Multimorbidity and clinical guidelines

Across a number of conditions, we are examining how people who are eligible for trials differ from those who are ineligible, and are working with guideline developers, including the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN), to explore how epidemiological data about applicability of evidence could be best incorporated into guideline development.

Description

Most people with any condition would be excluded from research trials examining the effectiveness of treatments for their condition. The main groups excluded from trials of treatment are older people, people with other conditions (comorbidity), and people prescribed interacting medicines (co-prescribing). However, single-disease guideline development does not usually explicitly consider the implications of comorbidity and coprescribing for treatment recommendations. A key reason for this is that guideline developers do not have access to detailed data about the clinical population they are making recommendations for. This study has two stages. In the first, we are examining how people eligible for trials differ from people not eligible in terms of the other conditions they have (comorbidity), the other drugs they are prescribed (co-prescribing), frailty and their risk of dying from other conditions. In the second stage, we are working with NICE and SIGN guideline developers to make a web-based tool which will allow them to examine how applicable trial evidence is to the clinical population for whom the guideline is making recommendations. This project has an advisory group including representatives affected by the conditions being researched.