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Involving patients in decision ‘makes no difference to health outcomes’



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

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

NICE currently recommends that patients with multimorbidity receive ‘an individualised management plan’ and a review of 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 primary care 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 practice 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.’

But it added that since ‘improving patient experience’ is ‘one of the triple aims of healthcare’, 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’.

Lancet 2018; available online 28th June