3DLC
The 3 Dimensions for Long-Term Conditions (3DLC) programme aimed to scale up the model of integrated care that was successfully piloted by the 3 Dimensions for Diabetes (3DFD) programme.
3DLC was led by King’s College Hospital NHS Foundation Trust, working in partnership with Guy’s and St Thomas’, and South London and Maudsley NHS Foundation Trusts. The programme provided integrated medical, psychological and social care for people in Lambeth and Southwark who have either heart failure, Chronic Obstructive Pulmonary Disease (COPD) or resistant hypertension, and a mental health and/or social problem, and for whom comorbidity is affecting their ability to self-manage their condition.
Watch 3DLC service user Shawn Collick's Interview (subtitled)
Shawn's story
Shawn Collick, a 3DLC patient, talks about his experiences with long-term conditions and the importance of whole person care in helping him better manage and cope with his conditions.
Patients attending outpatient clinics were screened for depression and anxiety using the Integrating Mental & Physical healthcare: Research, Training & Services (IMPARTS) screening tool. A patient with depression or anxiety would be directed to a care pathway developed by the 3DLC team that provided suitable mind and body care, this might include self-management support, a referral to an Improving Access to Psychological Therapies (IAPT) service or direct support from the 3DLC service.
The 3DLC service was provided by a psychiatrist, a psychologist and a community support worker.
Community support worker: offered practical support and advice in areas including housing, debt, benefits, immigration and employment. They also helped with accessing local activities, community services and other resources.
Clinical Psychologist: provided assessment and talking therapies for people experiencing emotional distress or other mental health conditions, particularly where these impacted on the management of the long-term condition.
Psychiatrist: a medical doctor specialising in diagnosing and treating mental health problems. Treatments included medication, talking therapies and advice.
The service also delivered training, support and advice on psychosocial issues to the Respiratory Medicine, Cardiology and Heart Failure Nursing teams at King's College Hospital and Guy's and St Thomas' NHS Foundation Trusts, and the Consultant for Resistant Hypertension at King's College Hospital NHS Foundation Trust.
The project was funded by the Health Foundation as part of their Scaling Up Improvement initiative. This built on the success of the 3DFD programme - which demonstrated significant improvement in glycaemic control, depression, anxiety and social outcomes, and produced significant financial savings for the NHS of £850 per patient per year, even after additional investment. 3DLC expands this model to cover three more long term conditions: heart failure, hypertension and COPD. We hope to produce improvements in disease-specific biomedical outcomes, mental health status, quality of life, social functioning and service use.
Read the Evaluation of 3 Dimensions for Long-term Conditions (3DLC) (July 2019).