Editorials

Guideline recommended treatments in complex patients with multimorbidity

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5145 (Published 02 October 2015) Cite this as: BMJ 2015;351:h5145
  1. Christiane Muth, senior researcher1,
  2. Paul P Glasziou, professor of evidence based medicine2
  1. 1Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
  2. 2The Centre for Research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia
  1. Correspondence to: C Muth muth@allgemeinmedizin.uni-frankfurt.de

New evidence is reassuring, but every patient is different

Multimorbidity is an increasing problem for both clinicians and patients. Aging populations, the increased complexity of managing chronic illness, and the tendency of guidelines to focus on a single disease have created a “perfect storm” of treatment burden. Consider the following patient: “Mrs S is a 79 year old woman with osteoporosis, osteoarthritis, type 2 diabetes mellitus, hypertension, and chronic obstructive pulmonary disease who takes 12 separate drugs in 19 doses five times during a typical day. A drug review revealed three drug-disease interactions, nine drug-drug interactions, and eight potential drug-food interactions.” With this hypothetical case, a decade ago one study showed that the application of multiple guidelines to a patient with multimorbidity creates three problems1: firstly, as comorbidity is a common reason for exclusion in clinical trials it is not known whether treatment effects in patients with multimorbidity are equivalent to those in patients with single diseases.2 3 Secondly, the application of multiple disease oriented guidelines bears the risks of potentially harmful interactions between diseases and treatments.4 5 Thirdly, an uncritical application of multiple guidelines adds to the burden of …

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