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Applying the time needed to treat to NICE guidelines on lifestyle interventions
  1. Loai Albarqouni1,2,
  2. Victor Montori1,3,
  3. Karsten Juhl Jørgensen1,4,
  4. Martin Ringsten5,6,
  5. Helen Bulbeck7,
  6. Minna Johansson1,8
  1. 1 Global Center for Sustainable Healthcare, Global Center for Sustainable Healthcare, Uddevalla, Sweden
  2. 2 Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Robina, Queensland, Australia
  3. 3 The Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 Department of Clinical Research, Cochrane Denmark and Centre for Evidence-Based Medicine Odense (CEBMO), University of Southern Denmark, Odense, Denmark
  5. 5 Cochrane Sweden, Skåne University Hospital, Lund, Sweden
  6. 6 Department of Health Sciences, Lund University, Lund, Sweden
  7. 7 Cochrane Consumer Network Executive, Brainstrust, Cowes, UK
  8. 8 General Practice, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Dr Minna Johansson, General Practice, University of Gothenburg, Goteborg 45152, Sweden; minna.johansson{at}

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There is a growing emphasis on interventions where clinicians identify and aim to change unhealthy habits in individuals, such as dietary advice for people with obesity.1 2 Although such individually oriented lifestyle interventions (IOLIs) might be effective, it may not be feasible to implement all recommended IOLIs in the care of many eligible individuals, given the finite resources within health systems.3 Time needed to treat (TNT) has been proposed as a measure of guideline feasibility in practice.4 TNT estimates the fraction of the available time that clinicians would need to implement the recommendation. We aimed to estimate the TNT to provide all IOLIs recommended in the National Institute for Health and Care Excellence (NICE) guidelines to the eligible adult population in the UK.

A companion project outlining the methods in more detail has been reported elsewhere.5 In short, we multiplied the time needed for the relevant category of healthcare personnel to provide each recommended intervention to one individual by the number of eligible individuals in the UK population and converted those numbers into full time equivalents (FTEs) per 10 000 adults. A prospectively developed protocol and all extracted data are available at and

An IOLI was defined as any non-pharmacological intervention provided by clinicians to adults to improve their mental or physical health by targeting one or more of the following lifestyle habits: physical activity/exercise, diet, smoking and alcohol intake.

We systematically searched all NICE pathways (26 August 2020), and two authors independently and in duplicate screened retrieved eligible guidelines and extracted …

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  • Twitter @loaialbarqouni, @vmontori, @minnajohansson1

  • Correction notice Since this paper first published, the author surname Johannson has been updated to read Johansson.

  • Contributors MJ conceived the idea for this project and drafted the project plan. MJ, MR and LA performed the screening. MJ and LA performed data extraction, formal analysis and drafted the manuscript; are guarantors and accepted full responsibility for the work and the conduct of the study; had access to the data; and controlled the decision to publish. The corresponding author attested that all listed authors meet authorship criteria and that no one meeting the criteria have been omitted. All authors contributed with important intellectual content to develop the project plan through reviewing and editing the manuscript and approved the final version of the manuscript.

  • Funding This project was partly funded by Swedish Research Council for Health, Working Life, and Welfare (project number 2019-00928). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report or decision to submit the article for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.