Abstract
BackgroundIn 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.MethodsThe 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.ResultsFull 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.ConclusionsWhile 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.
Highlights
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
The project set out to develop a set of agreed population attributes that are important in clinical practice for chronic diseases, and would ideally be incorporated in some way into clinical practice guidelines and health services policy formulation
Full consensus was reached on the inclusion of twenty-four of these attributes. These attributes were grouped into three distinct themes, which form the basis of the conceptual framework for chronic disease management; hereon referred to as the Workforce Evidence-Based planning (WEB) model
Summary
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. Participants recruited into clinical trials often differ from the patient population in terms of education level, social class, age, race and disease severity; this makes translating evidence-based CPGs into clinical practice and policy problematic [3]. That this is an issue is indicated by clinician concerns with the usefulness of CPGs, and the lack of breadth and depth of CPGs
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