• 2.9 million people are predicted to have 3 or more long-term health conditions by 2018¹.
• The average health and social care cost for those with 3 or more long-term health conditions is estimated at around £7,700 per person per year¹.
• Patients should be involved at the heart of decisions about their care.

The draft guideline, which is open for consultation, sets out how to offer a tailored approach for people with multiple long-term conditions and how to put them at the heart of the decisions about their care.

To reduce treatment burden and minimise unwanted side effects from taking multiple medicines, this draft guideline recommends clinicians do the following:

• Stop treatment if it is considered to be of limited benefit
• Identify medicines with a higher risk of unwanted side effects
• Offer alternative treatment (non-pharmacological) to some medicines
• Consider making alternative arrangements to make the best use of appointments a person has to attend, so that they don’t have to  prioritise conflicting appointments for different conditions

People from deprived populations are more likely to have multimorbidity than those from affluent areas, where some people from deprived areas would have multimorbidity 10-15 years earlier than their more affluent peers².

In addition, the more long-term physical conditions a person has, the more likely they are to also have a long-term mental health condition².

This draft guideline outlines where it is appropriate to offer an individualised management plan. Factors that should be considered include the number of prescribed medicines, how often the person needs emergency care and how difficult it is to manage their treatments on a day-to-day basis.

Professor Mark Baker, director of clinical practice at NICE said: “Supporting people with multimorbidity represents one of the biggest clinical challenges of the day. This draft guideline is designed to help health-care professionals, especially GPs and acute physicians, to make complex decisions more simple and to offer the best advice on maintaining people’s health and wellbeing.”

Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee and chair of the group that developed the draft guideline, said: “Care for people with multiple conditions is often complicated. This is because the conditions themselves and their treatments interact in complex ways, and care can be fragmented across many different specialists and services.

“General practice and other generalist services, like care of the elderly, have a crucial role in co-ordinating care through a person-centred rather than disease-focused perspective. The new draft guideline emphasises the importance of this perspective.”

The number of people with 3 or more long-term health conditions is predicted to rise from 1.9 million in 2008 to 2.9 million in 2018¹. The average health and social care cost for those with 3 or more long-term health conditions is estimated to be approximately £7,700 per person per year¹.

The increase in the amount of people with multimorbidity, coupled with caring for an ageing population, could require £5 billion in additional expenditure by 2018¹.

Research by Professor Guthrie and colleagues shows the number of people with multimorbidity increases with age. Even so, more than half of all people in the study with multimorbidity were aged 65 and under².

Professor David Haslam, chair of NICE and a former GP, added: “When working with patients, health-care professionals should use their judgement when deciding treatments or services appropriate to someone with more than one long-term health condition. It is important to balance the evidence for benefit with the potential harm of treatment for the individual, and take into account the preferences and wishes of the person themselves.”

The consultation is open until 12 May 2016, with an expected publication date for the final guideline in September 2016.

Notes to Editors

References

1. Department of Health (2012), Long-term conditions compendium of information: 3rd edition
2. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S and Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research and medical education: a cross sectional study

About the guidance

1. The draft guidance, ‘Multimorbidity: clinical assessment and management’, is avaiable at at /guidance/indevelopment/GID-CGWAVE0704/consultation/html-content.