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Open Access Highly Accessed Debate

Epidemiological strategies for adapting clinical practice guidelines to the needs of multimorbid patients

Eva Blozik1*, Hendrik van den Bussche1, Felix Gurtner12, Ingmar Schäfer1 and Martin Scherer1

Author Affiliations

1 Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52 D- 20246 Hamburg, Germany

2 Swiss Federal Office of Public Health, Berne, Switzerland

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BMC Health Services Research 2013, 13:352  doi:10.1186/1472-6963-13-352

Published: 16 September 2013



Clinical practice guidelines have been developed to improve the quality of health care. However, adherence to current monomorbidity-focused, mono-disciplinary guidelines may result in undesirable effects for persons with several comorbidities, in adverse interactions between drugs and diseases, conflicting management strategies, and polypharmacy. This is why new types of guidelines that address the problem of interacting medical interventions and conditions in multimorbid patients are needed.


Previous research projects investigated patterns of multimorbidity and were able to identify combinations of the most prevalent chronic conditions, or clusters of comorbidities. These results represent potential methodological starting points for the development of guidelines that account for multimorbidity. The objective of these efforts is to identify frequent reasons for interactions and adverse events that may occur when the current type of guideline is rigorously applied in multimorbid patients.


The epidemiologic approaches described above may help guideline developers as a kind of check list of disease combinations that should systematically be considered during guideline development. Given the risk of worse outcomes in a huge group of vulnerable patients, researchers, guideline developers, and funding institutions should give first priority to the development of guidelines more appropriate for use in multimorbid persons.

Clinical practice guideline; Multimorbidity; Chronic conditions