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Invited article on co-morbidities

As part of the G-I-N North America Webinar Series, Anand Parekh, MD, MPH, Deputy Assistant Secretary for Health at the U.S. Department of Health & Human Services, presented in January 2013 on multiple chronic conditions as part of guideline development and implementation. In the brief invited article that follows he addresses the G-I-N community on the importance of this topic and invites North American to share experience.

U.S. Department of Health and Human Services Strategic Framework on Multiple Chronic Conditions and Clinical Practice Guidelines

One of the greatest challenges that faces the health care system today is how to care for patients with multiple chronic conditions. It is not uncommon for providers to increasingly see patients with five, six, or seven concurrent chronic conditions;indeed, one in four Americans and two in three Medicare beneficiaries have multiple chronic conditions. With the aging of the population, the continued existence of chronic disease risk factors, and the marvels of modern medicine, these numbers will only increase. Unfortunately, more often than not, evidence-based clinical guidelines on specific chronic conditions do not take into account the presence of multiple chronic conditions and, importantly, how these co-morbidities may affect the treatment plan.

The U.S. Department of Health and Human Services’ (HHS) Strategic Framework on Multiple Chronic Conditions calls on guideline developers to address multiple chronic conditions. An interim goal by the end of 2013 is for at least ten guideline developers to launch a process of updating specific guidelines to include information on the most common comorbidities clustering with the incident chronic condition.

Guideline developers should continue to use systematic reviews to accomplish this task and they ought to consider inviting subject matter experts on specific comorbidities to be a part of their guideline committees or look to partner with other professional societies that write guidelines on specific comorbidities. Information revealed from this process can help interpret the evidence and its application to recommendations in the guideline, with the level of evidence stipulated. If no evidence is found, this should also be stated as it would be helpful for providers and other users of the guideline.

It is true that we need more research focused on improving outcomes for individuals with multiple chronic conditions. This evidence will continue to be generated over time. But, we need to act now - front-line providers are caring for people with multiple chronic conditions every day. They need to know what the best evidence is, to date, on how their patients’ comorbidities may impact the treatment of specific ailments.

We urge all members of G-I-N, and in particular, U.S. members, to visit the HHS Initiative on Multiple Chronic Conditions website and contact us at We would like to learn more about your plans and commitment, as we work together to achieve the goal of optimizing health and quality of life for individuals with multiple chronic conditions.

Anand Parekh, MD, MPH
Deputy Assistant Secretary for Health
U.S. Department of Health and Human Services

Page last updated: Jun 07, 2013
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