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Centre for Policy on Ageing | |
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Guidelines for people not for diseases
— the challenges of applying UK clinical guidelines to people with multimorbidity | | Author(s) | Lloyd D Hughes, Marion E T McMurdo, Bruce Guthrie |
| Journal title | Age and Ageing, vol 42, no 1, January 2013 |
| Publisher | Oxford University Press, January 2013 |
| Pages | pp 62-69 |
| Source | http://ageing.oxfordjournals.org/ http://www.bgs.org.uk/ |
| Keywords | Ill health ; Diseases ; Multiple ; Therapeutics ; Standards of provision. |
| Annotation | One of the major challenges now facing clinical guidelines is multimorbidity, as current guidelines are not designed to consider the cumulative impact of treatment recommendations on people with several conditions. The objective of this study was to examine the extent to which National Institute of Health and Clinical Excellence (NICE) guidelines address patient comorbidity, patient centred care and patient compliance to treatment recommendations. Five NICE clinical guidelines were selected for review (type-2 diabetes mellitus, secondary prevention for people with myocardial infarction, osteoarthritis, chronic obstructive pulmonary disease and depression) as these conditions are common causes of comorbidity and the guidelines had all been produced since 2007. Two authors extracted information from each full guideline and noted the extent to which the guidelines accounted for patient comorbidity, patient centred care and patient compliance. The cumulative recommended treatment, follow-up and self-care regime for two hypothetical patients were then created to illustrate the potential cumulative impact of applying single disease recommendations to people with multimorbidity. Results of the study showed that comorbidity and patient adherence were inconsistently accounted for in the guidelines, ranging from extensive discussion to none at all. Patient centred care was discussed in generic terms across the guidelines with limited disease-specific recommendations for clinicians. Explicitly following guideline recommendations for the two hypothetical patients would lead to a considerable treatment burden, even when recommendations were followed for mild to moderate conditions. In addition, the follow-up and self-care regime was complex potentially presenting problems for patient compliance. The authors conclude that clinical guidelines have played an important role in improving healthcare for people with long-term conditions. However, in people with multimorbidity current guideline recommendations rapidly cumulate to drive polypharmacy, without providing guidance on how best to prioritise recommendations for individuals in whom treatment burden will sometimes be overwhelming. (JL). |
| Accession Number | CPA-130104207 A |
| Classmark | CH: CJ: 58G: LL: 583 |
Data © Centre for Policy on Ageing |
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| ...from the Ageinfo database published by Centre for Policy on Ageing. |
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