title: Potential workload in applying clinical practice guidelines for patients with chronic conditions and multimorbidity: a systematic analysis.
abstract: OBJECTIVE
  To describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines.
  
  
  METHODS
  Systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach.
  
  
  METHODS
  National Guideline Clearinghouse index of US clinical practice guidelines.
  
  
  METHODS
  We 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).
  
  
  METHODS
  From 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.
  For 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.
  
  
  RESULTS
  Depending 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.
authors.affiliation: Département 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.
authors.forename: Céline
authors.initials: C
authors.lastname: Buffel du Vaure
authors.affiliation: 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 Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Epidémiologie Clinique, Paris, France Centre de Médecine Fondée sur les Preuves (EHESP, HAS, INSERM, AP-HP), Paris, France Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.affiliation: 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 Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Epidémiologie Clinique, Paris, France Centre de Médecine Fondée sur les Preuves (EHESP, HAS, INSERM, AP-HP), Paris, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Baron
authors.affiliation: 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.
authors.forename: Caroline
authors.initials: C
authors.lastname: Barnes
authors.affiliation: Département 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.
authors.forename: Serge
authors.initials: S
authors.lastname: Gilberg
authors.affiliation: 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 Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Centre d'Epidémiologie Clinique, Paris, France Centre de Médecine Fondée sur les Preuves (EHESP, HAS, INSERM, AP-HP), Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boutron
mesh_terms: D002908:Chronic Disease / Q000523:psychology; D015897:Comorbidity; D006801:Humans; D010349:Patient Compliance; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012648:Self Care; D014481:United States / Q000453:epidemiology; D016526:Workload
keywords: Chronic disease; Multimorbidity; PRIMARY CARE; Practice guidelines