Multimorbidity: is the patient-centred care model flawed?

  • Lancet

  • curated by Dawn O'Shea
  • UK Medical News
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There is international consensus that care for multimorbidity should be patient-centred, focus on QoL and promote self-management towards agreed goals. However, there is little evidence about the effectiveness of this approach.

Now, new research published in the Lancet, suggests that patient-centred interventions may improve patients’ perceptions of care quality but not their QoL.

The cluster-randomised trial recruited 1546 multimorbid patients from 33 general practices in England and Scotland between 20 May and 31 December 2015. The practices were randomly allocated to provide usual care (n=17) or a novel patient-centred 3D approach based on dimensions of health, depression, and drugs (n=16).

The 3D approach replaced disease-focussed reviews of each health condition with a 6-monthly comprehensive multidisciplinary review. Each review consisted of 2 appointments (with a nurse and then a named responsible physician) and a medication review by a pharmacist. The components included tailoring treatment recommendations to the individual’s priorities and situation, balancing risks and benefits of treatment while seeking to reduce treatment burden, promoting self-management, and agreeing on individualised care plan.

In the intention-to-treat analysis, the intervention was not associated with improvements in QoL or perceived illness/treatment burden and had mixed effects on the process of care, although it was associated with significant improvements in measures of patient-centred care.

The authors theorise that, “the intervention might have supported changes in organisation more than it supported changing the clinicians’ attitudes.” It is also possible that the intervention was not sufficiently intensive, they add.

On the other hand, they say, the outcomes could signal a deeper problem. “An alternative interpretation of our findings is that the causal model underlying the international consensus is flawed,” they add.