New NICE guidance on addressing multimorbidity

NICE has issued a new guideline setting out ways to tailor care for adults with multimorbidity.

The new guidance aims to optimise care for patients with multiple long-term conditions by identifying ways of reducing treatment burdens (such as polypharmacy and multiple appointments) and unplanned or emergency care. It promotes shared decision-making based on asking patients what is important to them individually in terms of treatments, health priorities, lifestyle and goals.

The guideline also sets out which people are most likely to benefit from an approach to care that takes account of multimorbidity.

The term multimorbidity refers to the presence of two or more long-term health conditions, which can include defined physical and mental health conditions such as diabetes or schizophrenia, ongoing conditions such as learning disability, symptom complexes such as frailty or chronic pain, sensory impairment such as sight or hearing loss, and alcohol and substance misuse.

A 2012 report by the Department of Health estimated that caring for more people with multiple health conditions, coupled with an ageing population, could require an extra £5 billion in spending by 2018.

Many of the conditions common in multimorbidity are covered in other guidance notes but NICE points out that evidence for recommendations on single health conditions is regularly drawn from people without multimorbidity and taking fewer prescribed regular medicines.

The new guidance recommends that when offering an approach to care that takes account of multimorbidity, clinicians should focus on:

  • how the person's health conditions and their treatments interact and how this affects quality of life
  • the person's individual needs, preferences for treatments, health priorities, lifestyle and goals
  • the benefits and risks of following recommendations from guidance on single health conditions
  • improving quality of life by reducing treatment burden, adverse events, and unplanned care
  • improving coordination of care across services.

Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee and chair of the guideline group, said: "The number of people with many long-term health conditions is set to rise. It can be really difficult to care for these patients because the conditions they have and their treatments can interact causing unwanted side effects.

"The new guideline highlights the need for clinicians to discuss with their patients what the benefits and side effects of drugs or treatments might be. A decision on what treatment is best for the patient, based on their wishes, can then be made – and this could lead to stopping treatment if appropriate."

A database has been created alongside the new guideline which summarises the benefits and adverse side effects of a number of common treatments. It should help healthcare professionals work together with their patients to make joint decisions about care.

Professor Mark Baker, director of the centre for guidelines at NICE, said: "Our guideline brings an important perspective to light – that it’s our responsibility as healthcare professionals to deliver person-centred care, not disease-focused treatment."

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