Process Evaluation of Integrating mental, physical and social care in long term conditions: 3Dimensions for Long-Term Conditions (3DLC)

Common mental health disorders are more prevalent in people with long-term conditions, such as diabetes, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD). Treating psychiatric co-morbidities has been shown to improve self-management and reduce morbidity and mortality in people with long-term conditions but often there is no integrated psychological or social care for these patients.

The 3 Dimensions of Care for Diabetes (3DFD) programme, which integrated psychological and social support with diabetes services, demonstrated clinically significant improvements in glycaemic control, depression, anxiety, social outcomes and, subsequently, significant financial savings. The 3 Dimensions for Long-term Conditions (3DLC) project, which is funded by The Health Foundation as part of the Scaling Up Improvement programme, will scale-up the 3DFD model, to prove integrating medical, psychological and social care for people in Lambeth and Southwark with COPD, Heart Failure and Hypertension, where co-morbidity is impacting on their capacity to self-manage. The project is led by Kings College Hospital, working with Guy’s and St Thomas’ NHS Foundation Trust, South London and Maudsley NHS Foundation Trust.

The evaluation of 3DLC is being conducted by a joint team from King’s Health Partners’ Academic Health Science Centre and the Mental Health and Addiction Research Group (Department of Health Sciences) at the University of York. It has three main aims:

• To assess if scaling-up a diabetes specific model to people with other long term conditions (a multi-condition model) leads to improvements in health and economic outcomes, and 
• To quantify the effectiveness, efficiency, and acceptability of the 3DLC service
• To identify the processes effective in delivering the scaled-up interventions.

The evaluation is a mixed-method study, with two separate but related elements: a quantitative evaluation of the effectiveness of 3DLC in improving health outcome and cost savings; and a process evaluation focusing on the implementation and take-up of the new integrated service. The quantitative evaluation will collect data the point of referral and at 12 month following, which will include; sociodemographic information; condition specific functional status measures; psychological measures and information about health service use.

The process evaluation has three main strands:

• One to one interviews with a purposive sample of up to 30 service users from the three condition groups
• One to one interviews with up to 30 healthcare providers and commissioners, undertaken early in the life of the project and after approximately 12 months
• Non-participant observations of the Heart Failure and COPD multi-disciplinary team meetings, at three time points (approximately four months apart) over the duration of the project

Useful links: