How best to treat patients with multiple conditions

Reported by Susan Aldridge, PhD, medical journalist

If doctors follow current clinical guidelines when caring for patients with many different conditions, they may not be doing them any favors.
Many older people have a range of chronic diseases such as angina, diabetes and arthritis. For several such conditions there are clinical guidelines laid down which advise how to it should be treated. But little attention has been given on how to care for patients who have three or more such chronic diseases.

Doctors at Johns Hopkins University in the USA now assess what would happen if linical guidelines are followed for nine out of the 15 most common diseases. For instance, they cite the hypothetical case of a 79 year old woman with osteoporosis, diabetes, high blood pressure, arthritis and chronic obstructive pulmonary disease. She would have to take 12 medications at 19 doses a day five times a day. Another 14 non-pharmacological interventions would be recommended too - such as diet, education and monitoring.

This approach may lead to interactions between medications and contradictory advice. For example, weight bearing exercise is recommended in osteoporosis but may be contraindicated in some cases of diabetes. It is time that guidelines were simplified to protect the interests of those with multiple chronic diseases.

Source
Journal of the American Medical Association 10th August 2005 Volume 294 pages 716-724