title: Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy.
abstract: BACKGROUND
  In order for clinical practice guidelines (CPGs) to meet their broad objective of enhancing the quality of care and supporting improved patient outcomes, they must address the needs of diverse patient populations. We set out to explore the patient attributes that are likely to demand a unique approach to the management of chronic disease, and which are crucial if evidence or services planning is to reflect clinic populations. These were incorporated into a new conceptual framework; using diabetes mellitus as an exemplar.
  
  
  METHODS
  The patient attributes that informed the framework were identified from CPGs, the diabetes literature, an expert academic panel, and two cross-disciplinary panels; and agreed upon using a modified nominal group technique.
  
  
  RESULTS
  Full consensus was reached on twenty-four attributes. These factors fell into one of three themes: (1) type/stage of disease, (2) morbid events, and (3) factors impacting on capacity to self-care. These three themes were incorporated in a convenient way in the workforce evidence-based (WEB) model.
  
  
  CONCLUSIONS
  While biomedical factors are frequently recognised in published clinical practice guidelines, little attention is given to attributes influencing a person's capacity to self-care. Paying explicit attention to predictable threats to effective self-care in clinical practice guidelines, by drawing on the WEB model, may assist in refinements that would address observed disparities in health outcomes across socio-economic groups. The WEB model also provides a framework to inform clinical training, and health services and workforce planning and research; including the assessment of healthcare needs, and the allocation of healthcare resources.
authors.affiliation: Health Economics and Social Policy Group, University of South Australia, Adelaide, South Australia. matthew.leach@unisa.edu.au
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Leach
authors.forename: Leonie
authors.initials: L
authors.lastname: Segal
mesh_terms: D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006282:Health Personnel / Q000458:organization & administration*; D006285:Health Planning / Q000592:standards*; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D008297:Male; D017146:Models, Organizational; D010358:Patient Participation; D011050:Policy Making; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D013021:South Australia