IOM and DHHS Meeting on Making Clinical Practice Guidelines Appropriate for Patients with Multiple Chronic Conditions

Abstract

BACKGROUND The increasing prevalence of Americans with multiple (2 or more) chronic conditions raises concerns about the appropriateness and applicability of clinical practice guidelines for patient management. Most guidelines clinicians currently rely on have been designed with a single chronic condition in mind, and many such guidelines are inattentive to issues related to comorbidities.PURPOSE In response to the need for guideline developers to address comorbidities in guidelines, the Department of Health and Human Services convened a meeting in May 2012 in partnership with the Institute of Medicine to identify principles and action options.RESULTS Eleven principles to improve guidelines' attentiveness to the population with multiple chronic conditions were identified during the meeting. They are grouped into 3 interrelated categories: (1) principles intended to improve the stakeholder technical process for developing guidelines; (2) principles intended to strengthen content of guidelines in terms of multiple chronic conditions; and (3) principles intended to increase focus on patient-centered care.CONCLUSION This meeting built upon previously recommended actions by identifying additional principles and options for government, guideline developers, and others to use in strengthening the applicability of clinical practice guidelines to the growing population of people with multiple chronic conditions. The suggested principles are helping professional societies to improve guidelines' attentiveness to persons with multiple chronic conditions. Ann Fam Med 2014;256-259. doi:10.1370/afm.1646. INTRODUCTIONT he prevalence of comorbidities is high and increasing in Americans: one-fourth of all adults have multiple (2 or more) chronic conditions.1 Among older adults, the prevalence of multiple chronic conditions is at least 75%. The presence of multiple conditions creates many challenges for family physicians and other clinicians, including the need to decide what evidence to use in making clinical decisions and the need to take into account patients' contexts and personal preferences in relation to clinical decision making. [2][3][4] Clinicians are encouraged to follow evidencebased clinical practice guidelines in managing their patients' conditions, and most often they must rely on guidelines that have been designed for a single chronic condition. Most single-condition guidelines, however, are inattentive to issues related to the coexistence of other chronic conditions. 5-9The failure of condition-specific guidelines to address comorbidities has prompted concerns about the appropriateness of using current singlecondition guidelines in managing patients with multiple chronic conditions. To begin with, results of randomized clinical trials that evaluate medications for single target conditions but exclude individuals with comorbidities Richard A. Goodman, MD, Cynthia Boyd, MD may not be generalizable to persons with comorbid conditions. 5,6,8,[10][11][12][13] Other issues include whether adherence to a medicati...

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