- Winter 2006-

Clinical Practice Guidelines May Not Apply to Older Patients

Results of a Johns Hopkins study suggests that health care providers who follow current clinical practice guidelines when caring for an older person with multiple conditions may yield an overly complicated health regimen for the patient, or potentially harmful drug interactions.

The report, published in the Aug. 10 issue of The Journal of the American Medical Association, says standard guidelines designed for conditions rarely account for older patients with several coexisting illnesses.

“It is evident that these guidelines, designed largely by specialty-dominated committees for managing single diseases, provide clinicians little guidance about caring for older patients with multiple chronic diseases,” says lead author Cynthia M. Boyd, M.D., M.P.H., an assistant professor of geriatric medicine and gerontology at Johns Hopkins Bayview Medical Center. “While some recommend interventions for specific pairs of diseases, they rarely give recommendations for treating patients with three or more chronic diseases—a group that includes half of the population over age 65.”

Clinical practice guidelines are systematically developed recommendations designed to assist practitioners in the prevention, diagnosis and management of specific illnesses. When handling patients with multiple conditions, health care providers need to rely on their clinical judgment and create individual treatment plans that account for the individual circumstances and wishes of the patient and family members who contribute to the patient’s care, says Boyd.

Moreover, because standards for quality of care and reimbursements to physicians who perform medical tests for patients with chronic conditions are often based on clinical practice guidelines, “these could create perverse incentives that emphasize the wrong aspects of care for this population and diminish the quality of their care,” Boyd adds.

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