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Health

3 Dimensions for Long-term Conditions (3DLC)

Integrating psychological and social care for long-term conditions: 3 Dimensions of Care for long-term conditions

The 3 Dimensions of Long-term Conditions (3DLC) service provides integrated medical, psychological and social care for patients who have either heart failure, COPD or resistant hypertension, and a mental health and/or social problem, and for whom co-morbidity is affecting their ability to self-manage.

Methods

Following mental health screening, n=193 patients with long-term conditions were recruited who were receiving either their usual medical care or 3DLC care. Their health service use was recorded, and condition specific functional status and psychological measures were collected. Paired t-tests were used to compare pre- and post-outcomes.

Results

Patients who received integrated care by the 3DLC service showed a statistically significant difference at 5% level in PHQ-9 scores (p-value = 0.004) and GAD-7 scores (p-value = 0.001), CAT scores (p- value 0.030) and Minnesota scores (p-value 0.862). While the A&E visits remained constant for 3DLC patients, the inpatient hospital admissions showed a noteworthy reduction from 3.1 to 1.4. The intervention of 3DLC resulted in an overall increase in cost (£831).

Conclusions

Within the group of patients who received integrated care, significant improvements in depression and anxiety and condition specific outcomes were evident at 6 months. The findings suggest that by targeting the co-morbidity and by providing holistic care to these patients, they are able to self-manage their condition.

Publications

Patient and public involvement in integrated psychosocial care 

3 Dimensions for Long-Term Conditions - creating a sustainable bio-psycho-social approach to healthcare