Exclusive: NICE guidance on multimorbidities to help GPs avoid over-prescribing

NICE will publish guidance next year on multimorbidities to help GPs decide when to stop giving drugs to patients on a potentially dangerous cocktail of treatments, its chairman Professor David Haslam has told GPonline.

NICE multimorbidity guidelines will help GPs decide what treatments ‘can be stopped as well as started’ to help improve patient outcomes and combat the growing issue of polypharmacy in multimorbid patients.

The guidance comes in answer to critics who say the institute’s guidelines target single conditions and feed off research that actively excludes patients with other conditions or frailty – which does not reflect the reality facing most patients.

The overhaul signifies a marked change for the institute, which usually specifies treatments that doctors should give to patients, not ones they should take away.

Read more NICE conference coverage

Professor Haslam told GPonline: ‘Some really important work that’s going to come out of NICE soon is the multimorbidity guidance.

‘Polypharmacy is a real issue. Particularly in the elderly, there is a recognition that many people with multiple health problems are on too many treatments.

‘There was a study by Birmingham University recently that showed the average person in a care home is on nine different medications.

‘And so understanding the way these medications interact and work together, how to minimise side effects, and to see what drugs can be stopped as well as started – there’s really important work there and it’s coming out next year.’

NICE guidance

Speaking at the NICE conference, RCGP chairwoman Dr Maureen Baker warned that single condition-based guidelines do not easily apply to real-world situations.

But she added that the push for evidence-based medicine – which NICE has largely been at the helm of – has been beneficial to GPs.

She said: ‘The problem is that guidelines relate to single disease conditions, and are drawn from studies where confounding factors such as older age and on-going multimorbidities are excluded.

‘The results therefore relate to people with single conditions – and my patients aren’t like that, in the main.’

Professor Haslam said he hoped the new guideline will have a ‘big impact’ on how GPs work. ‘In no way will it be the answer for all time to cope with every possible problem, but it’s a real recognition that every GP faces numerous times a day,’ he said.

Photo: JH Lancy

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