Persistent URL of this record https://hdl.handle.net/1887/96159
In Collections
This item can be found in the following collections:
![Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus](https://scholarlypublications.universiteitleiden.nl/sites/all/themes/scholarly/img/closed_access.png)
Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus
renders traditional disease-oriented guidelines often inadequate and complicates
clinical decision making. To address this challenge, guidelines have been
developed on multimorbidity or polypharmacy. To systematically analyse their
recommendations, we conducted a systematic guideline review using the Ariadne
principles for managing multimorbidity as analytical framework. The information
synthesis included a multistep consensus process involving 18 multidisciplinary
experts from seven countries. We included eight guidelines (four each on
multimorbidity and polypharmacy) and extracted about 250 recommendations. The
guideline addressed (i) the identification of the target population (risk
factors); (ii) the assessment of interacting conditions and treatments: medical
history, clinical and psychosocial assessment including physiological status and ...Show moreThe complexity and heterogeneity of patients with multimorbidity and polypharmacy
renders traditional disease-oriented guidelines often inadequate and complicates
clinical decision making. To address this challenge, guidelines have been
developed on multimorbidity or polypharmacy. To systematically analyse their
recommendations, we conducted a systematic guideline review using the Ariadne
principles for managing multimorbidity as analytical framework. The information
synthesis included a multistep consensus process involving 18 multidisciplinary
experts from seven countries. We included eight guidelines (four each on
multimorbidity and polypharmacy) and extracted about 250 recommendations. The
guideline addressed (i) the identification of the target population (risk
factors); (ii) the assessment of interacting conditions and treatments: medical
history, clinical and psychosocial assessment including physiological status and
frailty, reviews of medication and encounters with healthcare providers
highlighting informational continuity; (iii) the need to incorporate patient
preferences and goal setting: eliciting preferences and expectations, the process
of shared decision making in relation to treatment options and the level of
involvement of patients and carers; (iv) individualized management: guiding
principles on optimization of treatment benefits over possible harms, treatment
communication and the information content of medication/care plans; (v)
monitoring and follow-up: strategies in care planning, self-management and
medication-related aspects, communication with patients including safety
instructions and adherence, coordination of care regarding referral and discharge
management, medication appropriateness and safety concerns. The spectrum of
clinical and self-management issues varied from guiding principles to specific
recommendations and tools providing actionable support. The limited availability
of reliable risk prediction models, feasible interventions of proven
effectiveness and decision aids, and limited consensus on appropriate outcomes of
care highlight major research deficits. An integrated approach to both
multimorbidity and polypharmacy should be considered in future guidelines.Show less
- All authors
- Muth, C.; Blom, J.W.; Smith, S.M.; Johnell, K.; Gonzalez-Gonzalez, A.I.; Nguyen, T.S.; Brueckle, M.S.; Cesari, M.; Tinetti, M.E.; Valderas, J.M.
- Date
- 2018-10-24
- Journal
- journal of internal medicine