Evidence map›Paper›PMID 31959601›Full record

Trial reportBMJ open2020

Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial.

Joanna Thorn, Mei-See Man, Katherine Chaplin, Peter Bower, Sara Brookes, Daisy Gaunt, Bridie Fitzpatrick, Caroline Gardner, Bruce Guthrie, Sandra Hollinghurst and 3 more

Open access · goldAbstract readMulticenter StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 3 pooled it
2.5field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 26 citations in OpenAlex.

  1. Pooled it
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  4. Trial
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  7. Review
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  10. Article
  11. Article
  12. Multimorbidity Management: A Scoping Review of Interventions and Health Outcomes.International journal of environmental research and public health · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 4 institutions in 1 country.

Joanna ThornCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK joanna.thorn@bristol.ac.uk.ORCID 0000-0001-8962-2428
Mei-See ManCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.ORCID 0000-0003-4948-5670
Katherine ChaplinCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.ORCID 0000-0003-1261-9938
Peter BowerNIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
Sara BrookesBristol Randomised Trials Collaboration, Population Health Sciences, University of Bristol, Bristol, UK.
Daisy GauntBristol Randomised Trials Collaboration, Population Health Sciences, University of Bristol, Bristol, UK.
Bridie FitzpatrickInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Caroline GardnerNIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
Bruce GuthriePopulation Health Sciences Division, Medical Research Institute, University of Dundee, Dundee, UK.
Sandra HollinghurstCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.
Victoria LeeNIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
Stewart W MercerInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Chris SalisburyCentre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.ORCID 0000-0002-4378-3960
University of Bristol · GBUniversity of Manchester · GBUniversity of Glasgow · GBUniversity of Dundee · GB

Funding

Department of Health 12/130/15
6 · The paper itself

Abstract

objectivePatients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to determine the cost-effectiveness of the 3D intervention, which was developed to improve the system of care.

designEconomic evaluation conducted alongside a pragmatic cluster-randomised trial.

settingGeneral practices in three centres in England and Scotland.

participants797 adults with three or more chronic conditions were randomised to the 3D intervention, while 749 participants were randomised to receive usual care.

interventionThe 3D approach: comprehensive 6-monthly general practitioner consultations, supported by medication reviews and nurse appointments. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary economic evaluation assessed the cost per quality-adjusted life year (QALY) gained from the perspective of the National Health Service (NHS) and personal social services (PSS). Costs were related to changes in a range of secondary outcomes (QALYs accrued by both participants and carers, and deaths) in a cost-consequences analysis from the perspectives of the NHS/PSS, patients/carers and productivity losses.

resultsVery small increases were found in both QALYs (adjusted mean difference 0.007 (-0.009 to 0.023)) and costs (adjusted mean difference £126 (£-739 to £991)) in the intervention arm compared with usual care after 15 months. The incremental cost-effectiveness ratio was £18 499, with a 50.8% chance of being cost-effective at a willingness-to-pay threshold of £20 000 per QALY (55.8% at £30 000 per QALY).

conclusionsThe small differences in costs and outcomes were consistent with chance, and the uncertainty was substantial; therefore, the evidence for the cost-effectiveness of the 3D approach from the NHS/PSS perspective should be considered equivocal. TRIAL REGISTRATION NUMBER: ISCRTN06180958.

Indexed as

Quality-Adjusted Life YearsQuality of LifeAdultChronic DiseaseCost-Benefit AnalysisEnglandFemaleHumansMaleMultimorbidityPrimary Health CareScotlandState Medicineeconomic evaluationmultimorbiditypatient-centred careprimary care

Identifiers

PMID31959601
PMCPMC7044971
OpenAlexW2999652774

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.