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Review
. 2016 Mar 22;6(3):e010119.
doi: 10.1136/bmjopen-2015-010119.

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

Céline Buffel du Vaure  1 , Philippe Ravaud  2 , Gabriel Baron  3 , Caroline Barnes  4 , Serge Gilberg  5 , Isabelle Boutron  3
Affiliations
Review

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

Céline Buffel du Vaure et al. BMJ Open. .

Abstract

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 45-64 years 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.

Keywords: Chronic disease; Multimorbidity; PRIMARY CARE; Practice guidelines.

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Figures

Figure 1
Figure 1
Time spent by patients in health-related activities (hours/month) by multimorbidity profile. CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; D, diabetes; Dp, depression; HT, hypertension; OA, oesteoarthritis.
Figure 2
Figure 2
Time spent by patients in health-related activities (hours/month) by activity and multimorbidity profile. CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; D, diabetes; Dp, depression; HT, hypertension; OA, oesteoarthritis.
See this image and copyright information in PMC

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