Abstract
BackgroundGuidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity.Methodology/Principal FindingsWe conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines.Conclusions/SignificanceOur study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions.
Highlights
Medical care is focused on the prevention, diagnosis and treatment of single diseases [1]
Physicians are encouraged to adhere to evidence-based clinical practice guidelines (CPGs), as these are regarded as important tools for quality improvement [4]
We focused on highly prevalent chronic diseases that have a high impact on quality of life
Summary
Medical care is focused on the prevention, diagnosis and treatment of single diseases [1]. Most research studies focus on the effectiveness of disease-specific interventions and patients with comorbidity or complex problems are often excluded from clinical trials [2,3]. Physicians are encouraged to adhere to evidence-based clinical practice guidelines (CPGs), as these are regarded as important tools for quality improvement [4]. In line with both clinical practice and research traditions, most CPGs are disease-oriented documents focusing on the diagnosis and management of single diseases [5]. Guidelines traditionally focus on the diagnosis and treatment of single diseases.
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