Key principles on how to manage patients with multimorbidity in primary care practice – facilitated by visiting researcher Dr. Christiane Muth, Goethe-University, Frankfurt, Germany and Professor Paul Glasziou:

Background:

In 2005, Boyd et al. published a landmark paper to show that the application of multiple guidelines in a patient with multimorbidity is not feasible and may actually cause harms due to interactions within and among treatments and conditions.(1) Nevertheless, up to 80% of the consultations in primary care are dedicated to patients with multimorbidity,(2) and GPs may feel overwhelmed by simultaneously dealing with the various aspects of multimorbidity and the potential conflicts arising from that attempt. Difficulties include defining the relationship between presenting and continuing problems, such as actual and existing (chronic) conditions, psychosocial issues, (multiple) medication, and prognostic aspects.

Aim and methods:

To provide GPs with key principles to support clinical decision making in patients with multimorbidity, a 2-day international expert workshop was held after the symposium “Evidence-based Medicine Meets Multimorbidity: A Blind Date?” in Frankfurt (Germany) in 2012 (http://www.allgemeinmedizin.uni-frankfurt.de/forschung2/ebm_symposium_e.html). Nineteen participants from six countries (Australia, Canada, Germany, the Netherlands, Spain, and the UK) identified the key issues of concern in panel and small group discussions and agreed upon principles.

Currently, we discuss the principles with external experts in several countries to achieve structured feedbacks on their usability. As a part of this ongoing consultation process we discussed the principles at the Journal Club at CREBP.

Group discussion:

There was a broad agreement on the necessity and appropriateness of the principles. Furthermore, the principles were argued alongside of case examples provided by the group. Most valuable, points for further clarification and simplification were identified. The format of the meeting assisted the pre-publication discussion of the manuscript, and we will work-up the results from the group process in the further editing of the manuscript.

Reference List

  1. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005 Aug 10;294(6):716-24.
  2. Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA. Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 2011 Jan 1;61(582):e12-e21.