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

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.

Keywords: chronic disease; comorbidity; family practice; multimorbidity; patient centred care.

Figure 1

3D logic model including theoretical mechanisms of action. GP, general practitioner; LTCs, long-term conditions; QOL, quality of life.

Figure 2

Flow of patients into the 3D trial. GP, general practitioner.