Patient-centred interventions to improve care of people with multiple chronic conditions do not improve quality of life or clinical outcomes, according to the findings of a UK study published in The
The research involved adults with at least 3 of 17 major chronic conditions under the care of 33 GP practices in England and Wales who were randomly assigned to the intervention or to continue receiving usual care.
Patients assigned to the intervention were invited to a comprehensive, holistic (as opposed to disease-specific) review at their GP surgery with both a nurse and their doctor, followed by a records-based medication review by a pharmacist every six months. Overall, 797 patients were recruited to the intervention and 749 patients to usual care. Outcomes were assessed after 15 months.
Overall, there was no significant difference between the two groups with regard to quality of life (measured by EQ-5D-5L score) or in any measure of illness and treatment burden, such as self-rated health, Hospital Anxiety and Depression score or Morisky Medication Adherence score.
However, patients in the intervention group did report a significant improvement in patient-centred care outcomes, such as having a written treatment plan, being able to discuss the problem most important to them, and satisfaction with their care.
The researchers, led by Chris Salisbury at the National Institute for Health Research School for Primary Care Research, Bristol Medical School, explained that there was an international consensus that care for multimorbidity should be patient-centred and should focus on self-management and quality of life.
However, the evidence base to support this is inadequate, as highlighted by a 2016 Cochrane review of the existing research. The authors of the current study said it was the largest trial to date of an intervention to improve the management of multimorbidity.
Salisbury and colleagues concluded that the evidence base indicated limited or no impact of interventions for multimorbidity on quality of life. However, they acknowledged that improving patient experience of care was an important goal in itself.
“Providing care that is demonstrably more patient-centred is arguably sufficient justification for implementation in itself, especially since our evidence shows it is not associated with disadvantages in terms of disease management or hospital use,” they concluded.
 Salisbury C, Man M-S, Bower P et al. Management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach. Lancet 2018. doi: 10.1016/S0140-6736(18)31308-4