Protocol for a process evaluation of a cluster randomised controlled trial to improve management of multimorbidity in general practice: the 3D study.

If there is a clear trend towards initiatives that are very similar to 3D, any improvements in care resulting from 3D may be matched by those that occur as a result of ‘secular trends’. 29 It is also expected that the various components of the intervention may not be uniformly implemented across practices, in part due to differences in context, for example, nurse roles, baseline arrangements for LTC care and whether the practice has their own pharmacist, and that this may be reflected in differences in outcomes.

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