Coping with complexity: working beyond the guidelines for patients with multimorbidities

Primary care physicians believe they are delivering evidence-based care, understanding that adherence to evidence-based clinical guidelines results in tangible benefits in the populations for which they were developed. Unfortunately, most clinical guidelines are based on trial populations which are very different to primary care populations [1], and do not reflect the reality of multimorbidity in general practice [2–6]. Since patients with multimorbidity account for around eight in every 10 primary care consultations [7], it is unsurprising that many primary care physicians find managing these patients challenging. Additionally, current clinical guidelines do not provide guidance on how best to prioritize recommendations for individuals with multimorbidity, and may therefore result in over-treatment and polypharmacy, and a risk of overlooking patient preferences [2,8]. Journal of Comorbidity 2015;5(1):11–1

Improving GPs' knowledge of the benefits and harms of treatment to support decision making in multimorbidity: qualitative research and co-design of a novel electronic information resource

Background General practitioners (GPs) regularly prescribe prolonged treatments for long-term conditions. However, GPs may benefit from further understanding of the absolute benefits and harms of these treatments, enhancing their ability to engage in shared decision-making and manage multimorbidity and polypharmacy. Aim To produce and evaluate a website to provide information on the benefits and harms of treatments for long-term conditions in a way that can be understood by GPs and potentially integrated into their practice. Methods The study consisted of three parts. First, a qualitative interview study and framework analysis with GPs exploring their attitudes to and understanding of the quantitative benefits and harms of treatments. Second, a participatory co-design process to design the website, coupled with a pragmatic approach to evidence collation to provide clinical content. Finally, an exploratory evaluation study of the website using online focus groups. Results The interview study reported findings on GPs’ understanding of quantitative information on the benefits and harms of treatments which informed the co-design research. The co-design research resulted in the creation of a website, www.gpevidence.org, which presents complex scientific information on treatment effect sizes and the nature and quality of the relevant clinical evidence. The evaluation study showed that participating GPs were able to understand the clinical information on GP Evidence, and that in hypothetical scenarios this might change their prescribing practice. Some participants found some information confusing. There was limited evidence that this new information could be integrated into complex decision-making for multimorbidity and polypharmacy. Conclusion The aim of producing a website able to deliver information on the benefits and harms of treatments for long-term conditions to GPs was achieved. Further research is needed to evaluate the effect of GP Evidence in real-world practice

Promissory Note, 7 February 1831

https://egrove.olemiss.edu/aldrichcorr_a/1057/thumbnail.jp

Reforming disease definitions: a new primary care led, people-centred approach

Expanding disease definitions are causing more and more previously healthy people to be labelled as diseased, contributing to the problem of overdiagnosis and related overtreatment. Often the specialist guideline panels which expand definitions have close tis to industry and do not investigate the harms of defining more people as sick. Responding to growing calls to address these problems, an international group of leading researchers and clinicians is proposing a new way to set diagnostic thresholds and mark the boundaries of condition definitions, to try to tackle a key driver of overdiagnosis and overtreatment. The group proposes new evidence-informed principles, with new process and new people constituting new multi-disciplinary panels, free from financial conflicts of interest

Widening Disease Definitions: What Can Physicians Do?

Editorial Article. Disease definitions are often broadened over time to include milder and earlier cases. A strong driver for such definitional changes is the belief that they will benefit patients by preventing more severe disease or future complications