Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity
Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity
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DOI：
10.1093/ageing/afs100
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发表时间：
2013-01-01
期刊：
影响因子：
6.7
通讯作者：
Guthrie, Bruce
中科院分区：
文献类型：
--
作者：
Hughes, Lloyd D.;McMurdo, Marion E. T.;Guthrie, Bruce
目的：检查美国国家健康与临床卓越研究所（NICE）指南在多大程度上解决了患者合并症、以患者为中心的护理以及患者对治疗建议的依从性。方法：选择了五个NICE临床指南进行审查（2型糖尿病，心肌梗死、骨关节炎患者的二级预防，慢性阻塞性肺疾病和抑郁症），因为这些疾病是并发症的常见原因，自2007年以来一直在制定指南。两位作者从每个完整的指南中提取信息，并注意到指南对患者合并症、以患者为中心的护理和患者依从性的解释程度。累积推荐的治疗，随访和自我保健制度，为两个假设的病人，然后创建说明潜在的累积影响，应用单一疾病的建议，以人与multimorphine.Results：合并症和患者的依从性不一致占在指南中，从广泛的讨论，根本没有。以患者为中心的护理在整个指南中以通用术语进行了讨论，为临床医生提供了有限的疾病特异性建议。对我们这两个假设的患者明确遵循指南建议将导致相当大的治疗负担，即使在轻度至中度疾病中遵循建议。此外，后续行动和自我护理制度是复杂的潜在问题，为患者compliance.Conclusion：临床指南发挥了重要作用，改善医疗保健的人与长期的条件。然而，在患有多药综合征的患者中，目前的指南建议迅速累积，以推动多种药物治疗，而没有提供关于如何最好地优先考虑治疗负担有时会压倒性的个人的建议的指导。
Objective: to examine the extent to which National Institute of Health and Clinical Excellence (NICE) guidelines address patient comorbidity, patient centred care and patient compliance to treatment recommendations.Methods: five NICE clinical guidelines were selected for review (type-2 diabetes mellitus, secondary prevention for people with myocardial infarction, osteoarthritis, chronic obstructive pulmonary disease and depression) as these conditions are common causes of comorbidity and the guidelines had all been produced since 2007. Two authors extracted information from each full guideline and noted the extent to which the guidelines accounted for patient comorbidity, patient centred care and patient compliance. The cumulative recommended treatment, follow-up and self-care regime for two hypothetical patients were then created to illustrate the potential cumulative impact of applying single disease recommendations to people with multimorbidity.Results: comorbidity and patient adherence were inconsistently accounted for in the guidelines, ranging from extensive discussion to none at all. Patient centred care was discussed in generic terms across the guidelines with limited disease-specific recommendations for clinicians. Explicitly following guideline recommendations for our two hypothetical patients would lead to a considerable treatment burden, even when recommendations were followed for mild to moderate conditions. In addition, the follow-up and self-care regime was complex potentially presenting problems for patient compliance.Conclusion: clinical guidelines have played an important role in improving healthcare for people with long-term conditions. However, in people with multimorbidity current guideline recommendations rapidly cumulate to drive polypharmacy, without providing guidance on how best to prioritise recommendations for individuals in whom treatment burden will sometimes be overwhelming.