NICE Offers Advice on Multiple Long-Term Conditions

NICE has suggested that GPs should develop tailored care plans for patients with multiple long-term conditions.

The authoritative healthcare organisation also believes that working alongside such patients closely, in order to help decide whether it is in their best interest to stop or start certain treatments, is preferable for GPs.

This latest guidance is the first time that NICE has attempted to address more than a single condition at one time.

And it calls for doctors to take a tailored approach caring for patients with multiple health conditions, with the intention of addressing their specific needs more adequately.

NICE guidance suggests that patients with complex health issues should be placed at the heart of decisions about their care, essentially engaging in what could be described as a collaborative process.

This process should include decisions on which medicines and treatments are to be prioritised, and may involve stopping treatments that were recommended in other versions of the NICE guidelines.

NICE has also compiled a ‘database of treatment effects’ summarising the benefits and adverse side-effects of common treatments for doctors to use alongside the multimorbidity guideline.

GPs are recommended to discuss reducing or stopping treatment with patients if they feel unsure of their benefits, or if they believe that treatment could possibly be causing harm.

This is then followed by a review in order to monitor the impact of any changes made in treatment, and to decide what approach should be taken going forward.

Screening tools, such as the STOPP/START tool, should also be utilised in order to help identify medicine-related safety concerns.

Professor Mark Baker, director of the centre for guidelines at NICE, suggested that multimorbidity involves a special set of circumstances that need to be addressed appropriately.

“Multimorbidity isn’t a term that most people use in everyday life, but caring for someone with many health conditions is one of the biggest challenges we face as clinicians. 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.”

Professor Bruce Guthrie, professor of primary care medicine and chair of the guideline development group, supported the new initiative, indicating that it will be essential in an evolving population.

“The number of people with many long-term health conditions is set to rise. It can be really difficult to care for these patients because the conditions they have and their treatments interact. It’s not unusual for patients to be on lots of different medicines, to be taken at different times of the day for each of their conditions. The new guideline highlights the need for clinicians to discuss with their patients what the benefits and unwanted side effects of drugs or treatments are. A decision on what treatment is best for the patient, based on their wishes, can then be made – and this could lead to stopping treatment if appropriate.”

It is believed that the number of people in Britain coping with three or more long-term health conditions will increase by over a million in the next 10 years.


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