What is the ‘3D approach’ for managing multiple long-term conditions?

by Dr Mei-See Man
Trial Manager
Centre for Academic Primary Care

The 3D study, led by researchers from the Centre for Academic Primary Care (CAPC), is examining a new approach for GP practices to manage patients with multiple long-term health problems.

Meeting a need

Existing treatment is based on guidelines for each separate condition meaning that patients often attend multiple appointments for each disease which can be repetitive, inconvenient and inefficient. They see different nurses and doctors who may give conflicting advice. These patients frequently get depressed and they also sometimes complain that no-one treats them as a ‘whole person’ or takes their views into account.

The 3D approach was developed by patients and GPs together to address these issues. Based around patient-centred care, the approach focuses on three ‘D’s: Depression, Drugs and the patient’s Dimensions of health, such as their quality of life, priorities and concerns.

A common problem for patients with multiple long-term conditions (or multimorbidity) is that they have to attend multiple single-disease-specific clinics for frequent checks and reviews. As part of the 3D approach these are re-organised into longer combined whole-person reviews delivered in two parts by a named nurse and a named GP. Having a named nurse and GP means that the patient knows who to go to when there is a problem without having to constantly repeat their history and the clinicians can maintain continuity of care.

A novel approach

Using a bespoke dynamic computer template the named nurse finds out about the patient’s main concerns as well as performing the required health checks and screening for depression. This creates the patient’s agenda which is discussed in the second part of the review with the named GP. The GP also reviews a pharmacist’s medication review, and works with the patient to agree on a health plan with the aim of improving the patient’s quality of life.

This approach is currently being tested in the 3D study, a large randomised controlled trial funded by the National Institute for Health Research Health Services and Delivery Research Programme (NIHR HS&DR). The study involves over 1,500 patients with multimorbidity from GP practices in Bristol, Manchester and Glasgow/Ayrshire. Patients in the study are being followed up over 15 months and results are expected by the end of 2017.

It is hoped this approach will assist those working in general practice to improve whole person care, assess and manage depression and simplify drug regimes with the overall aim of improving patients’ quality of life.

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (project number 12/130/15).

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

The 3D Study research team acknowledges the support of the NIHR Clinical Research Network (CRN).

Further information

We have launched three new videos about the 3D approach. One describes the approach, one presents the 3D study and one shows patients discussing the need for this new approach. These are available on the CAPC YouTube channel.

For further information, please visit the 3D study website.


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