Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.

<h4>Background</h4>Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guide...

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Autores principales:	Marjolein Lugtenberg, Jako S Burgers, Carolyn Clancy, Gert P Westert, Eric C Schneider
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/eb3a7e9dd1d043378ea2c3b063f21c50
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spelling	oai:doaj.org-article:eb3a7e9dd1d043378ea2c3b063f21c502021-11-18T07:36:04ZCurrent guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.1932-620310.1371/journal.pone.0025987https://doaj.org/article/eb3a7e9dd1d043378ea2c3b063f21c502011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22028802/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity.<h4>Methodology/principal findings</h4>We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines.<h4>Conclusions/significance</h4>Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions.Marjolein LugtenbergJako S BurgersCarolyn ClancyGert P WestertEric C SchneiderPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 10, p e25987 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Marjolein Lugtenberg Jako S Burgers Carolyn Clancy Gert P Westert Eric C Schneider Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.
description	<h4>Background</h4>Guidelines traditionally focus on the diagnosis and treatment of single diseases. As almost half of the patients with a chronic disease have more than one disease, the applicability of guidelines may be limited. The aim of this study was to assess the extent that guidelines address comorbidity and to assess the supporting evidence of recommendations related to comorbidity.<h4>Methodology/principal findings</h4>We conducted a systematic analysis of evidence-based guidelines focusing on four highly prevalent chronic conditions with a high impact on quality of life: chronic obstructive pulmonary disease, depressive disorder, diabetes mellitus type 2, and osteoarthritis. Data were abstracted from each guideline on the extent that comorbidity was addressed (general comments, specific recommendations), the type of comorbidity discussed (concordant, discordant), and the supporting evidence of the comorbidity-related recommendations (level of evidence, translation of evidence). Of the 20 guidelines, 17 (85%) addressed the issue of comorbidity and 14 (70%) provided specific recommendations on comorbidity. In general, the guidelines included few recommendations on patients with comorbidity (mean 3 recommendations per guideline, range 0 to 26). Of the 59 comorbidity-related recommendations provided, 46 (78%) addressed concordant comorbidities, 8 (14%) discordant comorbidities, and for 5 (8%) the type of comorbidity was not specified. The strength of the supporting evidence was moderate for 25% (15/59) and low for 37% (22/59) of the recommendations. In addition, for 73% (43/59) of the recommendations the evidence was not adequately translated into the guidelines.<h4>Conclusions/significance</h4>Our study showed that the applicability of current evidence-based guidelines to patients with comorbid conditions is limited. Most guidelines do not provide explicit guidance on treatment of patients with comorbidity, particularly for discordant combinations. Guidelines should be more explicit about the applicability of their recommendations to patients with comorbidity. Future clinical trials should also include patients with the most prevalent combinations of chronic conditions.
format	article
author	Marjolein Lugtenberg Jako S Burgers Carolyn Clancy Gert P Westert Eric C Schneider
author_facet	Marjolein Lugtenberg Jako S Burgers Carolyn Clancy Gert P Westert Eric C Schneider
author_sort	Marjolein Lugtenberg
title	Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.
title_short	Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.
title_full	Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.
title_fullStr	Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.
title_full_unstemmed	Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.
title_sort	current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/eb3a7e9dd1d043378ea2c3b063f21c50
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Current guidelines have limited applicability to patients with comorbid conditions: a systematic analysis of evidence-based guidelines.

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