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5. Incorporating patient preferences in the management of multiple long-term conditions: is this a role for clinical practice guidelines?

Author

Young, Charlotte E., Boyle, Frances M., Brooker, Katie S., and Mutch, Allyson J.

Subjects
multimorbidity, comorbidity, primary care, patient preference, consumer participation, clinical practice guidelines
Abstract

Background:Clinical practice guidelines provide an evidence-based approach to managing single chronic conditions, but their applicability to multiple conditions has been actively debated. Incorporating patient-preference recommendations and involving consumers in guideline development may enhance their applicability, but further understanding is needed.Objectives:To assess guidelines that include recommendations for comorbid conditions to determine the extent to which they incorporate patient-preference recommendations; use consumer-engagement processes during development, and, if so, whether these processes produce more patient-preference recommendations; and meet standard quality criteria, particularly in relation to stakeholder involvement.Design:A review of Australian guidelines published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Document analysis of guidelines examined the presence of patient-preference recommendations and the consumer-engagement processes used. The Appraisal of Guidelines for Research and Evaluation instrument was used to assess guideline quality.Results:Thirteen guidelines were reviewed. Twelve included at least one core patient-preference recommendation. Ten used consumer-engagement processes, including participation in development groups (seven guidelines) and reviewing drafts (ten guidelines). More extensive consumer engagement was generally linked to greater incorporation of patient-preference recommendations. Overall quality of guidelines was mixed, particularly in relation to stakeholder involvement.Conclusions:Guidelines do incorporate some patient-preference recommendations, but more explicit acknowledgement is required. Consumer-engagement processes used during guideline development have the potential to assist in identifying patient preferences, but further research is needed. Clarification of the consumer role and investment in consumer training may strengthen these processes. Journal of Comorbidity 2015;5(1):122–131

Published
2015

11. Why do people with chronic disease not contact consumer health organisations? A survey of general practice patients.

Author

Boyle, Frances M., Dean, Julie H., Young, Charlotte E., and Mutch, Allyson J.

Subjects
CHI-squared test, CHRONIC diseases, COMMUNITY health services, CONFIDENCE intervals, FAMILY medicine, HEALTH services accessibility, INTERVIEWING, MULTIVARIATE analysis, QUESTIONNAIRES, RESEARCH funding, STATISTICAL sampling, T-test (Statistics), LOGISTIC regression analysis, THEMATIC analysis, DATA analysis software, PATIENTS' attitudes, DESCRIPTIVE statistics, ODDS ratio
Abstract

AimConsumer health organisations (CHOs) are non-profit or voluntary sector organisations that promote and represent the interests of patients and carers affected by particular conditions. The purpose of this study was to examine, among patients with chronic disease, what differentiates those who contact CHOs from those who do not and what stops people from making contact.BackgroundCHOs can enhance people’s capacity to manage chronic disease by providing information, education and psychosocial support, but are under-utilised. Little is known about barriers to access.MethodsData were from a baseline telephone survey conducted as part of a randomised trial of an intervention to improve access to CHOs. Participants constituted a consecutive sample of 276 adults with diagnosed chronic disease recruited via 18 general practitioners in Brisbane, Australia. Quantitative survey items examined participants’ use and perceptions of CHOs and a single open-ended question explored barriers to CHO use. Multiple logistic regression and thematic analysis were used.FindingsOverall, 39% of participants had ever contacted a CHO for their health and 28% had contacted a CHO specifically focussed on their diagnosed chronic condition. Diabetes, poorer self-reported physical health and greater health system contact were significantly associated with CHO contact. The view that ‘my doctor does it all’ was prevalent and, together with a belief that their health problems were ‘not serious enough’, was the primary reason patients did not make contact.ConclusionAttitudinal and system-related barriers limit use of CHOs by those for whom they are designed. Developing referral pathways to CHOs and promoting awareness about what they offer is needed to improve access. [ABSTRACT FROM AUTHOR]

Published
2016
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