Recommendations for managing multiple long-term conditions: a systemaftic guideline review and modified Delphi study
Year: 2026
Type: article
Abstract: 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.
Source: BMC Medicine
Authors: Hanna A. Tuinhof, Emma A. Gans, Karin M. Vermeulen, Diana D. Kwast-Hoekstra, Robbert J. Duvivier, Jako S. Burgers, Marlies Verhoeff, Barbara C. van Munster, Ana Basto-Abreu, Anna Björg Jónsdóttir, Anna Ramírez-Morros, Ann-Cathrine Dalgaard Dunvald, Antonio Bernabé-Ortiz, Elena Jureviciene, Grace Marie V. Ku, Gro K. Rosvold Berntsen, Ilona Mikkola, Jan Václavík, Janne Estill, Jon André Walton-Christensen, Josefien van Olmen, Josep Vidal-Alaball, Kevin Bliek-Bueno, Marco Salvi, Maria Cristina Fererra, Marjan Van Den Akker, Máximo Bernabeu-Wittel, Mieke Rijken, Nele Van Den Noortgate, Olivier Lidove, Opeyemi O. Babatunde, Paul Van Royen, Rikje Ruiter, Silvan Licher, Siri Rostoft, Stine Jorstad Bugge, Thomas Münzer, Ursula W. de Ruijter, Zijun Wang
Institutions: University Medical Center Groningen, Leiden University Medical Center, Stichting Vooruit, Parnassia Groep, Maastricht University, Care and Public Health Research Institute, Ziekenhuis Amstelland, Martini Ziekenhuis, Instituto Nacional de Salud Pública, University of Iceland, National University Hospital of Iceland, Institut Català de la Salut, University of Southern Denmark, Odense University Hospital, Universidad Científica del Sur, Vejle Sygehus, Vrije Universiteit Brussel, Instituut voor Tropische Geneeskunde, University of Santo Tomas, University Hospital of North Norway, UiT The Arctic University of Norway, Finnish Medical Society Duodecim, University of Ostrava, University Hospital Ostrava, University of Geneva, Lanzhou University, Copenhagen University Hospital, Midt- og Vestsjællands Hospital, University of Antwerp, National University of Singapore, National University Health System, Instituto de Investigación Sanitaria Aragón, University of Milano-Bicocca, Bielefeld University, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, University of Eastern Finland, Netherlands Institute for Health Services Research, Ghent University Hospital, Groupe Hospitalier Diaconesses Croix Saint-Simon, Keele University, Maasstad Ziekenhuis, Erasmus MC, Oslo University Hospital, University of Oslo, Kantonsspital St. Gallen, Noordwest Ziekenhuisgroep, First Hospital of Lanzhou University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,190
OpenAlex ID: W7224181218