Individualized guidelines needed when one size does not fit most

NATIONAL REPORTS-Individualized clinical treatment guidelines can achieve greater care efficiencies compared to the existing guidelines, according to healthcare experts.

"That is, the same benefit can be achieved at a considerably lower cost, or a considerably greater benefit can be achieved at no increase in cost, compared to current guidelines," according to a recent study's lead author David M. Eddy, MD.

One region of Kaiser Permanente implemented individualized guidelines in two clinics where they were used by physicians and patients for one-on-one patient-physician decision-making.

The concept of tailoring guidelines to each patient's needs is not new and is inherent in every physician's desire to take the whole patient into account when making decisions, Dr. Eddy says. That is what individualized guidelines can accomplish, according to the study published in the May issue of the Annals of Internal Medicine.

"This study is focused on hypertension, but the results generalize to many other risk factors and treatments such as cholesterol, glucose, smoking cessation, weight-loss programs, and screening for cancers," he adds.

Currently, population-based guidelines use a small number of risk factors and sharp thresholds to sort people into just a few treatment categories.

"In essence, they assume that one size fits all, or maybe two sizes fit all," Dr. Eddy says. "Individualized guidelines take into account all the important risk factors and the continuous nature of those risk factors. Instead of assuming that one or two sizes fit all, they tailor-make each guideline to meet each particular patient's needs."

For example, if a patient's systolic blood pressure is greater than 140 mmHG, then he should be treated, otherwise he should not, Dr. Eddy says. Individualized guidelines look at a broad spectrum of risk factors and take into account the fact that the effects of risk factors are continuous-they do not make sharp jumps when they hit particular thresholds.

The study estimates the potential improvements in quality and cost. It showed that compared to not using guidelines at all, individualized guidelines can deliver the same benefit as the national hypertension guideline (called the JNC-7), in terms of reducing heart attacks and strokes, at a 67% greater reduction in cost.

"Or if one wanted to spend the same amount of money as the JNC-7 hypertension guidelines, then individualized guidelines could achieve a 43% greater benefit without any increase in cost," Dr. Eddy says.