NICE publishes first guidance for treating patients with multiple conditions

GPs should develop tailored care plans for patients with multiple long-term conditions, and work alongside them to decide whether it is in their best interest to stop or start certain treatments, NICE has said.

The guidance – NICE’s first to address more than a single condition at a time – calls on GPs to take a tailored approach caring for patients with multiple health conditions.

It says patients with complex health issues should be placed at the heart of decisions about their care – including how to decide which medicines and treatments should be prioritised.

This may involve stopping treatments that were recommended in other versions of the NICE guidelines.

NICE has also compiled a ‘database of treatment effects’ summarising the benefits and adverse side effects of common treatments for doctors to use alongside the multimorbidity guideline.

GPs are recommended to discuss reducing or stopping treatments with patients if they feel unsure of its benefits or if it is causing harm. This should be followed by a review to monitor the effects of any changes made and to decide whether any further changes in treatment are needed.

They could consider using a screening tool, such as the STOPP/START tool, in older people to identify medicine-related safety concerns or any medicines that the person may benefit from taking, it said.

Multimorbidity guidance

Professor Mark Baker, director of the centre for guidelines at NICE, said: ‘Multimorbidity isn’t a term that most people use in everyday life, but caring for someone with many health conditions is one of the biggest challenges we face as clinicians.

‘We have set out recommendations and developed tools to help clinicians work together with their patients to establish what’s important. Giving tailored care will make a real difference to how a patient can manage their conditions in their daily lives.’

Professor Bruce Guthrie, professor of primary care medicine and chair of the guideline development group, said: ‘The number of people with many long-term health conditions is set to rise. It can be really difficult to care for these patients because the conditions they have and their treatments interact.

‘It’s not unusual for patients to be on lots of different medicines, to be taken at different times of the day for each of their conditions. The new guideline highlights the need for clinicians to discuss with their patients what the benefits and unwanted side effects of drugs or treatments are.

‘A decision on what treatment is best for the patient, based on their wishes, can then be made – and this could lead to stopping treatment if appropriate.’

The number of people living with three or more long-term health conditions is expected to have risen by 1m over 10 years from 2008 to 2018 – up to 2.9m.

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