Salisbury C, et al. - Authors tested the presumption that the patient-centered, so-called 3D approach (based on dimensions of health, depression, and drugs) for patients with multimorbidity would improve their health-related quality of life, which is the ultimate aim of the 3D intervention. Patients' quality of life was not improved by the 3D intervention, as suggested in this trial. This was the largest investigation of the international consensus about optimal management of multimorbidity.

Methods

• Experts conducted this pragmatic cluster-randomized trial in general practices in England and Scotland.
• They randomly allocated the practices to continue usual care (17 practices) or to provide 6-monthly comprehensive 3D reviews, including patient-centered strategies that reflected international consensus on best care (16 practices).
• Randomization done was computer-generated, stratified by area, and minimized by practice deprivation and list size.
• They recruited adults with three or more chronic conditions.
• Quality of life (assessed with EQ-5D-5L) after 15 months' follow-up was the primary outcome.
• Researchers did not mask the participants to group assignment, but analysis of outcomes was blinded.
• They evaluated the primary outcome in the intention-to-treat population, with missing data being multiply imputed.

Results

• Findings suggested that between May 20, 2015 and December 31, 2015, 1,546 patients from 33 practices were recruited and were randomly assigned to receive the intervention (n=797) or usual care (n=749).
• As per data, there was no difference between trial groups in the primary outcome of quality of life in the intention-to-treat analysis, (adjusted difference in mean EQ-5D-5L 0.00, 95% CI -0.02 to 0.02; p=0.93).
• Ultimately 78 patients died, and consideration of death was not done as related to the intervention.