The first-ever NICE guidance on multimorbidity, published today, aims to improve quality of life in people with multiple long-term conditions by helping healthcare professionals reduce the burden of polypharmacy, multiple appointments and unplanned care.
The guidance highlights the importance of shared decisions between patients and healthcare providers based on what is important to each patient in terms of treatments, health priorities, lifestyle and goals. It highlights the importance of enabling patients to actively participate in their own care.
Further informationNICE guidance on multimorbidity
Multimorbidity is defined in the guidance as the presence of two or more long-term health conditions, including diabetes or schizophrenia, learning disability, symptom complexes such as frailty or chronic pain, sensory impairment and alcohol and substance misuse.
The guideline's recommendations should be considered in people who find it difficult to manage their treatments or day-to-day activities, receive care and support from multiple services, frequently seek unplanned or emergency care, are prescribed 10 or more regular medicines or are at particular risk of adverse effects.
"Our guideline brings an important perspective to light – that it’s our responsibility as health care professionals to deliver person-centred care, not disease-focused treatment," said Professor Mark Baker, director of the centre for guidelines at NICE.
"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."
Central to the guidance is the recommendation to establish the person's individual needs, attitudes to and preferences for treatments, health priorities, lifestyle and goals. Their personal goals may focus on maintaining independence, being able to work or socialise, lengthening their life, or minimising the disruptive effects of treatment on their life. It is also important to establish their perspective on the burden of both disease and treatment, says NICE.
Once established, these factors should form the basis of an individualised management plan agreed by the healthcare professional and patient, which states who is responsible for co-ordination of care. Copies of the plan should be given to the patient and the other professionals involved in their care.
Recommendations to optimise the patient's use of medications also form a key part of the guidance.
Medicines and other treatments should be reviewed in order to ensure the benefit of existing treatments is maximised and to identify any treatments of limited benefit or high burden that can be stopped or replaced with non-pharmacological alternatives.
This may include stopping treatments that are recommended in NICE guidelines on single conditions, which are generally based on people without multimorbidity and taking fewer medications. In particular, NICE highlights that treatments prescribed to improve the patient's long-term prognosis may offer reduced overall benefit in people with limited life expectancy or frailty.
A screening tool such as STOPP/START can be used to identify medicine-related safety concerns and medicines the person might benefit from but is not currently taking.
Again, NICE urges healthcare professionals to take into account the patient's opinion on whether treatments are having a positive effect on outcomes that matter to them or causing harm by increasing the risk of adverse events or imposing an excessive monitoring burden.
To support the medication review process, a database that summarises the benefits and adverse effects of a number of common treatments has been created alongside the new guideline.
Specific mention is made in the guidance to advise patients who have been taking bisphosphonates for osteoporosis for 3 years or more that there is no consistent evidence of further benefit from continuing treatment.