GERMAN GUIDELINE ON MULTIMORBIDITY

International Conference on General Practice & Hospital Management

December 8-9, 2016 | Dubai, UAE

Martin Scherer

University Medical Center Hamburg, Germany

Keynote: J Gen Practice

Abstract :

Adherence to current monomorbidity-focused, mono-disciplinary guidelines may result in undesirable effects, for persons with several commodities, in adverse interactions between drugs and diseases, conflicting management strategies, and polypharmacy. As yet no satisfactory approaches has been existing to address multimorbidity (MM) in clinical guidelines, until the NICE-guideline on MM has shortly been published. The MM guideline of the German College of General Practitioners and Family Physicians (DEGAM) will follow soon and will be presented in Dubai. We followed a new 6-step, mixed methods approach comprising: (1) interdisciplinary focus groups developed case vignettes according to both internal evidence and the results of a literature review of epidemiological data; (2) guideline synopsis based on case-vignettes; (3) collection of general practice-experts� perspective regarding case vignettes; (4) development of case-based recommendations according to case vignettes (N-of-one-guidelines); (5) development of a clinical Meta-Algorithm based on the N-of-one-guidelines; (6) identification of patients� views and perspective based on literature review and qualitative interviews. Step one revealed three different approaches for the selection criteria of case vignettes: first, cases addressing MM disease patterns from epidemiological studies (MM clusters); second, cases addressing triads of the 6 most prevalent chronic conditions; third, cases according to a problem-oriented prioritization of focus group participants. All in all 10 N-of-one-guidelines according to 10 cases could be developed according to the new 5-step-process. We present a new approach in order to capture the complex and heterogeneous problems of MM through evidence-based and case-based recommendations. The set of N-of-one-guidelines served as a framework of evidence-based recommendations for MM patients as the base for the development of a clinical meta-algorithm as one of the core elements of the German Guideline on MM.

Biography :

Martin Scherer, MD (certified primary care physician) is a professor at the University Medical Center Hamburg-Eppendorf (Hamburg, Germany), since 2011 director of the department of primary care. His main research interests are: development and implementation of guidelines and quality indicators as well as health services and clinical research in an ambulatory setting with a focus on patients’ chronic diseases and multi morbidity. He is vice president and guideline coordinator of the German College of General Practitioners and Family Physicians (DEGAM) and board member of the European Primary Care Cardiovascular Society. He is currently principal investigator of large cohort studies in the primary care setting.

Email: m.scherer@uke.de