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Workshop Co-morbidity and chronic disease

Workshop Co-morbidity and chronic disease. NICE Guidance. Clinical practice: Health technology appraisals Clinical guidelines Interventional procedures Public health: Interventions Programmes. Clinical guidelines.

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Workshop Co-morbidity and chronic disease

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  1. WorkshopCo-morbidity and chronic disease

  2. NICE Guidance • Clinical practice: • Health technology appraisals • Clinical guidelines • Interventional procedures • Public health: • Interventions • Programmes

  3. Clinical guidelines • “Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”. • Institute of Medicine, 1993

  4. Chronic diseases • 1. Common cause of ill health • 2. Major contribution to workloads in primary and secondary care • 3. Frequent cause of emergency admission to hospital • 4. Substantial resource implications for the NHS

  5. Guidelines completed: Post-myocardial infarction Type 1 diabetes Type 2 diabetes Schizophrenia Chronic heart failure Multiple sclerosis Eating disorders COPD Hypertension Epilepsy Falls Anxiety Depression Guidelines in progress: Depression in children Obsessive compulsive disorder Parkinson’s disease Bipolar disorder Familial hypercholesterolemia Hyperlipidaemia and cardiovascular risk Breast cancer Prostate cancer Atrial fibrillation Osteoporosis Obesity Chronic fatigue syndrome Dementia Osteoarthritis Faecal incontinence Chronic disease management Co-morbidity

  6. Is there a problem (1)?

  7. Is there a problem (2)?

  8. Co-morbidity - COPD

  9. COPD: Osteoarthritis: Heart failure: Depression: Inhaled beta-agonist Inhaled/oral steroid Paracetamol NSAID Diuretic ACE-inhibitor Spironolactone Beta-blocker Digoxin (?) SSRI Managing COPD

  10. COPD problems • 1. Number of medications (n=11) • 2. Number of daily doses (n=19 - 24) • 3. Adverse reactions – increase exponentially with the number of drugs • 4. Interactions • NSAIDs and oral steroids • NSAIDs and diuretics • Beta-agonists and heart failure • Beta-blockers and COPD • Beta-agonists and beta-antagonists

  11. Co-morbidity - PD

  12. Parkinsons: Osteoarthritis: Hypertension: Depression: CHD: COPD: Levo-dopa DDI Dopamine-agonist Paracetamol NSAID Diuretic Beta-blocker ACE-inhibitor TCA/SSRI Nitrate Beta-blocker Ca-blocker Inhaled beta-agonist Inhaled/oral steroid Managing PD

  13. Managing PD problems • 1. Number of medications (n=11) • 2. Number of daily doses (n=24-30) • 3. Adverse reactions increasing exponentially with the number of drugs • 4. Interactions • NSAIDs and antihypertensive therapy • Levodopa and antihypertensive therapy • Beta-blocker and PD • Nitrates and PD • Beta-agonists and beta-blockers • NSAIDs and steroids

  14. Conclusions • 1. There is a problem – but how large? • 2. If there is a problem, is it NICE’s? • 3. If it is a NICE problem, what should we do about it?

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