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Out of context: clinical practice guidelines and patients with multiple chronic conditions: a systematic review

Kirk D Wyatt1, Louise M Stuart, Juan P Brito

  • 1*Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN †Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN ‡Section of Endocrinology, Baylor College of Medicine, Houston, TX §Division of Endocrinology, Diabetes, Metabolism and Nutrition ∥Healthcare Policy and Research ¶Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.

Medical Care
|August 24, 2013
PubMed
Abstract

Insights

Clinical practice guidelines often fail to address multiple chronic conditions (MCC), patient context, and preferences, leading to poor care quality. Guidelines need improvement to better support patients with complex health needs.

Area of Science:

  • Health Services Research
  • Clinical Practice Guidelines
  • Patient-Centered Care

Background:

  • Practice guidelines for multiple chronic conditions (MCC) show poor fidelity due to limited consideration of patient context and preferences.
  • Patients and clinicians face challenges applying recommendations that don't account for the interplay of MCC, socio-personal context, and patient values.

Purpose of the Study:

  • To assess the quality of clinical practice guideline development.
  • To evaluate the extent to which guidelines incorporate the impact of MCC, patients' socio-personal contexts, and personal values/preferences.

Main Methods:

  • Systematic search of clinical practice guidelines for type 2 diabetes mellitus (2006-2012).
  • Independent data extraction and quality evaluation by two reviewers.
  • Searches conducted across multiple databases including National Guideline Clearinghouse.

Main Results:

  • 28 eligible guidelines had major methodological limitations (AGREE II score: 3.8/7).
  • Patients (71%) and methodologists (86%) were largely excluded from guideline development.
  • MCC, socio-personal context, and patient preferences were absent or narrowly considered in 29-57% of guidelines.

Conclusions:

  • Current guidelines for single chronic diseases offer limited contextual consideration for patients with MCC.
  • Guideline development panels must broaden their perspective to practically guide care for patients with MCC.

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