There is a massive mismatch between what is being recommended in clinical practice guidelines and the available time for clinicians to implement the recommended care. To follow current guidelines for preventive care, chronic disease care, and acute care, US primary care physicians are estimated to require 27 hours per working day.1 To fully satisfy the recommendations from the US Preventive Services Task Force, 7.4 hours per working day would be needed for the provision of preventive services only.2 Just to implement the European hypertension guidelines, Norway would need more general practitioners than currently in practice.3 More physicians (from all specialties) and five times as many nurses than currently available may be needed to implement all lifestyle interventions recommended by the National Institute of Health and Care Excellence (NICE) in the United Kingdom (UK).4 Were clinicians to follow these guidelines, there would be no time left to care for other ill patients and the healthcare system would collapse.
It is thus evident that clinicians face a barrage of recommendations that in total are impossible to implement. As a result, clinicians must prioritize which recommendations to follow in which patients. Without guidance, and under the pressure of time, prioritizing decisions at the point of care will be implicit, variable, and likely often misguided.
One – at least partial – solution to this problem would be for guideline panels to consider the time needed to implement a recommendation when determining the direction and strength of recommendations. This requires a new methodology that highlights time constraints and provides a structure for their consideration. TNT provides such a structure for how guideline panels can consider the time needed to implement the recommended care.
The ultimate goal of estimating TNT is to avoid that clinicians and patients spend their limited time together on recommendations with smaller rather than greater importance to the individual patient, as well as to improve access to care for patients with the greatest need of medical attention.
Read more about why TNT is needed in this BMJ publication.
- Porter J, Boyd C, Skandari MR, et al. Revisiting the Time Needed to Provide Adult Primary Care. J Gen Int Med 2022. Epub ahead of print. doi: 10.1007/s11606-022-07707-x.
- Privett N, Guerrier S. Estimation of the Time Needed to Deliver the 2020 USPSTF Preventive Care Recommendations in Primary Care. Am J Public Health 2021;111(1):145-149. doi: 10.2105/AJPH.2020.305967.
- Petursson H, Getz L, Sigurdsson JA, Hetlevik I. Current European guidelines for management of arterial hypertension: are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population. BMC Family Practice 2009;10:70. doi: 10.1186/1471‐2296‐10‐70.
- Albarqouni L, Ringsten M, Montori V, Jørgensen KJ,Bulbeck H, Johansson M. Clinician time needed to follow NICE guidelines on lifestyle interventions. In Manus.