Comorbidity and guidelines: conflicting interests

Abstract

The fourth epidemiological transition is characterised by an unprecedented increase in chronic degenerative disorders. 1 Olshansky SJ Ault AB The fourth stage of the epidemiologic transition: the age of delayed degenerative diseases. Milbank Q. 1986; 64: 355-391 Crossref PubMed Scopus (480) Google Scholar Thus chronic disease is a particularly important area in which to ensure high-quality care. Clinical practice guidelines are increasingly being used for performance indicators. Stephen Campbell and colleagues recently showed substantial improvement in the quality of clinical care in UK general practice when judged on this basis. 2 Campbell SM Roland MO Middleton E Reeves D Improvements in quality of clinical care in English general practice 1998–2003; longitudinal observational study. BMJ. 2005; 331: 1121-1125 Crossref PubMed Scopus (158) Google Scholar Reassuring as this result is, this method ignores the reality that 25–50% of people with a chronic disease have comorbidity or multimorbidity (table). 3 Feinstein AR The pre-therapeutic classification of co-morbidity in chronic disease. J Chron Dis. 1970; 23: 455-468 Summary Full Text PDF PubMed Scopus (991) Google Scholar , 4 van den Akker M Buntinx F Metsemakers JF Roos S Knottnerus JA Multimorbidity in general practice: prevalence, incidence, and determinants of co-occuring chronic and recurrent diseases. J Clin Epidemiol. 1998; 51: 367-375 Summary Full Text Full Text PDF PubMed Scopus (740) Google Scholar , 5 Schellevis FG van der Velden J van der Lisdonk E van Eijk JThM van Weel C Comorbidity of chronic diseases in general practice. J Clin Epidemiol. 1993; 46: 469-473 Summary Full Text PDF PubMed Scopus (246) Google Scholar , 6 Westert GP Jabaaij L Schellevis FG Morbidity, performance and quality in primary care: Dutch general practice on stage. Radcliffe Publishing, Oxford2004 Google Scholar , 7 van Weel C Chronic diseases in general practice: the longitudinal dimension. Eur J Gen Pract. 1996; 2: 17-21 Crossref Scopus (55) Google Scholar