Potential Pitfalls of Disease-Specific Guidelines for Patients with Multiple Conditions

Quality-measurement and payment-for-performance programs encourage physicians to deliver care that is consistent with practice guidelines. In the treatment of patients with multiple medical problems, adherence to disease-specific guidelines often requires the use of 10 or more medications, yet the marginal benefits and adverse effects of the 8th, 9th, or 10th medication in such patients are not known. The authors emphasize the importance of considering patients' quality of life, preferences, and values when prescribing medications for those with multiple chronic illnesses.