Multimorbidity assessment, prioritisation, and management of care for people with commonly occurring multimorbidity : clinical assessment and management

Polypharmacy in people with multimorbidity is often driven by the introduction of multiple drugs intended to prevent future morbidity and mortality, but the case for using such drugs weakens as life expectancy reduces. The absolute difference made by each additional drug may also reduce when people...

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Bibliographic Details
Corporate Authors: National Guideline Centre (Great Britain), National Institute for Health and Care Excellence (Great Britain)
Format: eBook
Language:English
Published: London National Institute for Health and Care Excellence 2016, September 2016
Series:NICE guideline: methods, evidence and recommendations
Subjects:
Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
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653 |a Comorbidity 
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520 |a Polypharmacy in people with multimorbidity is often driven by the introduction of multiple drugs intended to prevent future morbidity and mortality, but the case for using such drugs weakens as life expectancy reduces. The absolute difference made by each additional drug may also reduce when people are taking multiple preventative medicines. The implications of multimorbidity for organisation of healthcare are highly variable depending on which conditions an individual has. Groups of conditions which have closely related or concordant treatment, such as diabetes, hypertension and angina pose fewer problems of co-ordination than groups where treatment is discordant, such as people who experience both physical and mental health conditions. NICE guidelines have been developed for the management of many individual diseases and conditions.  
520 |a The aim of this guideline is to inform patient and clinical decision-making and models of care for people with multimorbidity who would benefit from an individual approach because of high impact on their quality of life or functioning due to their conditions or their treatments. Although this is a particular concern of generalists such as general practitioners or geriatricians, the guideline is also relevant to specialists since many of the patients they care for will have other significant conditions 
520 |a The recognition of multimorbidity associated with socioeconomic deprivation is particularly important as NHS England has a legal duty to have regard to the need to reduce health inequalities. Whereas rates of multimorbidity in older people was largely due to higher rates of physical conditions, in the less affluent multimorbidity was due to combinations of physical and mental health conditions was common. For many people multimorbidity will present few problems but multimorbidity matters because it is associated with reduced quality of life, higher mortality, polypharmacy and high treatment burden, higher rates of adverse drug events, and much greater health services use including emergency hospital admissions. A particular issue for health services and clinicians is that pharmacological and non-pharmacological treatment regimens can become burdensome in people with complex multimorbidity, and care can become uncoordinated and fragmented.  
520 |a Multimorbidity is usually defined as when an individual has two or more long-term conditions. Measuring the prevalence of multimorbidity is not straightforward since this will vary depending on which conditions are counted, but all recent studies show that multimorbidity is common, becomes more common as people age, and is more common in people from less affluent areas. A recent large UK based study found that 42% of the population had at least one of the 40 conditions counted, and 23% had multimorbidity. Two-thirds of people aged 65 years or over had multimorbidity, and 47% had three or more conditions. People living in the most deprived areas had double the rate of multimorbidity in middle age than those living in the most affluent areas. Put another way, they developed multimorbidity 10-15 years before their more affluent peers.