Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: a systematic analysis

作者：du Vaure Celine Buffel^*; Ravaud Philippe; Baron Gabriel; Barnes Caroline; Gilberg Serge; Boutron Isabelle

来源：BMJ Open, 2016, 6(3): e010119.

DOI：10.1136/bmjopen-2015-010119

• Multimorbidity
• Chronic disease
• PRIMARY CARE
• Practice guidelines

Objectives To describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines.
Design Systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach.
Data sources National Guideline Clearinghouse index of US clinical practice guidelines.
Study selection We identified the most recent guidelines for adults with 1 of 6 prevalent chronic conditions in primary care (ie hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), osteoarthritis and depression).
Data extraction From the guidelines, we extracted all recommended health-related activities (HRAs) such as drug management, self-monitoring, visits to the doctor, laboratory tests and changes of lifestyle for a patient aged 45-64years with moderate severity of conditions.
Simulation modelling approach For each HRA identified, we performed a literature review to determine the potential workload in terms of time spent on this HRA. Then, we used a simulation modelling approach to estimate the potential workload needed to comply with these recommended HRAs for patients with several of these chronic conditions.
Results Depending on the concomitant chronic condition, patients with 3 chronic conditions complying with all the guidelines would have to take a minimum of 6 to a maximum of 13 medications per day, visit a health caregiver a minimum of 1.2 to a maximum of 5.9 times per month and spend a mean (SD) of 49.6 (27.3) to 71.0 (34.5) h/month in HRAs. The potential workload increased greatly with increasing number of concomitant conditions, rising to 18 medications per day, 6.6 visits per month and 80.7 (35.8) h/month in HRAs for patients with 6 chronic conditions.

• 出版日期2016