gms | German Medical Science

Background: The progressive aging of the population leads to a high prevalence of people with multiple chronic conditions. Patients with multiple comorbid diseases are in general excluded from most randomized controlled trials. Thus, CPGs are focused on the diagnosis and management of a single disease. It is an important barrier to their implementation (various combinations of medications, additional risk of adverse effects, decreased adherence …).

Objectives: To describe how comorbid diseases are taken into account in CPGs. To propose changes in the development of guidelines and in clinical decision making.

Methods: 1/We was surveyed the CPGs development’s unit of French national authority for health about consideration one or more comorbidities in their recommendation. 2/ Literature search was performed - to identify if and how comorbidities were addressed in international CPGs - if specific guideline manuals have been developped.

Results: 1/ We studied the relevance of French CPGs for the treatment of patients with comorbid conditions. Five CPGs have been identified. 2/ Three relevant articles about patients with comorbid conditions management in CPGs were identified. They focused on the more frequent chronic diseases (hypertension, diabetes mellitus) but quality of evidence was poor. No specific guideline has been developed.

Discussion/Implication for guideline developers/users: So, development of specific guideline manual for taking into account comorbidity in CPGs doesn’t seem to be possible. It would be more relevant to provide or to develop specific tools for subpopulation of comorbid patients (for example of Beers criteria for old patients).