{"id":978,"date":"2014-09-16T14:31:20","date_gmt":"2014-09-16T19:31:20","guid":{"rendered":"http:\/\/crmcspl-blog.recherche.usherbrooke.ca\/?p=978"},"modified":"2014-09-16T14:31:20","modified_gmt":"2014-09-16T19:31:20","slug":"improving-care-for-patients-with-multimorbidity","status":"publish","type":"post","link":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/?p=978","title":{"rendered":"Improving care for patients with multimorbidity"},"content":{"rendered":"<p><a class=\"twitter-share-button\" href=\"https:\/\/twitter.com\/share\">Tweet<\/a><br \/>\n<script type=\"text\/javascript\">\/\/ <![CDATA[\n!function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=\/^http:\/.test(d.location)?'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+':\/\/platform.twitter.com\/widgets.js';fjs.parentNode.insertBefore(js,fjs);}}(document, 'script', 'twitter-wjs');\n\/\/ ]]><\/script><br \/>\nBy Chris Salisbury<br \/>\n<a href=\"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/wp-content\/uploads\/Chris-Salisbury2.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-979\" title=\"Chris Salisbury2\" src=\"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/wp-content\/uploads\/Chris-Salisbury2.jpg\" alt=\"\" width=\"92\" height=\"132\" \/><\/a><\/p>\n<p>Although there is a fairly clear sense of direction about how care needs to change for patients with multimorbidity, there have been few rigorous studies of new approaches.<br \/>\nResearchers from the Universities of Bristol, Glasgow, Manchester, Dundee, in partnership with the NHS and the Royal College of General Practitioners, have obtained funding for the \u20183D\u2019 study to improve whole person care. This is an ambitious multi-centre cluster randomised trial of a new approach to improve the management of patients with multimorbidity in general practice, led by Professor Chris Salisbury. Funding of \u00a31.78 million study has been obtained from the National Institute of Health Research (NIHR) through its <a href=\"http:\/\/www.nets.nihr.ac.uk\/programmes\/hsdr\" target=\"_blank\">Health Services and Delivery Research (HS&amp;DR) Programme<\/a>.<\/p>\n<p>Following a pilot and optimisation study in 4 general practices, 32 practices will be recruited to the main trial and randomised to receive the new intervention or continue usual care. The intervention is designed to address the problems of illness burden (poor quality of life, depression) treatment burden (multiple unco-ordinated appointments, polypharmacy, poor primary\/secondary care co-ordination) and lack of patient-centred care (low continuity, disregard of patients\u2019 priorities) experienced by patients with multimorbidity.<br \/>\nPatients with multimorbidity will be identified and offered longer appointments with the same GP and nurse whenever possible, to maximise continuity of care. Instead of separate reviews of each of their long term conditions, patients will be invited for a comprehensive \u20183D\u2019 health review every 6 months designed to cover all of their health issues. This will focus on identifying their main concerns and priorities to improve their quality of life, as well as seeking to improve disease control (<strong>D<\/strong>imensions of health). The patients\u2019 <strong>D<\/strong>rug regime will be reviewed and simplified, seeking to improve medication adherence.\u00a0 The clinician will check for and treat <strong>D<\/strong>epression. In order to improve integration of care, the practice will have a linked \u2018general physician\u2019 at the local hospital.<br \/>\nThe aim is to recruit 1382 multimorbid patients into the trial and follow them up for 12 months. The primary outcome is the patient\u2019s quality of life, with secondary outcomes including measures of disease control, the burden of illness and treatment, and measures of patient centred care. A parallel process evaluation using mixed methods will explore how the intervention is implemented and achieves its effects and how it could be improved. Through an economic evaluation we will compare the costs and benefits of the intervention from different perspectives and determine whether it is cost-effective. Further information is available from the study website at <a href=\"http:\/\/www.bristol.ac.uk\/social-community-medicine\/projects\/3d-study\/\" target=\"_blank\">http:\/\/www.bristol.ac.uk\/3d-study<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tweet By Chris Salisbury Although there is a fairly clear sense of direction about how care needs to change for patients with multimorbidity, there have been few rigorous studies of new approaches. Researchers from the Universities of Bristol, Glasgow, Manchester, Dundee, in partnership with the NHS and the Royal College of General Practitioners, have obtained <a href=\"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/?p=978\"> read more <span class=\"meta-nav\">&raquo;<\/span><\/a><\/p>\n","protected":false},"author":39,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_s2mail":"yes","footnotes":""},"categories":[9],"tags":[],"class_list":["post-978","post","type-post","status-publish","format-standard","hentry","category-intervention"],"_links":{"self":[{"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=\/wp\/v2\/posts\/978","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=\/wp\/v2\/users\/39"}],"replies":[{"embeddable":true,"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=978"}],"version-history":[{"count":6,"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=\/wp\/v2\/posts\/978\/revisions"}],"predecessor-version":[{"id":985,"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=\/wp\/v2\/posts\/978\/revisions\/985"}],"wp:attachment":[{"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=978"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=978"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/crmcspl-blog.recherche.usherbrooke.ca\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=978"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}