Patients with multimorbidity in general practice; characterisation of patients in The 3D Study
Patients with multiple long term conditions (LTC) are increasingly prevalent in general practice. These patients have a high disease burden and can be complex to manage. Guidelines on how best to prioritise and manage these patients with multimorbidity are currently being developed by NICE. At present, current practice relies on disease specific guidelines. Patients often attend multiple single condition clinics. To address these issues, the 3D study is a multi-centre, cluster randomised controlled trial investigating a complex intervention designed to improve how general practices manage patients with multimorbidity. The study focusses on Dimensions of health (patients’ unique needs), Depression and Drugs using a patient-centred care model. The first part of the study involves identifying, recruiting and characterising this diverse patient group.
Patients with three or more LTCs, defined by the Quality Outcomes Framework (QOF) disease registers, were identified from practice lists using a custom built search tool. Eleven long term conditions were included with some disease groups (eg coronary heart disease, hypertension and chronic kidney disease) clustered and counted as one condition. A random sample of 150 eligible patients per practice were invited to take part in the 3D study. Baseline characteristics based on practice coded data and patient questionnaires were compared with national prevalence rates.
33 practices were recruited across England and Scotland. For an average practice, 296 patients were eligible with 3 or more LTCs. An eligibility rate of 4% was higher than expected based on previous estimates of the prevalence of multimorbidity. A total of 1546 patients were recruited (above target = 1383). Recruited patients were 49% male, 97% white, mean age 71 years old (range 25-97 years). Participants were proportionally representative of all eligible patients when compared by condition, apart from dementia which was under-represented in our study population. The most prevalent single LTCs were cardiovascular disease/chronic kidney disease (93% of participants), diabetes (52%), COPD or asthma (50%), and depression (36%). 65% participants described their health as poor or fair; 49% were very satisfied with the care from their GP surgery, although only 37% regularly saw their preferred GP and 35% described their care as joined up. However 33% never or rarely discussed what was most important in managing their own health and only 10% had a written care plan. Participants took an average of 8 types of medications whilst 36% admitted to sometimes forgetting to take their medications.
We have shown higher than expected prevalence rates for multimorbidity and hence more people eligible to take part in the 3D study. Recruited patients are representative of the eligible patient pool. Therefore the 3D study population is typical of the multimorbidity population across the country and the findings of the study are likely to be generalizable.