Monitoring in chronic disease: a rational approach

Partners/ AuthorsPaul Glasziou, Les Irwig and David Mant
Start & end date2005
OutcomeQuality control charts for peak flow measurements for people with asthma could detect exacerbations four days earlier than conventional methods. For example, a recent trial in which some diabetes patients were randomised to self monitoring of risk factors showed a better achievement of target measurements of blood pressure, low density lipoprotein cholesterol, and HbA1c; and a reduction in clinical events The second group—children randomised to measure their peak expiratory flow rate only when symptomatic—had lower asthma severity scores, fewer days of symptoms, and fewer healthcare visits than children randomised to either daily peak flow monitoring or monitoring only at times of symptoms Chronic care could potentially be improved (and often at reduced costs) if for each chronic disease we determined whether and how monitoring was necessary, set explicit monitoring ranges and provided appropriate graphical representations that aided decision making, recognised the need for different optimal intervals for different phases, and understood better when and how to adjust treatment to avoid the increases in variability caused by overadjustment.