Analysis

Better management of patients with multimorbidity

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2510 (Published 02 May 2013) Cite this as: BMJ 2013;346:f2510
  1. Martin Roland, professor of health services research,
  2. Charlotte Paddison, senior research associate
  1. 1Cambridge Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
  1. Correspondence to: M Roland mr108{at}cam.ac.uk
  • Accepted 17 March 2013

Martin Roland and Charlotte Paddison call for greater emphasis on continuity of care and clinical judgment to improve the experience of patients with multiple conditions

As the population ages more people are living with multiple medical conditions,1 2 and a new model of care for these patients is needed. This should take account of the complex health, emotional, and social problems they face which can make their management so challenging, especially in socioeconomically deprived areas.3

Although this is widely acknowledged, there are few practical examples of good models of care for this group of patients and worrying trends that are taking care in the wrong direction. This paper discusses current problems in the care of patients with multimorbidity and suggests steps that should be taken to improve it.

Role of guidelines

It has been argued that evidence based guidelines (mostly developed for people with single diseases) are inappropriate for people with multiple conditions, resulting in overtreatment and overcomplex regimes of assessment and surveillance.4 5 This is a particular problem for patients who are elderly, less well educated, or from less affluent communities.6 7

Although the criticisms levelled against guidelines for single conditions may sometimes be valid, we have little with which to replace them. Guidelines could be made for a few specific combinations of conditions and common comorbidities such as depression,8 but their role is limited because there are simply too many conditions and combinations to cover.2 A less well recognised limitation of guidelines is their lack of recognition of the effect of age and general frailty. The effect and management of multimorbidity in a 50 year old is very different from that in a 100 year old, in whom the burdens of both illness and treatment are likely to be greater.

That said, the notion that …

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