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BMC Health Services Research

, 11:221

First Online: 19 September 2011Received: 17 February 2011Accepted: 19 September 2011DOI: 10.1186-1472-6963-11-221

Cite this article as: Leach, M.J. & Segal, L. BMC Health Serv Res 2011 11: 221. doi:10.1186-1472-6963-11-221


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.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-11-221 contains supplementary material, which is available to authorized users.

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Autor: Matthew J Leach - Leonie Segal


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