Chronic Disease Multimorbidity Management in Primary Care: Moving Beyond Single-Disease Guidelines

Abstract

Background: Primary care physicians manage increasing numbers of patients with multimorbidity. Single-disease clinical guidelines fail to address conflicts arising when managing multiple concurrent conditions, creating substantial care delivery challenges.

Aim: This narrative review examines critical gaps in multimorbidity management, focusing on guideline conflicts, polypharmacy management, treatment burden assessment, and patient-physician priority alignment in primary care practice.

Methods: We synthesized current evidence on multimorbidity management challenges from systematic reviews, clinical guidelines, and original research published through 2024, including guideline applicability limitations, polypharmacy prevalence and drug interactions, deprescribing frameworks, treatment burden assessment tools, and patient-physician priority misalignment.

Results: Primary care physicians require 26.7 hours daily to implement all guideline recommendations for a standard 2,500-patient panel. Most patients with chronic conditions would be excluded from the trials that generated treatment guidelines for their conditions. Polypharmacy affects 33.9% of older adults in primary care, with 47% of multimorbid patients experiencing potential drug-drug interactions. Treatment burden overwhelms 40% of patients taking five or more medications daily. Significant misalignment exists between patient priorities (functional status, current symptom control) and physician priorities (mortality reduction, disease-specific targets). Multimorbidity develops 10-15 years earlier in socioeconomically disadvantaged populations yet these groups remain understudied.

Conclusion: Family physicians require practical frameworks for managing conflicting guidelines, identifying overburdened patients, and aligning treatment decisions with patient priorities. Evidence-based implementation strategies must address polypharmacy reduction, systematic treatment burden assessment, and shared decision-making within time-constrained primary care practice.