Better management of patients with multimorbidity

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 …