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Aten Primaria. 2014 Aug-Sep;46(7):385-92. doi: 10.1016/j.aprim.2013.11.013. Epub 2014 Jun 23.

[Development of clinical practice guidelines for patients with comorbidity and multiple diseases].

[Article in Spanish]

Author information

Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Virgen del Rocío, SEMI, Sevilla, España. Electronic address:
Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica (IIB Sant Pau), Grupo MBE semFYC, Barcelona, España.
Unidad de Apoyo a la Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, España; Facultad de Enfermería, Universidad de Alcalá, FAECAP, Alcalá de Henares, España.
Centro de Salud de Alza, Osakidetza, Grupo MBE semFYC, San Sebastián, España.
Comarca de Araba, Osakidetza, Escuela Universitaria de Enfermería de Vitoria-Gasteiz, Grupo de Crónicos, FAECAP, Vitoria, España.
Servicio de Medicina Interna, Hospital Lucus Augusti, SEMI, Lugo, España.


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.


Clinical practice guidelines; Comorbidity; Comorbilidad; Guías de práctica clínica; Multimorbidity; Multimorbilidad; Pluripatología; Polypathology

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