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

Céline Buffel du Vaure1, Philippe Ravaud2, Gabriel Baron3

  • 1Département de Médecine Générale, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité, Research Center UMR 1153, INSERM, Paris, France.

BMJ Open
|March 24, 2016
PubMed

Insights

Patients with multiple chronic conditions face significant daily workloads, including managing 6-13 medications and dedicating up to 71 hours monthly to health-related activities (HRAs). This burden escalates with more conditions, impacting adherence and quality of life.

Area of Science:

  • Health Services Research
  • Clinical Practice Guidelines
  • Multimorbidity Management

Background:

  • Existing clinical practice guidelines (CPGs) are often condition-specific.
  • Patients with multimorbidity (multiple chronic conditions) frequently exceed the scope of single-disease CPGs.
  • The cumulative workload of adhering to multiple CPGs for patients with multimorbidity is not well-defined.

Purpose of the Study:

  • To quantify the potential workload for patients with multimorbidity when applying existing CPGs.
  • To estimate the time and effort required for health-related activities (HRAs) across multiple chronic conditions.

Main Methods:

  • Systematic analysis of CPGs for six prevalent chronic conditions (hypertension, diabetes, CHD, COPD, osteoarthritis, depression).
  • Extraction of all recommended HRAs (medication management, self-monitoring, doctor visits, lifestyle changes).
  • Simulation modeling to estimate the cumulative workload for patients with 1-6 chronic conditions.

Main Results:

  • Patients with three chronic conditions require 6-13 medications daily and 49.6-71.0 hours/month for HRAs.
  • Workload increases substantially with more conditions, reaching 18 medications and 80.7 hours/month for six conditions.
  • Monthly healthcare visits range from 1.2 to 5.9 for three conditions, increasing with comorbidity.

Conclusions:

  • Adherence to current CPGs imposes a substantial and escalating workload on patients with multimorbidity.
  • The findings highlight a potential gap in CPG applicability for complex patient populations.
  • Future guideline development should consider the cumulative burden on patients with multiple chronic conditions.
Abstract

Keywords:
Chronic diseaseMultimorbidityPRIMARY CAREPractice guidelines

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