Appropriateness of drugs at centre of UK’s multiple morbidity guideline

Weighing up the benefits and side effects of medicines to decide whether patients should continue taking them are at the heart of a new guideline published by the UK’s National Institute of Health and Care Excellence (NICE).  

The ‘Multi-morbidity: clinical assessment and management’ guideline, which focuses on care for patients with two or more long-term conditions, urges practitioners to think about the burden of treatment on patients — especially those who regularly take 15 or more medicines — which may have only limited clinical benefit.

The guideline, which was published on 21 September 2016, recommends that the option of stopping some medicines altogether and discussing non-pharmacological alternatives, such as a change in diet or taking up exercise, should be considered. 

“Multi-morbidity matters because it is associated with reduced quality of life, higher mortality, polypharmacy and high treatment burden, higher rates of adverse drug events, and much greater health services use (including unplanned or emergency care),” it says.

“A particular issue for health services and healthcare professionals is that treatment regimens (including non-pharmacological treatments) can easily become very burdensome for people with multi-morbidity, and care can become uncoordinated and fragmented.” 

The document also says the decision to prescribe is driven by the desire to prevent future morbidity and mortality, but that argument weakens if life expectancy is reduced or preventative medicines become less effective as more are taken. 

Bruce Guthrie, professor of primary care medicine at the University of Dundee and chair of the draft guideline group, comments: “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.”