Largest ever multimorbidity trial in primary care challenges current thinking

Photo of older man consulting with GPA study co-led by IHW's Professor Stewart Mercer has found that a patient-centred approach to healthcare - involving people in the planning and delivery of their care - improved overall patient satisfaction but not their health-related quality of life (using measures such as mobility, self-care, pain and discomfort, and anxiety and depression).

The study, funded by the National Institute for Health Research, tested a new approach to caring for people with three or more long-term conditions, which aimed to improve their health-related quality of life and experience of patient-centred care, and reduce their burden of illness and treatment compared with usual care. The ‘3D’ approach, which encourages clinicians to think broadly about the different dimensions of health, simplify complex drug treatment and consider mental health (depression) as well as physical health, was designed to treat the whole person and overcome the disadvantages of treating individual conditions in isolation.

Professor Mercer said:

It was a privilege to lead the Scottish arm of this UK study, the biggest ever trial worldwide of a patient-centred, integrated approach to care for patients with multiple long term conditions. Although the intervention did not result in the expected improvement in quality of life, it was gratifying to see significant improvements in patient satisfaction with their care, and improved relationships with their GPs. This is itself is a valuable outcome, especially in this time of high GP workload and stress.

Further research in Scotland is required, especially in areas of high deprivation as exist in Glasgow, where multimorbidity is more common and occurs at a younger age, to build on this current study, and our previous research (in the CARE Plus Study) specifically targeted at multimorbid patients living in the most deprived areas of Glasgow.”

Professor Chris Salisbury, from the University of Bristol’s Centre for Academic Primary Care and lead author on the Lancet paper in which these findings are reported, said:

Internationally, there is broad consensus about the key components of an approach to improve care for people with multimorbidity but we found little evidence about their effectiveness. We incorporated these components in the 3D approach, including a regular review of patients’ problems according to their individual circumstances. We were surprised to find no evidence of improved quality of life for patients as a result of the intervention but this was balanced by significant improvements in patients’ experience of care.

The question now is whether improved patient experience is sufficient justification for this approach. Given that improving patient experience is one of the triple arms of health care, alongside improving health and reducing costs, our view is that providing care that significantly improves patients’ experience is justification in itself.

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First published: 14 March 2018

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