title: Epidemiological strategies for adapting clinical practice guidelines to the needs of multimorbid patients.
abstract: BACKGROUND
  Clinical practice guidelines have been developed to improve the quality of health care. However, adherence to current monomorbidity-focused, mono-disciplinary guidelines may result in undesirable effects for persons with several comorbidities, in adverse interactions between drugs and diseases, conflicting management strategies, and polypharmacy. This is why new types of guidelines that address the problem of interacting medical interventions and conditions in multimorbid patients are needed.
  
  
  CONCLUSIONS
  Previous research projects investigated patterns of multimorbidity and were able to identify combinations of the most prevalent chronic conditions, or clusters of comorbidities. These results represent potential methodological starting points for the development of guidelines that account for multimorbidity. The objective of these efforts is to identify frequent reasons for interactions and adverse events that may occur when the current type of guideline is rigorously applied in multimorbid patients.
  
  
  CONCLUSIONS
  The epidemiologic approaches described above may help guideline developers as a kind of check list of disease combinations that should systematically be considered during guideline development. Given the risk of worse outcomes in a huge group of vulnerable patients, researchers, guideline developers, and funding institutions should give first priority to the development of guidelines more appropriate for use in multimorbid persons.
authors.affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52 D- 20246 Hamburg, Germany. e.blozik@uke.de.
authors.forename: Eva
authors.initials: E
authors.lastname: Blozik
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.forename: Felix
authors.initials: F
authors.lastname: Gurtner
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schäfer
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D006301:Health Services Needs and Demand; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards; D015995:Prevalence
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