Out of context

Clinical practice guidelines and patients with multiple chronic conditions a systematic review

Kirk D. Wyatt, Louise M. Stuart, Juan Brito Campana, Barbara Carranza Leon, Juan Pablo Domecq, Gabriela J. Prutsky, Jason S. Egginton, Andrew D. Calvin, Nilay D Shah, Mohammad H Murad, Victor Manuel Montori

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Background: Poor fidelity to practice guidelines in the care of people with multiple chronic conditions (MCC) may result from patients and clinicians struggling to apply recommendations that do not consider the interplay of MCC, socio-personal context, and patient preferences. Objective: The objective of the study was to assess the quality of guideline development and the extent to which guidelines take into account 3 important factors: the impact of MCC, patients' sociopersonal contexts, and patients' personal values and preferences. Research Design: We conducted a systematic search of clinical practice guidelines for patients with type 2 diabetes mellitus published between 2006 and 2012. Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Scopus, EBSCO CINAHL, and the National Guideline Clearinghouse were searched. Two reviewers working independently selected studies, extracted data, and evaluated the quality of the guidelines. Results: We found 28 eligible guidelines, which, on average, had major methodological limitations (AGREE II mean score 3.8 of 7, SD = 1.6). Patients or methodologists were not included in the guideline development process in 20 (71%) and 24 (86%) guidelines, respectively. There was a complete absence of incorporating the impact of MCC, socio-personal context, and patient preferences in 8 (29%), 11 (39%), and 16 (57%) of the 28 guidelines, respectively. When mentioned, MCC were considered biologically, but not as contributors of complexity or patient work or as motivation to focus on patient-centered outcomes. Conclusions: Extant clinical practice guidelines for one chronic disease sometimes consider the context of the patient with that disease, but only do so narrowly. Guideline panels must remove their contextual blinders if they want to practically guide the care of patients with MCC.

Original languageEnglish (US)
JournalMedical Care
Volume52
Issue number3 SUPPL. 2
DOIs
StatePublished - 2014

Fingerprint

Practice Guidelines
Guidelines
Patient Preference
Multiple Chronic Conditions
MEDLINE
Type 2 Diabetes Mellitus
Patient Care
Chronic Disease
Research Design

Keywords

  • Comorbidities
  • Diabetes
  • Diabetes mellitus
  • Minimally disruptive medicine
  • Shared decision making

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Out of context : Clinical practice guidelines and patients with multiple chronic conditions a systematic review. / Wyatt, Kirk D.; Stuart, Louise M.; Brito Campana, Juan; Leon, Barbara Carranza; Domecq, Juan Pablo; Prutsky, Gabriela J.; Egginton, Jason S.; Calvin, Andrew D.; Shah, Nilay D; Murad, Mohammad H; Montori, Victor Manuel.

In: Medical Care, Vol. 52, No. 3 SUPPL. 2, 2014.

Research output: Contribution to journalArticle

Wyatt, Kirk D. ; Stuart, Louise M. ; Brito Campana, Juan ; Leon, Barbara Carranza ; Domecq, Juan Pablo ; Prutsky, Gabriela J. ; Egginton, Jason S. ; Calvin, Andrew D. ; Shah, Nilay D ; Murad, Mohammad H ; Montori, Victor Manuel. / Out of context : Clinical practice guidelines and patients with multiple chronic conditions a systematic review. In: Medical Care. 2014 ; Vol. 52, No. 3 SUPPL. 2.
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abstract = "Background: Poor fidelity to practice guidelines in the care of people with multiple chronic conditions (MCC) may result from patients and clinicians struggling to apply recommendations that do not consider the interplay of MCC, socio-personal context, and patient preferences. Objective: The objective of the study was to assess the quality of guideline development and the extent to which guidelines take into account 3 important factors: the impact of MCC, patients' sociopersonal contexts, and patients' personal values and preferences. Research Design: We conducted a systematic search of clinical practice guidelines for patients with type 2 diabetes mellitus published between 2006 and 2012. Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Scopus, EBSCO CINAHL, and the National Guideline Clearinghouse were searched. Two reviewers working independently selected studies, extracted data, and evaluated the quality of the guidelines. Results: We found 28 eligible guidelines, which, on average, had major methodological limitations (AGREE II mean score 3.8 of 7, SD = 1.6). Patients or methodologists were not included in the guideline development process in 20 (71{\%}) and 24 (86{\%}) guidelines, respectively. There was a complete absence of incorporating the impact of MCC, socio-personal context, and patient preferences in 8 (29{\%}), 11 (39{\%}), and 16 (57{\%}) of the 28 guidelines, respectively. When mentioned, MCC were considered biologically, but not as contributors of complexity or patient work or as motivation to focus on patient-centered outcomes. Conclusions: Extant clinical practice guidelines for one chronic disease sometimes consider the context of the patient with that disease, but only do so narrowly. Guideline panels must remove their contextual blinders if they want to practically guide the care of patients with MCC.",
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AU - Stuart, Louise M.

AU - Brito Campana, Juan

AU - Leon, Barbara Carranza

AU - Domecq, Juan Pablo

AU - Prutsky, Gabriela J.

AU - Egginton, Jason S.

AU - Calvin, Andrew D.

AU - Shah, Nilay D

AU - Murad, Mohammad H

AU - Montori, Victor Manuel

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KW - Comorbidities

KW - Diabetes

KW - Diabetes mellitus

KW - Minimally disruptive medicine

KW - Shared decision making

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