Caring for Patients With Multiple Chronic Conditions
Authors: Mary E. Tinetti, Ariel R. Green, Jennifer Ouellet, Michael W. Rich, Cynthia Boyd
Journal: Annals of Internal Medicine (2019)

Ideas and Opinions5 February 2019Caring for Patients With Multiple Chronic ConditionsCorrection(s) for this article:CorrectionsMar 2019Correction: Caring for Patients With Multiple Chronic ConditionsFREEMary E. Tinetti, MD, Ariel R. Green, MD, MPH, Jennifer Ouellet, MD, Michael W. Rich, MD, and Cynthia Boyd, MD, MPHMary E. Tinetti, MDYale School of Medicine and Yale School of Public Health, New Haven, Connecticut (M.E.T., J.O.), Ariel R. Green, MD, MPHJohns Hopkins University School of Medicine, Baltimore, Maryland (A.R.G., C.B.), Jennifer Ouellet, MDYale School of Medicine and Yale School of Public Health, New Haven, Connecticut (M.E.T., J.O.), Michael W. Rich, MDWashington University School of Medicine, St. Louis, Missouri (M.W.R.), and Cynthia Boyd, MD, MPHJohns Hopkins University School of Medicine, Baltimore, Maryland (A.R.G., C.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3269 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Multimorbidity, the coexistence of multiple chronic conditions, is common among all adults receiving health care and the norm among older adults. Almost 15 years ago, we raised concerns about the limitations of disease-focused, guideline-based medication prescribing (and the randomized clinical trials that inform it) for older adults with multimorbidity (1, 2). At that time, we noted the following 9 limitations of such care: Results observed in younger study participants without multimorbidity may not apply to older adults with multimorbidity, prescribing based on survival or disease-specific outcomes may be inadequate for patients with competing risks from multiple diseases and whose quality ...References1. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294:716-24. [PMID: 16091574] CrossrefMedlineGoogle Scholar2. Tinetti ME, Bogardus ST, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. N Engl J Med. 2004;351:2870-4. [PMID: 15625341] CrossrefMedlineGoogle Scholar3. Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. 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Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann Intern Med. 2018;168:569-76. [PMID: 29507945]. doi:10.7326/M17-0939 LinkGoogle Scholar7. American Geriatrics Society. Guidelines for improving the care of older adults with diabetes mellitus: 2013 update. 2013. Accessed at https://geriatricscareonline.org/ProductAbstract/guidelines-for-improving-the-care-of-the-older-adult-with-diabetes-mellitus-2013-update-and-supplemental-information/CL008# on 16 November 2018. Google Scholar8. Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175:827-34. [PMID: 25798731] doi:10.1001/jamainternmed.2015.0324 CrossrefMedlineGoogle Scholar9. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012;60:1957-68. [PMID: 22994844] doi:10.1111/j.1532-5415.2012.04187.x CrossrefMedlineGoogle Scholar10. Naik AD, Dindo LN, Van Liew JR, Hundt NE, Vo L, Hernandez-Bigos K, et al. Development of a clinically feasible process for identifying individual health priorities. J Am Geriatr Soc. 2018;66:1872-9. [PMID: 30281794] doi:10.1111/jgs.15437 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Yale School of Medicine and Yale School of Public Health, New Haven, Connecticut (M.E.T., J.O.)Johns Hopkins University School of Medicine, Baltimore, Maryland (A.R.G., C.B.)Washington University School of Medicine, St. Louis, Missouri (M.W.R.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3269.Corresponding Author: Mary E. Tinetti, MD, Section of Geriatrics, Yale School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025; e-mail, mary.[email protected]edu.Current Author Addresses: Drs. Tinetti and Ouellet: Section of Geriatrics, Yale School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025.Dr. Green: Johns Hopkins Bayview Medical Center, Mason F. Lord Center Tower, 7th Floor, 5200 Eastern Avenue, Baltimore, MD 21224.Dr. Rich: Cardiovascular Division, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8086, St. Louis, MO 63110.Dr. Boyd: Johns Hopkins Center on Aging and Health, 7th Floor, 5200 Eastern Avenue, Baltimore, MD 21224.Author Contributions: Conception and design: M.E. Tinetti, J. Ouellet, C. Boyd.Analysis and interpretation of the data: A.R. Green, C. Boyd.Drafting of the article: M.E. Tinetti, J. Ouellet.Critical revision of the article for important intellectual content: M.E. Tinetti, A.R. Green, J. Ouellet, M.W. Rich, C. Boyd.Final approval of the article: M.E. Tinetti, A.R. Green, J. Ouellet, M.W. Rich, C. Boyd.This article was published at Annals.org on 22 January 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCorrection: Caring for Patients With Multiple Chronic Conditions Metrics Cited bySelf‐care of patients with multiple chronic conditions and their caregivers during the COVID‐19 pandemic: A qualitative descriptive studyInterventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic reviewOutcome Goals and Health Care Preferences of Older Adults With Multiple Chronic ConditionsImplementing Patient‐Centred Behavioural Health Integration into Primary Care Using Model‐Based Systems EngineeringPharmacist-driven medication recognition/ reconciliation in older medical patientsIntroductory Chapter: Managing Multiple Chronic Conditions - A Patient-Centered Holistic Approach Rather than Single Disease-Focused PerspectiveAIDSImpact special issue – broadening the lens: recommendations from rehabilitation in chronic disease to advance healthy ageing with HIVPatient-Reported Barriers and Facilitators to Deprescribing Cardiovascular MedicationsHow Can We Optimize Care and Outcomes for Patients with Mild Cognitive Impairment and Acute Myocardial Infarction?Improving Care Coordination for Comorbidity and CancerPhysician Perspectives on Deprescribing Cardiovascular Medications for Older AdultsPerson‐centred shared decision makingLower limb chronic edema management program: Perspectives of disengaged patients on challenges, enablers and barriers to program attendance and adherenceClinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital DischargeMultidisciplinary care to older patients with multiple chronic conditions: A challenge for the health systemMultidisciplinary care to older patients with multiple chronic conditions: A challenge for the health systemCorrection: Caring for Patients With Multiple Chronic Conditions 5 February 2019Volume 170, Issue 3Page: 199-200KeywordsDecision makingDisclosureElderlyGeriatricsHealth carePatientsPopulation statisticsQuality of lifeTreatment guidelines ePublished: 22 January 2019 Issue Published: 5 February 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. 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