title: Therapeutic conflicts in emergency department patients with multimorbidity: a cross-sectional study.
abstract: BACKGROUND
  Patients with multimorbidity are an increasing concern in healthcare. Clinical practice guidelines, however, do not take into account potential therapeutic conflicts caused by co-occurring medical conditions. This makes therapeutic decisions complex, especially in emergency situations.
  
  
  OBJECTIVE
  The aim of this study was to identify and quantify therapeutic conflicts in emergency department patients with multimorbidity.
  
  
  METHODS
  We reviewed electronic records of all patients ≥18 years with two or more concurrent active medical conditions, admitted from the emergency department to the hospital ward of the University Hospital Zurich in January 2009. We cross-tabulated all active diagnoses with treatments recommended by guidelines for each diagnosis. Then, we identified potential therapeutic conflicts and classified them as either major or minor conflicts according to their clinical significance.
  
  
  RESULTS
  166 emergency inpatients with multimorbidity were included. The mean number of active diagnoses per patient was 6.6 (SD±3.4). We identified a total of 239 therapeutic conflicts in 49% of the of the study population. In 29% of the study population major therapeutic conflicts, in 41% of the patients minor therapeutic conflicts occurred.
  
  
  CONCLUSIONS
  Therapeutic conflicts are common among multimorbid patients, with one out of two experiencing minor, and one out of three experiencing major therapeutic conflicts. Clinical practice guidelines need to address frequent therapeutic conflicts in patients with co-morbid medical conditions.
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Markun
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Holzer
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Roksana
authors.initials: R
authors.lastname: Rodak
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kaplan
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Claudia C
authors.initials: CC
authors.lastname: Wagner
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland; University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland.
authors.forename: Edouard
authors.initials: E
authors.lastname: Battegay
authors.affiliation: Division of Internal Medicine, University Hospital Zurich, Zurich, Switzerland; Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Zimmerli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D019468:Disease Management; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult