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Clinical Guidelines May Not Suit Older Adults With Several Illnesses

Doctors should tailor treatment to an individual patient's needs, study says

TUESDAY, Aug. 9, 2005 (HealthDay News) -- So-called current clinical practice guidelines could have a negative impact on older adults struggling with several illnesses, a new study suggests.

The study noted that most clinical practice guidelines (CPGs), which are based on clinical evidence and expert consensus to help doctors deal with health problems, address single diseases. However, doctors treating older patients with several diseases must find a balance between CPGs and an individual patient's circumstances.

In this study, researchers at the Center on Aging and Health at Johns Hopkins University in Baltimore examined what happened when single-disease CPGs were applied to a hypothetical 79-year-old woman with five common chronic diseases -- type 2 diabetes, chronic obstructive pulmonary disease, osteoporosis, hypertension and osteoarthritis.

The study found that, if the relevant CPGs were followed in this case, the patient would be prescribed 12 medications (costing $406 a month) and could experience adverse interactions between drugs and diseases.

The study appears in the Aug. 10 issue of the Journal of the American Medical Association.

"For the present, widely used CPGs offer little guidance to clinicians caring for older patients with several chronic diseases. The use of CPGs as the basis for pay-for-performance initiatives that focus on specific treatments for single diseases may be particularly unsuited to the care of older individuals with multiple chronic diseases," the study authors wrote.

"Quality improvement and pay-for-performance initiatives within the Medicare system should be designed to improve the quality of care for older patients with multiple chronic diseases; a critical first step is research to define measures of the quality of care needed by this population, including care coordination, education, empowerment for self-management, and shared decision making based on the individual circumstances of older patients," the authors wrote.

More information

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SOURCE: Journal of the American Medical Association, news release, Aug. 9, 2005
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