Implementation of the German Clinical Practice Guideline for Multimorbidity Using a Digital Tool in Primary Care: Pilot Cluster Randomized Clinical Trial
Notice bibliographique
Résumé
BACKGROUND: Clinical practice guidelines (CPGs) summarize the best available evidence in a specific field. To improve patient-centered outcomes, guidelines have to be implemented, using, for example, information and communications technology. Although there are CPGs addressing multimorbidity, there is still a lack of studies investigating their implementation. OBJECTIVE: This study aimed to evaluate whether the implementation of a CPG for multimorbidity using a digital tool is feasible and explore possible effects of this intervention. METHODS: A pilot cluster randomized clinical trial based on telephone interviews was conducted from October 25, 2023, to September 8, 2024. Patients enrolled in any disease management program who were aged ≥65 years and had at least 2 additional chronic conditions were randomly selected from 20 general practitioner (GP) practices and contacted for informed consent. Each practice was randomized after baseline interviews of all participating patients in the practice were finished. The use of a web application facilitating collection and documentation of treatment-relevant data in accordance with the German CPG for multimorbidity was compared with treatment as usual. The primary outcome was time spent in hospital. As a secondary outcome, the number of patients with at least one hospital admission was calculated. Further secondary outcomes included outpatient health care use, quality of life, patient satisfaction, and quality of care. Feasibility assessment included examination of sample size, participation rate, and compliance with the study protocol. Outcome measures were analyzed using linear, logistic, and negative binomial regressions with random intercepts for practices. RESULTS: Of 384 patients who were contacted, 123 (32%) agreed to participate, and 120 (31.3%, including 54/120, 45% in the intervention group and 66/120, 55% in the control group) completed baseline and follow-up assessments. Mean age was 75.4 (SD 6.6) years, and 51.7% (62/120) were women. The compliance rate, or the proportion of patients who were treated per protocol, was 89% (48/54). In our data, the incidence rate of hospital days was comparable in both groups (incidence rate ratio [IRR] 0.94, 95% CI 0.09-9.42; P=.96), but the odds of hospital admission were almost reduced by half in the intervention group (odds ratio 0.51, 95% CI 0.17-1.54; P=.23). Our data also suggest a higher incidence rate of GP contacts (IRR 1.13, 95% CI 0.83-1.53; P=.43) and lower incidence rate of contacts with outpatient specialists (IRR 0.79, 95% CI 0.54-1.15; P=.24) in the intervention group compared to usual care. Moreover, patients and GPs reported a better quality of care (mean difference 0.51, 95% CI -0.12 to 1.14; P=.12 and mean difference 1.19, 95% CI 0.13-2.25; P=.03, respectively) in the intervention group. CONCLUSIONS: Implementation of the CPG using a digital tool was feasible. Our data suggest that the probability of hospital admissions and contacts with outpatient specialists might be reduced and quality of care might be improved. TRIAL REGISTRATION: ClinicalTrials.gov NCT06061172; https://clinicaltrials.gov/study/NCT06061172.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».