23rd March 2018, Volume 131 Number 1472

Elinor Millar, Anthony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati

Multimorbidity (the coexistence of more than one long-term condition) is now the norm among those with long-term conditions, with more people living with multiple conditions than with a single one.1…

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More people are now living with multimorbidity (multiple long-term conditions). Currently clinical treatment guidelines focus on the management of individual conditions, and don’t usually consider the impact of combining multiple guidelines for someone with multiple conditions. This may lead to interactions between treatments and often leads to a burdensome treatment regime for patients. Clinical guidelines could be improved to better support clinicians to provide care for people with multimorbidity.


More people now live with multimorbidity than with a single long-term condition. Despite this, clinical guidelines remain focused on the management of individual conditions. When the treatment recommendations from multiple different disease-specific guidelines are combined for one individual it frequently leads to interactions between treatments, along with a high burden of treatment for patients. It is also recognised that people with multimorbidity are often excluded from the trials that generate the underlying evidence for these guidelines, and that treatment goals from guidelines often fail to align with patient goals. This viewpoint discusses the main issues with applying disease-specific guidelines to individuals with multiple long-term conditions, and presents a set of eight recommendations to improve care for people with multimorbidity in New Zealand.

Author Information

Elinor Millar, Research Fellow, Department of Public Health, University of Otago, Wellington;
Tony Dowell, Professor, Department of Primary Health Care and General Practice, University of Otago, Wellington; Ross Lawrenson, Professor, University of Waikato, Hamilton;
Dee Mangin, Professor, Department of Family Medicine, McMaster University, Canada;
Diana Sarfati, Professor, Department of Public Health, University of Otago, Wellington.


With thanks to the wider multimorbidity research team for their work that helped shape this viewpoint. 


Dr Elinor Millar, Department of Public Health, University of Otago, PO Box 7343, Wellington.

Correspondence Email


Competing Interests

Dr Millar, Dr Dowell, Dr Mangin and Dr Sarfati report grants from Health Research Council, during the conduct of the study. Professor Lawrenson is both an employee of the University of Waikato and Waikato District Health Board.


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