The 3D trial

Based on the existing evidence and international consensus on ‘best practice’, we believed that the patient-centred 3D approach for patients with multimorbidity had the potential to improve patients’ quality of life, make their care more patient-centred and reduce their burden of illness and treatment compared with usual care.

The aim of the 3D trial was to test whether these outcomes were actually improved.

Trial methods 

The 3D approach was evaluated in a randomised controlled trial in general practices in England and Scotland:

• 16 practices provided the 3D approach while 17 practices continued usual care.

• 1,546 adult patients, each suffering from three or more different types of major long-term health conditions, took part. 

Measures of success included patients’ quality-of-life, experience of patient-centred care, illness burden and treatment burden. We also assessed use of health care services, including continuity of care, and cost-effectiveness.

We interviewed patients and staff to understand how 3D worked, and how it could be improved.

Findings

At the outset of the trial, patients had poor quality of life with a third of them experiencing depression as well as multiple physical health problems. Many also reported problems with the organisation of their care.

• After 15 months follow-up there was  no significant difference on average between patients in the practices providing the 3D approach or usual care in terms of quality-of-life, illness burden or treatment burden.

• However, patients in practices providing the 3D approach reported  significant improvements in patient-centred care.

• They felt more able to discuss the problems that were most important to them, their care was better co-ordinated, and they were more satisfied with their overall health care.

• The cost of providing the 3D approach was not significantly higher than the cost of usual care.

"So the great thing about this is that they’re looking at you as a whole being and taking everything into account and that is very new." 3D trial participant

Interpretation

The 3D approach improved patients’ experience of patient-centred care but not their health outcomes. It is arguable that improved patient-centred care is itself sufficient reason to roll out the 3D approach more widely, given that it is not significantly more expensive.

From the interviews with patients and staff it was clear that most patients preferred the 3D approach, but it took time for practices to adapt to the new way of working particularly in a system that was organised and incentivised through the GP payment system to provide ‘disease-focused’ care.

The effectiveness of the 3D approach might improve over time and if it became normal practice.

Read:

• the full results published in the Lancet 

• the research summary published by the National Institute for Health Research Collaboration for Leadership in Applied Health Research West (NIHR CLAHRC West)

• the policy briefing published by PolicyBristol.

Funding

The research was funded by the National Institute for Health Research.

Disclaimer

The views and opinions expressed in this report are those of the authors and do not necessarily reflect those of the NIHR, the NHS or the Department of Health.