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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
- Source :
- BMJ Open, Chaplin, K, Bower, P, Man, M-S, Brookes, S, Gaunt, D, Guthrie, B, Mann, C, Mercer, S, Rafi, I, Shaw, A R G & 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, no. 8, e019845 . https://doi.org/10.1136/bmjopen-2017-019845, Chaplin, K, Bower, P, Man, M, Brookes, S T, Gaunt, D, Guthrie, B, Mann, C, Mercer, S W, Rafi, I, Shaw, A R G & 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, no. 8, pp. e019845 . https://doi.org/10.1136/bmjopen-2017-019845
- Publication Year :
- 2018
- Publisher :
- BMJ Publishing Group, 2018.
-
Abstract
- ObjectivesRecent 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.DesignAnalysis of baseline data from patients in a cluster-randomised controlled trial and additional data from practice staff.SettingPrimary care in the UK.ParticipantsPatients with multimorbidity (n=5253) and 154 practice staff.Primary and secondary outcome measuresUsing 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.ResultsParticipating 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.ConclusionThis 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 numberISRCTN06180958; Post-results.
- Subjects :
- Male
Health Knowledge, Attitudes, Practice
family practice
030204 cardiovascular system & hematology
patient centred care
law.invention
0302 clinical medicine
Cost of Illness
Randomized controlled trial
law
Patient-Centered Care
Surveys and Questionnaires
030212 general & internal medicine
Aged, 80 and over
Standard of Care
General Medicine
comorbidity
Patient Satisfaction
BRTC
Female
General practice / Family practice
medicine.medical_specialty
multimorbidity
Health Personnel
Disease cluster
BTC (Bristol Trials Centre)
External validity
03 medical and health sciences
Patient satisfaction
Intervention (counseling)
medicine
Humans
Dementia
Baseline (configuration management)
Aged
Primary Health Care
business.industry
Research
Patient Selection
medicine.disease
Comorbidity
Socioeconomic Factors
Family medicine
Chronic Disease
business
chronic disease
Subjects
Details
- Language :
- English
- ISSN :
- 20446055
- Database :
- OpenAIRE
- Journal :
- BMJ Open, Chaplin, K, Bower, P, Man, M-S, Brookes, S, Gaunt, D, Guthrie, B, Mann, C, Mercer, S, Rafi, I, Shaw, A R G & 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, no. 8, e019845 . https://doi.org/10.1136/bmjopen-2017-019845, Chaplin, K, Bower, P, Man, M, Brookes, S T, Gaunt, D, Guthrie, B, Mann, C, Mercer, S W, Rafi, I, Shaw, A R G & 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, no. 8, pp. e019845 . https://doi.org/10.1136/bmjopen-2017-019845
- Accession number :
- edsair.doi.dedup.....c138c1fc669731128e134cd4d6165821