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Clinical Intelligence

Clinical assessment and management of multimorbidity: NICE guideline

David Kernick, Carolyn A Chew-Graham and Norma O’Flynn
British Journal of General Practice 2017; 67 (658): 235-236. DOI: https://doi.org/10.3399/bjgp17X690857
David Kernick
St Thomas Medical Group, Exeter.
Roles: GP
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Carolyn A Chew-Graham
Research Institute, Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, Keele.
Roles: Professor of general practice research
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Norma O’Flynn
National Clinical Guideline Centre for Acute and Chronic Conditions, Royal College of Physicians, London.
Roles: Chief operating officer
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INTRODUCTION

The National Institute for Health and Care Excellence (NICE) has published a guideline on the assessment and management of patients with multimorbidity.1 Multimorbidity is defined as the presence of two or more long-term conditions and is increasingly common as people age.

Two-thirds of people aged >65 years will have multimorbidity, which is associated with reduced quality of life and higher mortality.2 In older people this is associated with higher rates of physical health conditions, polypharmacy, adverse drug events, high treatment burden, and greater use of health services. In younger people and people from less affluent areas, multimorbidity is often due to a combination of physical and mental health conditions. The guideline emphasises that multimorbidity includes conditions such as sensory problems and pain as well as defined physical and mental health conditions such as diabetes or schizophrenia; ongoing conditions such as learning disability; symptom complexes such as frailty or chronic pain; sensory impairment such as sight or hearing loss; and alcohol and substance misuse.

The aim of this guideline is to support patients and clinicians in optimising care for people with multimorbidity, in particular where there is potential for care to become burdensome or uncoordinated.

THE GUIDANCE

Impact of multimorbidity

Some patients with two or more conditions can manage those conditions and associated treatments in line with single disease guidelines. This guideline suggests that healthcare professionals should consider an approach to care that takes account of multimorbidity, for patients such as those who: find it difficult to manage their treatments for day-to-day activities; are prescribed multiple regular medications; frequently seek unplanned or emergency care; and have frailty (that is, reduction in resilience or biological/physiological reserve).

The guideline suggests that such people might be identified proactively using …

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British Journal of General Practice: 67 (658)
British Journal of General Practice
Vol. 67, Issue 658
May 2017
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Clinical assessment and management of multimorbidity: NICE guideline
David Kernick, Carolyn A Chew-Graham, Norma O’Flynn
British Journal of General Practice 2017; 67 (658): 235-236. DOI: 10.3399/bjgp17X690857

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Clinical assessment and management of multimorbidity: NICE guideline
David Kernick, Carolyn A Chew-Graham, Norma O’Flynn
British Journal of General Practice 2017; 67 (658): 235-236. DOI: 10.3399/bjgp17X690857
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Print ISSN: 0960-1643
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