Practice Guidelines

Clinical assessment and management of multimorbidity: summary of NICE guidance

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4843 (Published 21 September 2016) Cite this as: BMJ 2016;354:i4843

Infographic 1

Adapting clinical guidelines to take account of multimorbidity

 

Infographic 2

Single condition focused vs multimorbidity approach to management

  1. Caroline Farmer, senior research fellow1,
  2. Elisabetta Fenu, health economics lead1,
  3. Norma O’Flynn, chief operating officer1,
  4. Bruce Guthrie, professor of primary care medicine2
  1. 1National Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Population Health Sciences Division, University of Dundee, Dundee DD2 4BF, UK
  1. Correspondence to: N O’Flynn Norma.oflynn{at}rcplondon.ac.uk

What you need to know

For those with multimorbidity

  • Guidelines on single health conditions may not be applicable

  • Aggressive management of risk factors for future disease is often a major treatment burden and can be inappropriate

  • Assess whether patients may benefit from an approach to care that takes account of their multimorbidity

  • Consider all conditions and treatments simultaneously

  • Easier access to data about the absolute benefit of commonly prescribed treatments is needed

Most people with a chronic condition have one or more other chronic conditions, and multimorbidity is the norm in older people (see infographic 1 and box1).1 Multimorbidity matters because it is associated with reduced quality of life, higher mortality, polypharmacy and higher rates of adverse drug events, and high use of unplanned health care.2 3 4 5 Those with multimorbidity frequently receive care from both primary care and multiple specialists, who may not be communicating effectively with each other.6 7 Clinicians express uncertainty about the balance of benefit and harm of treatments in people with multimorbidity because evidence is largely based on trials of interventions for single conditions, from which people with multimorbidity are often excluded.8 9 Guidelines derived from such trials may lead to burdensome levels of treatment or unfeasible patterns of healthcare use .10

Box 1: What is multimorbidity?

Multimorbidityis the presence of two or more long term health conditions, which can include:

  • Physical and mental health pathologies

  • Ongoing conditions such as learning disability

  • Symptom complexes such as frailty or chronic pain

  • Sensory impairment such as sight or hearing loss

  • Alcohol and substance misuse

There is increasing recognition that care for some people with multimorbidity needs reorganisation,11 12 13 14 although not everyone with multimorbidity will require additional support. This guideline is intended to provide guidance on the optimum management of people with multimorbidity who need an approach to care …

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