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Publication - Dr Cindy Mann

    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, S, Gaunt, D, Guthrie, B, Mann, C, Mercer, S, 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, vol 8.


    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.

    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.

    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.

    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.

    Full details in the University publications repository