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Indicators of care improved by 3D reviews

Reviews of older people with multiple conditions using a 3D approach did not improve their quality of life but gave better indicators of patient-centred care

Reviews of older people with multiple conditions using a 3D approach did not improve their quality of life but gave better indicators of patient-centred care


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Primary care nurses often manage patients with long-term conditions but focus on single conditions.

However, many older adults have multiple chronic conditions. This cluster-randomised trial in 33 general practices in England and Scotland investigated whether a patient-centred, 3D approach – based on dimensions of health, depression and drugs – for people with multiple conditions would improve quality of life.

In the intervention practices, 797 patients (of a total 1,546) were invited to one six-monthly comprehensive multidisciplinary review rather than, as in the control practices, the usual care involving multiple single-disease review appointments.

What the review included

Each 3D review included time with a nurse to identify problems that bothered patients the most, as well as screening, a medication review with a pharmacist and time with a GP to develop a collaborative health plan based on the patient’s preferred objectives.

At a follow-up after 15 months there was no statistical difference in the measured quality of life scores between the 3D and usual care groups. Nor was there any difference between the two groups in patient-perceived illness or treatment burden, admissions to hospital, the number of medicines prescribed or improved medication adherence.

However, the intervention group were significantly more likely to report and discuss what was the most important problem to them, to having a care plan, having joined-up care and greater continuity than those having usual care. While the intervention did not impact on quality of life, it significantly improved indicators of patient-centred care.


Salisbury C, Man M-S, Bower P et al (2018) Management of multi-morbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach. The Lancet. doi: 10.1016/S0140-6736(18)31308-4

Compiled by Vari Drennan, professor of healthcare and policy research at Kingston and St. George’s, University of London

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