{
  "abstract": "Objectives To evaluate how UK guidelines for individual health conditions consider coexisting multiple long term conditions and to propose improvements to guideline development processes so that guidelines appropriately account for and consider coexisting multiple long term conditions.Design Analysis and recommendations from review of single condition guidelines.Setting Clinical guidelines developed by the National Institute for Health and Care Excellence (NICE), UK, 1 January 2013 to 31 December 2024.Population 56 clinical guidelines developed by NICE covering a broad range of long term conditions.Main outcome measures The extent to which guideline recommendations consider multiple long term conditions and coexisting conditions, distinguishing between concordant conditions (those affecting the same organ system as the index condition) and discordant conditions (those affecting different systems).Results All but one of the NICE guidelines (n=55, 98%) included some advice on managing the index condition in the presence of coexisting conditions, and 50 (89%) guidelines offered general guidance on tailoring care. Only 11 (20%) guidelines, however, explicitly referred to multiple long term conditions, and none included a dedicated section on multiple long term conditions or how care should be adapted in this context. 19 (34%) guidelines featured sections looking at specific coexisting conditions or coexisting conditions generally. Coverage of coexisting conditions varied widely across categories of conditions, with mental health guidelines dealing with the most coexisting conditions (median 10, interquartile range (IQR) 4.5-14.75) in contrast with guidelines on cancer and eye disease covering the fewest conditions (median 3, 1-4.5; median 3, 2.25-2.75, respectively). Of the 397 possible concordant pairings, 120 (30%) were referenced, whereas of the 3859 possible discordant pairings, 259 (7%) were referenced, indicating greater coverage of same system combinations. Data on the composition of guideline committees showed wide variation in size, disciplinary diversity, inclusion of generalist clinicians (eg, general practitioners, general physicians, or others with no single specialty focus), and public contributors, although lived experience of multiple long term conditions was rarely specified.Conclusions Despite widespread acknowledgement of coexisting or multiple long term conditions, NICE guidelines are predominantly condition specific and offer limited tailored support for the care of multiple long term conditions. Recommendations rarely considered common condition clusters or the cumulative effect of multiple long term conditions. Structured improvements, such as clearer guidance on adapting care, broader cross condition referencing, and more transparent inclusion of lived experience could enhance the relevance and usability of guidelines for clinicians managing patients with multiple long term conditions.",
  "authors": [
    {
      "affiliations": [
        "NIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, Newcastle upon Tyne, UK"
      ],
      "name": "Sara Pretorius"
    },
    {
      "affiliations": [
        "Patient Advisory Group, Admission Research Collaborative, UK-wide, UK"
      ],
      "name": "Victoria Bartle"
    },
    {
      "affiliations": [
        "AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland and Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Sue Bellass"
    },
    {
      "affiliations": [
        "NIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, Newcastle upon Tyne, UK"
      ],
      "name": "Ella-Rose Blackburn"
    },
    {
      "affiliations": [
        "Patient Advisory Group, Admission Research Collaborative, UK-wide, UK"
      ],
      "name": "Helen Bold"
    },
    {
      "affiliations": [
        "AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland and Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Rachel Cooper"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Heather Cordell"
    },
    {
      "affiliations": [
        "PIONEER Hub, University of Birmingham, Birmingham, UK",
        "Data Science Team, Research, Development, and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Felicity Evison"
    },
    {
      "affiliations": [
        "Patient Advisory Group, Admission Research Collaborative, UK-wide, UK"
      ],
      "name": "Ray Holding"
    },
    {
      "affiliations": [
        "NIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, Newcastle upon Tyne, UK"
      ],
      "name": "Nicola Howe"
    },
    {
      "affiliations": [
        "Patient Advisory Group, Admission Research Collaborative, UK-wide, UK"
      ],
      "name": "Emily Lam"
    },
    {
      "affiliations": [
        "Institute of Applied Health Research, University of Birmingham, Birmingham, UK"
      ],
      "name": "Tom Marshall"
    },
    {
      "affiliations": [
        "Clinical and Applied Health Research, University of Hull, Hull, UK"
      ],
      "name": "Fiona Matthews"
    },
    {
      "affiliations": [
        "School of Computer Science, University of Birmingham, Birmingham, UK"
      ],
      "name": "Paolo Missier"
    },
    {
      "affiliations": [
        "Division of Population Health and Genomics, Ninewells Hospital and School of Medicine, University of Dundee, Dundee, UK"
      ],
      "name": "Ewan R Pearson"
    },
    {
      "affiliations": [
        "NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland and Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "Digital Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK"
      ],
      "name": "Chris Plummer"
    },
    {
      "affiliations": [
        "Patient Advisory Group, Admission Research Collaborative, UK-wide, UK"
      ],
      "name": "Gillian Richards"
    },
    {
      "affiliations": [
        "AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland and Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Sian M Robinson"
    },
    {
      "affiliations": [
        "PIONEER Hub, University of Birmingham, Birmingham, UK",
        "Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK"
      ],
      "name": "Elizabeth Sapey"
    },
    {
      "affiliations": [
        "Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Thomas Scharf"
    },
    {
      "affiliations": [
        "Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK",
        "Bloomsbury Institute for Intensive Care Medicine, University College London, London, UK"
      ],
      "name": "Mervyn Singer"
    },
    {
      "affiliations": [
        "NIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, Newcastle upon Tyne, UK"
      ],
      "name": "Jana Suklan"
    },
    {
      "affiliations": [
        "NIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, Newcastle upon Tyne, UK"
      ],
      "name": "Phakapan Walker"
    },
    {
      "affiliations": [
        "Biostatistics Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "James Wason"
    },
    {
      "affiliations": [
        "AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland and Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Avan A Sayer"
    },
    {
      "affiliations": [
        "NIHR HealthTech Research Centre in Diagnostic and Technology Evaluation, Newcastle upon Tyne, UK",
        "AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK",
        "NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland and Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"
      ],
      "name": "Miles D Witham"
    }
  ],
  "title": "Making clinical guidelines work for people with multiple long term conditions: analysis and recommendations from review of single condition guidelines",
  "uid": "2e7582a3-3ec3-5ceb-a770-521ac4b6942a"
}