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Understanding usual care for patients with multimorbidity: baseline data from a cluster-randomised trial of the 3D intervention in primary care.

Chaplin, K; Bower, P; Man, M-S; Brookes, ST; Gaunt, D; Guthrie, B; Mann, C; Mercer, SW; Rafi, I; Shaw, ARG; et al. Chaplin, K; Bower, P; Man, M-S; Brookes, ST; Gaunt, D; Guthrie, B; Mann, C; Mercer, SW; Rafi, I; Shaw, ARG; Salisbury, C (2018) Understanding usual care for patients with multimorbidity: baseline data from a cluster-randomised trial of the 3D intervention in primary care. BMJ Open, 8 (8). e019845. ISSN 2044-6055 https://doi.org/10.1136/bmjopen-2017-019845
SGUL Authors: Rafi, Imran

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Abstract

OBJECTIVES: Recent evidence has highlighted the high prevalence and impact of multimorbidity, but the evidence base for improving management is limited. We have tested a new complex intervention for multimorbidity (the 3D model). The paper describes the baseline characteristics of practices and patients in order to establish the external validity of trial participants. It also explores current 'usual primary care' for multimorbidity, against which the 3D intervention was tested. DESIGN: Analysis of baseline data from patients in a cluster-randomised controlled trial and additional data from practice staff. SETTING: Primary care in the UK. PARTICIPANTS: Patients with multimorbidity (n=5253) and 154 practice staff. PRIMARY AND SECONDARY OUTCOME MEASURES: Using surveys and routinely available data, we compared the characteristics of participating and non-participating practices and participating and non-participating eligible patients.Baseline questionnaire data from patient participants was used to examine participant illness burden, treatment burden and perceptions of receiving patient-centred care. We obtained data about usual care preintervention from practice staff using questionnaires and a structured pro forma. RESULTS: Participating practices were slightly larger, in less deprived areas, and with slightly higher scores for patient satisfaction compared with non-participating practices. Patients with dementia or learning difficulties were likely to be excluded by their general practitioners, but comparison of participants with non-participants identified only minor differences in characteristics, suggesting that the sample was otherwise representative. Patients reported substantial illness burden, and an important minority reported high treatment burden. Although patients reported relatively high levels of satisfaction with care, many reported not having received potentially important components of care. CONCLUSION: This trial achieved good levels of external validity. Although patients were generally satisfied with primary care services, there was significant room for improvement in important aspects of care for multimorbidity that are targeted by the 3D intervention. TRIAL REGISTRATION NUMBER: ISRCTN06180958; Post-results.

Item Type: Article
Additional Information: © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Keywords: chronic disease, comorbidity, family practice, multimorbidity, patient centred care, Aged, Aged, 80 and over, Chronic Disease, Cost of Illness, Family Practice, Female, Health Knowledge, Attitudes, Practice, Health Personnel, Humans, Male, Multimorbidity, Patient Satisfaction, Patient Selection, Patient-Centered Care, Primary Health Care, Socioeconomic Factors, Standard of Care, Surveys and Questionnaires, Humans, Chronic Disease, Health Knowledge, Attitudes, Practice, Family Practice, Patient Selection, Cost of Illness, Socioeconomic Factors, Aged, Aged, 80 and over, Health Personnel, Patient Satisfaction, Patient-Centered Care, Primary Health Care, Female, Male, Standard of Care, Surveys and Questionnaires, Multimorbidity, chronic disease, family practice, multimorbidity, patient centred care, comorbidity
SGUL Research Institute / Research Centre: Academic Structure > Institute of Medical & Biomedical Education (IMBE)
Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE )
Journal or Publication Title: BMJ Open
ISSN: 2044-6055
Language: eng
Dates:
DateEvent
29 August 2018Published
25 June 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
12/130/15Department of Healthhttp://dx.doi.org/10.13039/501100000276
G0800800Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
PubMed ID: 30158215
Web of Science ID: WOS:000446470200017
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/113042
Publisher's version: https://doi.org/10.1136/bmjopen-2017-019845

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