Biography
Biography: Martin Scherer
Abstract
Adherence to current monomorbidity-focused, mono-disciplinary guidelines may result in undesirable effects, for persons with several commodities, in adverse interactions between drugs and diseases, conflicting management strategies, and polypharmacy. As yet no satisfactory approaches has been existing to address multimorbidity (MM) in clinical guidelines, until the NICE-guideline on MM has shortly been published. The MM guideline of the German College of General Practitioners and Family Physicians (DEGAM) will follow soon and will be presented in Dubai. We followed a new 6-step, mixed methods approach comprising: (1) interdisciplinary focus groups developed case vignettes according to both internal evidence and the results of a literature review of epidemiological data; (2) guideline synopsis based on case-vignettes; (3) collection of general practice-experts’ perspective regarding case vignettes; (4) development of case-based recommendations according to case vignettes (N-of-one-guidelines); (5) development of a clinical Meta-Algorithm based on the N-of-one-guidelines; (6) identification of patients’ views and perspective based on literature review and qualitative interviews. Step one revealed three different approaches for the selection criteria of case vignettes: first, cases addressing MM disease patterns from epidemiological studies (MM clusters); second, cases addressing triads of the 6 most prevalent chronic conditions; third, cases according to a problem-oriented prioritization of focus group participants. All in all 10 N-of-one-guidelines according to 10 cases could be developed according to the new 5-step-process. We present a new approach in order to capture the complex and heterogeneous problems of MM through evidence-based and case-based recommendations. The set of N-of-one-guidelines served as a framework of evidence-based recommendations for MM patients as the base for the development of a clinical meta-algorithm as one of the core elements of the German Guideline on MM.