Recommendations for managing multiple long-term conditions: a systemaftic guideline review and modified Delphi study

Recommendations for managing multiple long-term conditions (MLTC) aim to support healthcare professionals in delivering patient-centred, goal-oriented and coordinated care. Previous systematic reviews and consensus studies have informed MLTC management, and new guidance has become available since. However, challenges persist in implementing recommendations into routine clinical practice. Establishing consensus on the relevance of recommendations is an important prerequisite for subsequent evaluation of the feasibility and priority for implementation. Therefore, we conducted a systematic guideline review to identify recommendations and used these in a modified Delphi study with international experts to reach consensus on key recommendations for the management of MLTC. A systematic guideline review was performed to extract all recommendations on the management of MLTC. Using a snowball recruitment approach, we identified 53 professional experts on MLTC from 25 countries who agreed to participate in two online Delphi survey rounds to assess recommendations most relevant for the management of MLTC. Agreement for inclusion was defined a priori as ≥70% of respondents rating a recommendation ≥7 on an 11-point numeric rating scale (0 not important and 10 extremely important). Open-ended questions allowed for comments and additions. A total of 297 recommendations were extracted from 14 guidelines and synthesized into 65 recommendations to be assessed in the modified Delphi procedure. Forty-two experts (response rate 78%) reached consensus on the relevance of 32 recommendations in the first round. In the second round, 40 experts (response rate 74%) re-evaluated eleven recommendations derived from the first round and assessed four recommendations newly formulated based on open-ended responses. In this round consensus was reached on five recommendations in total, resulting in 37 consensus-based recommendations. As a final step, we refined these 37 recommendations into a final list of 31 across six categories: 1) approach to care addressing MLTC, 2) comprehensive assessment, 3) patient-centred consultation, 4) individualized care plan, 5) monitoring and follow-up, and 6) collaboration and coordination. The key recommendations represent a broadly endorsed set of advice, supporting healthcare professionals and policymakers in designing strategies to improve the quality of care for patients with MLTC.