gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Do we really need clinical practice guidelines (CPGs) on comorbidities?

Meeting Abstract

  • V. Ertel-Pau - Haute Autorité de Santé, Saint Denis, France
  • K. Petitprez - Haute Autorité de Santé, Saint Denis, France
  • M. Laurence - Haute Autorité de Santé, Saint Denis, France

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP089

doi: 10.3205/12gin201, urn:nbn:de:0183-12gin2010

Published: July 10, 2012

© 2012 Ertel-Pau et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: The progressive aging of the population leads to a high prevalence of people with multiple chronic conditions. Patients with multiple comorbid diseases are in general excluded from most randomized controlled trials. Thus, CPGs are focused on the diagnosis and management of a single disease. It is an important barrier to their implementation (various combinations of medications, additional risk of adverse effects, decreased adherence …).

Objectives: To describe how comorbid diseases are taken into account in CPGs. To propose changes in the development of guidelines and in clinical decision making.

Methods: 1/We was surveyed the CPGs development’s unit of French national authority for health about consideration one or more comorbidities in their recommendation. 2/ Literature search was performed - to identify if and how comorbidities were addressed in international CPGs - if specific guideline manuals have been developped.

Results: 1/ We studied the relevance of French CPGs for the treatment of patients with comorbid conditions. Five CPGs have been identified. 2/ Three relevant articles about patients with comorbid conditions management in CPGs were identified. They focused on the more frequent chronic diseases (hypertension, diabetes mellitus) but quality of evidence was poor. No specific guideline has been developed.

Discussion/Implication for guideline developers/users: So, development of specific guideline manual for taking into account comorbidity in CPGs doesn’t seem to be possible. It would be more relevant to provide or to develop specific tools for subpopulation of comorbid patients (for example of Beers criteria for old patients).