Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: a systematic analysis.
Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: a systematic analysis.
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DOI：
10.1136/bmjopen-2015-010119
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发表时间：
2016-03-22
期刊：
影响因子：
2.9
通讯作者：
Boutron I
中科院分区：
文献类型：
--
作者：
Buffel du Vaure C;Ravaud P;Baron G;Barnes C;Gilberg S;Boutron I
描述在应用现有临床实践指南时，多发性骨髓瘤患者的潜在工作量。慢性病临床实践指南的系统分析和模拟建模方法。美国临床实践指南的国家指南交换所索引。我们确定了针对患有初级保健中6种常见慢性疾病之一（即高血压、糖尿病、冠心病（CHD）、慢性阻塞性肺病（COPD）、骨关节炎和抑郁症）的成人的最新指南。从指南中，我们提取了所有推荐的健康相关活动（HRA），如药物管理，自我监测，看医生，实验室检查和生活方式的改变，患者年龄为45-64岁，病情严重程度中等。 对于确定的每个HRA，我们进行了文献综述，以确定在HRA上花费的时间方面的潜在工作量。然后，我们使用模拟建模方法来估计患有这些慢性疾病的患者遵守这些推荐的HRA所需的潜在工作量。根据伴随的慢性疾病，符合所有指南的3种慢性疾病患者每天必须服用至少6种至最多13种药物，每月至少1.2至最多5.9次访视健康护理人员，平均（SD）49.6（27.3）至71.0（34.5）h/月用于HRA。随着伴随疾病数量的增加，潜在的工作量大大增加，对于6种慢性疾病的患者，HRA增加到每天18种药物，每月6.6次访视和80.7（35.8）小时/月。
To describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines. Systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach. National Guideline Clearinghouse index of US clinical practice guidelines. 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). 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. 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. 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.