Bernabeu-Wittel M, Alonso-Coello P, Rico-Blázquez M, Rotaeche del Campo R, Sánchez Gómez S, Casariego Vales E
Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen del Rocío, SEMI, Sevilla, España.
Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica (IIB Sant Pau), Grupo MBE semFYC, Barcelona, España.
Aten Primaria. 2014 Aug-Sep;46(7):385-92. doi: 10.1016/j.aprim.2013.11.013. Epub 2014 Jun 23.
The management of patients with comorbidity and polypathology represents a challenge for all healthcare systems. Clinical practice guidelines (CPGs) have limitations when applied to this population. The aim of this study is to propose the terminology and methodology for optimally approach comorbidity and polypathology in the CPGs. Based on a literature review, we suggest a number of proposals for the approach in different phases of CPG preparation, with special attention to the inclusion of clusters of comorbidity in the initial questions the implementation of indirect evidence, the burden of disease management for patients and their environment, when establishing recommendations, as well as the strategies of dissemination and implementation. These proposals should be developed in greater depth with the implication of more agents in order to have valid and useful tools for this population.
合并症和多种病理状况患者的管理对所有医疗保健系统来说都是一项挑战。临床实践指南（CPG）应用于这一人群时存在局限性。本研究的目的是提出在CPG中优化处理合并症和多种病理状况的术语和方法。基于文献综述，我们针对CPG制定不同阶段的处理方法提出了一些建议，特别关注在初始问题中纳入合并症群组、间接证据的应用、患者及其环境的疾病管理负担、制定建议时的情况，以及传播和实施策略。这些建议应在更多机构的参与下进行更深入的完善，以便为这一人群提供有效且实用的工具。
