interventions addressing safety issues for multimorbid patients in primary care

Multimorbidity, unspecified conditions

• Needs assessment (n = 16)

• Ideation (n = 16)

• Prototype (n = 11)

Multimorbid patients, carers, primary healthcare professionals

Two proposed interventions to address safety issues for multimorbid patients in primary care. (1) Automatic reminders to support adherence to a medication schedule. (2) An enhanced review provided by a pharmacist, developed collaboratively with the patients, embedded within the patients’ practice

The study demonstrates the value of bringing patients and professionals together to directly contribute to co-design

Lo et al. 2018, Australia [35]

To develop a new model of care for co-morbid diabetes and chronic kidney disease (CKD) by integrating healthcare at home, coordinating between primary and tertiary levels of care and promoting patient’s self-management and empowerment

Diabetes and CKD

• Needs assessment (n = 1279)

• Ideation (n = not reported (N/R))

• Prototype (n = N/R)

Patients with diabetes and CKD, carers, healthcare professionals and consumer advocacy organisations—Diabetes and Kidney Health Australia

An integrated patient-centred model of care for multi-disciplinary care coordination

This model of care integrates with the patient-centred health-care home, allows coordination between primary and tertiary levels of care and promotes patient self-management and empowerment

Mehmet et al. 2020, Australia [36]

To analyse the role of social marketing using digital media initiatives to support the implementation of the Equally Well National Consensus Statement in rural and remote communities

Chronic physical and mental illness

• Needs assessment (n = 20)

• Ideation (n = 45)

• Pilot (n = N/R)

Patients with mental illness, carers, healthcare professionals, and service managers

A digital marketing strategy co-designed to help consumers, carers and clinicians to access quality, health-enhancing support and resources

The study proved that an embedded co-design process resulted in an integrated digital intervention mix that was useful in meeting the needs of rural stakeholders

Mercer et al. 2016, Scotland [37]

To develop and optimise a primary care-based complex intervention to enhance the quality of life of patients with multimorbidity in deprived areas

Multimorbidity, unspecified conditions

• Needs assessment (n = 32)

• Ideation (n = 32)

• Prototype (n = 32)

• Pilot (n > 20)

• Real-world health and well-being evaluation (n = 134)

Multimorbid patients, healthcare professionals, and representatives from third-sector organisations

The CARE Plus approach involves system changes, including longer consultations with relational continuity, patient–practitioner interaction changes using an empathic patient-centred structured approach, training and support for staff to deliver this and support for patient self-management

Enhancing primary care through a

whole-system approach may be a cost-effective way to protect the quality of life for multimorbid patients in

deprived areas

Porat et al. 2019, UK [38]

To design and evaluate an intervention informed by a learning health system approach to improve risk factor management and secondary prevention for stroke survivors with multimorbidity

Stroke with at least one other long-term condition

• Needs assessment (n = 45)

• Ideation (n = 45)

• Prototype (n = 44)

Stroke survivors, carers, healthcare professionals, commissioners, policymakers and researchers

A decision aid, DOTT (Deciding On Treatments Together) used in primary care during clinical consultations between the healthcare professional and stroke survivor, aims to facilitate shared decision-making on personalised treatments leading to improved treatment adherence and risk control

Adopting a user-centred data-driven design approach informed an intervention that is acceptable to users and has the potential to improve patient outcomes. Both stroke survivors and clinicians perceived the decision aid to be useful in consultations and eliciting preferences for treatment options

Sadler et al. 2017, UK [39]

To develop a process that engages stakeholders in the use of clinical and research data to co-produce potential solutions, informed by a Learning Health System, to improve long-term care for stroke survivors with multimorbidity

Stroke with at least one other long-term condition

• Needs assessment (n = 24)

• Ideation (n = 45)

• Prototype (n = 10)

Stroke survivors, family carers, healthcare professionals, service commissioners, policy-makers, service managers and researchers

A decision tool to identify stroke survivors at risk for a recurrent stroke, enhance shared decision-making between patients and clinicians and propose optical care pathways to reduce stroke survivor’s risk factors, improving secondary prevention after stroke

Stakeholder engagement to identify data-driven solutions is feasible but requires resources. Further work is required to evaluate the impact and implementation of data-driven interventions for long-term stroke survivors