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

Abstract

ObjectivesTo describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines.DesignSystematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach.Data sourcesNational Guideline Clearinghouse index of US clinical practice guidelines.Study selectionWe 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).Data extractionFrom 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.Simulation modelling approachFor 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.ResultsDepending 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.

Work pattern of neurology nurses in a Chinese hospital: A time and motion study

“…The number of participants observed, however, accounted for 87.5% (14/16) of all nurses working in the study setting, validly representing nursing activities in the study unit. Although patient disease severity can be a key factor accounting for nursing management (Buffel du Vaure et al, ) and workload (Kraljic et al, ), the conditions of most patients in the study unit were similarly stable; thus it is not possible for us to identify the relationship between patients’ disease severity and nursing work arrangement in this natural setting.…”

Treatment burden should be included in clinical practice guidelines

“…Disease treatment can occupy a large part of patients’ day and limit the amount of time they can spend on other activities such as work, studying, leisure, childcare, and being with friends and family. A study found that in order to comply with all disease specific guidelines patients with three chronic conditions (any combination of chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes, osteoarthritis, hypertension, and depression) would take from six to 13 different drugs a day, visit a health professional 1.2 to 5.9 times a month, and spend a mean (SD) of 49.6 (27.3) to 71.0 (34.5) hours each month in health related activities 2. In patients with all six chronic conditions, the workload rose to 18 medications a day, 6.6 healthcare visits a month, and 80.7 (35.8) hours a month in health related activities 2…”

Is My Patient Overwhelmed?

“…6 For patients with multimorbidity, the amount of time required to deal with all health care tasks can be comparable to a part-time job. 7 Thus, in addition to the burden of illness, patients with chronic conditions deal with a "burden of treatment," defined as the health care workload associated with everything they do to care for themselves and its impact on their well-being. 5 Whenever the work imposed on patients for health care competes with demands in their social, family, and professional lives, it may exceed patients' capacity to do it.…”