How can we treat multiple chronic conditions?

Two recent events started me thinking. The first involved a patient I heard about from a family medicine resident in clinic. She was an elderly woman with a common complement of problems: diabetes, hypertension, congestive heart failure, depression, and mild renal insufficiency. Balancing her medications was difficult, and she ended up being hospitalised for “tune ups” several times a year. The resident asked me for advice about treating such patients, and we started to look for some evidence based guidelines to help us out.

The second event was the US Institute of Medicine’s publication a few weeks ago of a report on the role of public health in the prevention and treatment of chronic diseases.1 Like all of the institute’s reports, its authors thoughtfully and carefully reviewed the literature on the topic, made recommendations for action, and concluded that more research was needed.

These two events left me very dissatisfied.

We all know that chronic diseases have displaced acute infectious diseases as the leading threats to population health throughout much (but not all) …