Jako Burgers, professor holding an endowed chair in Promoting Personalised Care in Clinical Practice Guidelines

 

“Guidelines for GPs could be far more personalised”

The guidelines currently used by GPs in day-to-day practice could be far more personalised than is now the case. Jako Burgers makes this statement in his inaugural lecture entitled ‘Personalised Care in Guidelines: contradiction or paradox’ (In Dutch). Burgers has been professor holding an endowed chair in Promoting Personalised Care in clinical practice guidelines at Caphri - a chair funded by the Dutch College of General Practitioners (NHG) - since July of last year. He held his inaugural lecture on 16 June.

“Guidelines have become an inextricable part of the Dutch healthcare system, and this can only be applauded”, explains Jako Burgers. “You need guidelines in order to provide high quality of care. In addition to summarising the relevant scientific evidence, they provide recommendations for clinical practice. Guidelines discuss aspects such as the effectiveness of interventions, while also considering safety issues such as the side effects of medicines in the short and long term and – where relevant – costs. New developments are systematically monitored by guideline staff teams. As a GP, you simply don’t have the time to keep track yourself”, he explains.

Jako Burgers is regarded as an expert in the field of guidelines. He earned his doctorate in Amsterdam following a study on the effectiveness of guidelines, and conducted research on multimorbidity in guideline development as a Harkness fellow in Boston. He is currently still involved in the subject in his capacity as chair of the multimorbidity working group of the Guidelines International Network. Burgers also serves as head of the NHG’s Guideline Development & Science department. He combines these activities with his work as a GP in Gorinchem, two days a week.

As he knows from experience, GPs tend to deviate from guidelines from time to time. He offered three examples in his inaugural lecture. “Care is becoming increasingly complex: people are getting older, and often have multiple conditions. At the same time, they are more likely to have the opportunity to choose between the available options. We have to make these options transparent, and explain the pros and cons of each one. This allows for a more personalised approach in practice.” There are already some effective practical examples, such as decision aids and option grids. In order to ensure that these tools are effective, NHG works closely with other parties such as medical specialists, patient organisations and the mental healthcare sector.

As he emphasised in his inaugural lecture, guidelines are tools rather than laws, and can be deviated from in individual cases. “The guidelines are intended to support GPs in the day-to-day practice”, he explains. As you would expect, he has been critical of the strict use of guidelines as a tool to measure the quality of care. “We’ve really taken that too far over the past few years.” For instance, the guidelines for diabetes patients set out certain target values. GPs that manage to keep as many patients as possible within these values are thus assumed to be providing better care. As a result, regional care groups then start managing GPs using these targets. “Like every other group of professionals, GPs obviously want to account for the quality of care they provide. How to measure quality of GP care is our challenge at the moment. In practice, the drive to achieve better scores can lead to excluding certain patients. Does that really serve as an incentive for more personalised care? Talking to patients is an essential part of providing effective care. You might want to bring down your target blood levels, but the patient might not want to take that extra pill.” If we really want to achieve better quality, healthcare providers, health insurers and patients should collaborate. “The NHG chair supports this goal. It underscores the sense of urgency to promote personalised care within our professional group.”