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The editorial on ‘Quality of life: what does it mean for general practice?’1 suggests that including patient-reported quality of life in chronic disease management may help health professionals to understand more about the patient's perspective. In relation to the important question of how best to measure changes in quality of life for patients who have more than one chronic condition, Jacobs suggests using a generic questionnaire such as the EQ-5D, despite its limited sensitivity to change and lack of attention to the details of any particular health problem.
An alternative, and one suited particularly to the provision of integrated holistic care, is to use an individualised outcome questionnaire. There are a number to choose from: Measure Yourself Medical Outcome Profile2 is a brief questionnaire developed specifically for use in multidisciplinary general practice that asks the patient to nominate the health problem that is most important to them on the day of attendance, and then score its severity across several dimensions. Consequently, it informs clinicians about patients' priorities and individual perceptions and is applicable across many health conditions (http://sites.pcmd.ac.uk/mymop/).
A more generic measure of individualised health-related quality-of-life is provided by the Patient-Generated Index3 which, while it is more complex to administer, has been validated in a wide range of patient populations. Taking an even broader view of quality-of-life, within which health is only one of many possible dimensions, is the Schedule for the Evaluation of Individual
Quality of Life,4 which highlights social and environmental influences on health. Individualised outcome questionnaires have the potential to promote shared understanding and decision making, as well as truly patient-centred outcome measurement.