Young Charlotte E, Boyle Frances M, Brooker Katie S, Mutch Allyson J
School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia.
Queensland Centre for Intellectual and Developmental Disability (QCIDD), School of Medicine, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia.
J Comorb. 2015 Nov 11;5:122-131. doi: 10.15256/joc.2015.5.53. eCollection 2015.
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.
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.
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.
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.
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.
临床实践指南为管理单一慢性病提供了循证方法，但其对多种病症的适用性一直存在激烈争论。纳入患者偏好建议并让消费者参与指南制定可能会提高其适用性，但仍需进一步了解。
评估包含合并症建议的指南，以确定其纳入患者偏好建议的程度；在制定过程中采用消费者参与流程，若采用，这些流程是否会产生更多患者偏好建议；以及是否符合标准质量标准，特别是在利益相关者参与方面。
对2006年至2014年发布的澳大利亚指南进行综述，这些指南纳入了初级保健中合并症管理的建议。对指南进行文献分析，检查患者偏好建议的存在情况以及所采用的消费者参与流程。使用《研究与评价指南评估工具》评估指南质量。
共审查了13项指南。12项指南至少包含一项核心患者偏好建议。10项指南采用了消费者参与流程，包括参与制定小组（7项指南）和审查草案（10项指南）。更广泛的消费者参与通常与更多地纳入患者偏好建议相关。指南的总体质量参差不齐，特别是在利益相关者参与方面。
指南确实纳入了一些患者偏好建议，但需要更明确的认可。指南制定过程中使用的消费者参与流程有可能帮助确定患者偏好，但仍需进一步研究。明确消费者角色并投资于消费者培训可能会加强这些流程。
