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.

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Journal
BMC Medicine
Published
2026-10-29
DOI
https://doi.org/10.1186/s12916-026-05304-x
Primary Topic
Chronic Disease Management Strategies
Type
article
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article

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

Siri Rostoft, Janne Anton Markus Estill, Antonio Bernabé‐Ortiz, Grace Marie Ku et al.
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BMC Medicine
Chronic Disease Management Strategies
article

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

Siri Rostoft, Janne Anton Markus Estill, Antonio Bernabé‐Ortiz, Grace Marie Ku, Ilona Mikkola, Paul Van Royen, Jako S. Burgers, Anna Björg Jónsdóttir, Anna Ramírez‐Morros, Marlies Verhoeff, Josep Vidal‐Alaball, Barbara C. Van Munster, Elena Jurevičienė, Máximo Bernabéu-Wittel, Karin Marianne Vermeulen, Kevin Bliek-Bueno, Marjan van den Akker, Olivier Lidove, Emma Adriana Gans, Silvan Licher, Josefien van Olmen, Thomas Münzer, Stine Jorstad Bugge, Ursula W. de Ruijter, Robbert J. Duvivier, Opeyemi O. Babatunde, Ana Cristina Basto-Abreu, Jan Václavík, Nele Van Den Noortgate, Rikje Ruiter, Mieke Rijken, Gro Berntsen, Marco Salvi, Hanna Tuinhof, Diana Kwast Hoekstra, Ann-Cathrine Dalgaard Dunvald, Zijun Wang, Jon André Walton-Christensen, Maria Cristina Fererra
article en

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.

BMC Medicine
University of Geneva (CH), Oslo University Hospital (NO), University Hospital of North Norway (NO), University Medical Center Groningen (NL), Vrije Universiteit Brussel (BE), University of Antwerp (BE), Generalitat de Catalunya (ES), University of Iceland (IS), National University of Singapore (SG), University of Eastern Finland (FI), University of Southern Denmark (DK), University of Oslo (NO), University of Ostrava (CZ), Bielefeld University (DE), Universidad Científica del Sur (PE), Kantonsspital St. Gallen (CH), Leiden University Medical Center (NL), Ghent University Hospital (BE), Odense University Hospital (DK), Erasmus MC (NL), Copenhagen University Hospital (DK), Maastricht University (NL), Parnassia Groep (NL), University Hospital Ostrava (CZ), Noordwest Ziekenhuisgroep (NL), Vejle Sygehus (DK), National University Hospital of Iceland (IS), Netherlands Institute for Health Services Research (NL), Maasstad Ziekenhuis (NL), Martini Ziekenhuis (NL), Groupe Hospitalier Diaconesses Croix Saint-Simon (FR), Instituto Nacional de Salud Pública (MX), Instituto de Investigación Sanitaria Aragón (ES), Ziekenhuis Amstelland (NL), National University Health System (SG), Hospital Universitario Virgen del Rocío (ES), Institut Català de la Salut (ES), Stichting Vooruit (NL), First Hospital of Lanzhou University (CN), Finnish Medical Society Duodecim (FI), Midt- og Vestsjællands Hospital (DK), Care and Public Health Research Institute (NL), Keele University (GB), University of Milano-Bicocca (IT), Lanzhou University (CN), UiT The Arctic University of Norway (NO), Instituut voor Tropische Geneeskunde (BE), Universidad de Sevilla (ES), University of Santo Tomas (PH)
Good health and well-being
Openalex Percentile: Top 12%
Chronic Disease Management Strategies
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