The use of guidelines in multimorbidity-related practice: an exploratory questionnaire survey

The use of guidelines in multimorbidity-related practice has not yet been extensively investigated. We aimed to explore how health-care professionals use guidelines when managing individuals with multimorbidity.

We conducted an exploratory survey among a convenience sample of medical professionals with clinical experience. The questionnaire addressed whether and how different types of guidelines are used in multimorbidity-related practice, the reasons for not using specific types of guidelines, and other approaches to inform multimorbidity practice. It was distributed through the investigators' contact networks. The results were presented descriptively.

We received 311 valid responses: 136 from the World Health Organization European Region, 137 from the Western Pacific Region, and 38 from other regions. Most participants were familiar with the concept of multimorbidity (n = 245, 79%). Among the 269 respondents who reported using guidelines in multimorbidity practice, 124 (46%) used guidelines specifically focusing on combinations of diseases, and 148 (55%) multiple single-disease guidelines together. Lack of availability was the main reason for not using guidelines that address multimorbidity itself, and the high number of guidelines (n = 76, 40%) and possible interactions between conditions or treatments (n = 62, 38%) for not using single-disease guidelines. Respondents frequently consult experts or refer to systematic reviews and primary studies when existing guidelines do not meet their needs. The development of a tool or method to guide the use of multiple guidelines ranked highest among possible actions to improve multimorbidity practice.

Although the medical professionals in our sample were generally familiar with the use of guidelines, there are many unmet needs and tool gaps related to guideline-informed multimorbidity-related practice.