Benefit-harm assessments to inform patient-centered care for older people with multiple chronic conditions

Blood pressure targets: benefit-harm balance web-calculator

Use our online calculator to see how different risk factors and outcome preferences impact on the benefit-harm balance of different blood pressure targets [1].

Adding basal insulin vs sulfonylurea

Evidence on many patient-important outcomes is lacking [2]. With the currently available evidence, sulfonylurea may be better than basal insulin for people who associate insulin shots with much more treatment burden than taking a daily pill of a sulfonylurea. For people who do not worry about insulin shots, basal insulin may be better than sulfonylurea.

Background

The majority of people with one chronic condition have multiple conditions, and care that focuses on one condition at a time is not patient-centered because patients and their families do not view each condition in isolation. Our existing evidence base fails to adequately inform patient-centered care of people with multiple chronic conditions (MCCs).

In this project, we developed methods to inform patient-centered care for people with MCCs. Patients selected two top priority questions [3]:

• If diabetes is not sufficiently controlled with metformin alone, is it better to add a basal insulin or a sulfonylurea?
• What is the blood pressure target for people with hypertension that optimally balances benefits and harms?

In both questions, we also considered whether there were differences between groups of people by clinical characteristics (e.g. age, sex, prior medical history), and individual preferences.

Publications and links:

• [1] Aschmann, Hélène E., et al. "Balance of benefits and harms of different blood pressure targets in people with multiple chronic conditions: A quantitative benefit-harm assessment. " BMJ Open (2019) In Press.
• [2] Bennett, Wendy L., et al. "A benefit-harm analysis of adding basal insulin vs. sulfonylurea to metformin to manage type 2 diabetes in people with multiple chronic conditions." Journal of clinical epidemiology (2019).
  https://doi.org/10.1016/j.jclinepi.2019.03.014
• [3] Bennett, Wendy L., et al. «Engaging stakeholders to inform clinical practice guidelines that address multiple chronic conditions.» Journal of general internal medicine 32.8 (2017): 883-890.
• https://doi.org/10.1007/s11606-017-4039-5
• [4] https://www.pcori.org/research-results/2014/including-patient-preferences-assess-balance-benefits-and-harms-treatment
• [5] https://www.g-i-n.net/library/webinars/g-i-n-n-a-webinars/gin-na-webinar-8-november-2017