By Martin Fortin

Clinical guidelines aim to improve the quality of care provided to patients. However, given that guidelines are mostly disease-oriented, we may discover conflicting recommendations when implementing those guidelines with patients presenting multiple concurrent chronic conditions. As a result, physicians frequently use their own clinical experience and patients’ views on treatment choice instead of national guidelines recommendations.

This situation prompted us to examine the relevance of Canadian clinical guidelines for patients with comorbidity for selected chronic diseases. The study was published by BMC Family Practice and is accessible through their website (http://www.biomedcentral.com/1471-2296/12/74). In summary, we found that despite the good to very good quality of the guidelines, only a few addressed specific recommendations for patients with two or more comorbid conditions.

The subject had been  previously addressed from different angles, but in this study we followed the steps of Australian colleagues [1] in the use of a tool developed by Boyd and colleagues [2] that allows to evaluate the applicability of guidelines on chronic diseases for the treatment of subjects with comorbidity. The tool is a checklist in which each item is scored as “yes” or “no”, and assesses whether guidelines address treatment for people with several comorbid conditions, as well as patient-centered aspects such as patient preferences and quality of life. We improved its comprehensiveness with the addition of items related to medication. To our knowledge, this is the only tool available for this purpose.

This study may potentially stimulate other researchers to follow suit with the assessment of their respective national guidelines, and further highlight the need for improved clinical guidelines relevant to patients with two or more chronic conditions worldwide.

1.    Vitry, A.I. and Y. Zhang, Quality of Australian clinical guidelines and relevance to the care of older people with multiple comorbid conditions. Med J Aust, 2008. 189: p. 360-5.

2.    Boyd, C.M., et al., Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. J.A.M.A., 2005. 294: p. 716-24.