Recommendations and quality of multimorbidity guidelines: A systematic review

As the population is aging, multimorbidity has become an increasingly important global health challenge. Clinical practice guidelines are essential references to guide daily practice for health care providers. This systematic review aims to assess whether existing multimorbidity guidelines adhered to the principles outlined in a previously developed framework for multimorbidity management recommendations, Ariadne, and evaluate their methodological and reporting quality.

We systematically searched six literature databases and nine guideline platforms from their inception until September 30, 2024. We included guidelines and guideline-like documents on multimorbidity and polypharmacy. Language was limited to English and Chinese. We extracted data related to basic information and guideline development methodology, and categorized guideline recommendations based on the Ariadne framework. We used the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist to evaluate the methodological and reporting quality of the guidelines, respectively.

Our systematic review identified 20 eligible guidelines, of which 10 focused on multimorbidity, eight on polypharmacy, and two covered both topics. The mean overall AGREE II score was 27.9 % and the mean compliance rate to the RIGHT reporting checklist 35.1 %. Individualized management was the most frequently addressed of the five steps of the Ariadne framework (n=18 guidelines, 90.0 %), followed by interaction assessment (n=17, 85.0 %).

The methodological and reporting quality of multimorbidity guidelines were suboptimal. The recommendations of these guidelines covered primarily the management process of multimorbid patients. Future guidelines should pay more attention to the scientific quality of the development methodology and the feasibility of implementing the guidelines in practice.

Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.