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GPs go forth

Study questions benefit of involving GP patients in decision making

The NICE-recommended model for GPs treating patients with long-term conditions may not improve their care, a study has concluded.

NICE currently recommends that GPs create 'an individualised management plan with the person' and review medicines and treatments based on 'outcomes important to the person'. It also says treatment should focus on the person's 'individual needs, preferences for treatments, health priorities, lifestyle and goals'.

However, a study including 1,500 UK-based GP patients found that while the model improved patient satisfaction, it had no impact on their health outcomes.

Researchers divided the patients, who all had three or more chronic conditions, into two groups comparing the different care models. Half of the patients received the so-called '3D intervention', including a comprehensive multidisciplinary review of their conditions by a nurse, doctor and pharmacist with the patient fully involved and informed about their care, while the other half received standard care.

The researchers found that after 15 months there was no difference in health-related quality of life measures between the two groups. There were however, improvements in the 3D intervention group in patient-reporting of joined up care and overall satisfaction with their care.

The paper said: ‘It is possible that the 3D intervention… improves patients’ perceptions of the quality of their care but not the quality of their lives.'

However it added that since 'improving patient experience' is 'one of the triple aims of health care', it was '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'.

RCGP chair Professor Helen Stokes-Lampard said: ‘We are surprised, as I’m sure professionals from across health and social care will be, to see the results of this study. It certainly challenges current thinking, as well as anecdotal evidence based on what GPs see in their surgeries, around the benefits of this particular model of delivering patient-centred care on our patients’ quality of life.

‘This is high-quality research and mustn’t be dismissed – but it is the first of its kind at this scale, so there is definitely a need for further research of this calibre, to see if the results can be replicated.'

Lancet 2018; available online 28th June




Readers' comments (2)

  • Vinci Ho

    I think there is an argument here about the selection criterion of three or more chronic conditions. Perhaps , the patient-centred , multidisciplinary approach is only beneficial in early stage of diseases as well as less co-existing morbidities and pathologies . Clearly , primary prevention is more essential than secondary . But the time of reaching three or more chronic diseases in a patient , the benefit of a relatively ‘vigorous’ management approach will be cancelled out by natural history of multiple diseaees

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  • I would have been helpful to work out the cost effectiveness.

    3D approach may improve satisfaction - but if it (lets say) costed x5 more then less involved one, can the nation afford it?

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