New comorbidities tool in BMJ best practice

A maxim of unknown source but often attributed to William Osler is "The good physician treats the disease; the great physician treats the patient who has the disease.” Becoming a great physician is certainly difficult and is made even more challenging by the scarcity of nuanced tools to manage the care of patients with multiple co-occurring conditions.

Approximately 33 per cent of North Americans suffer from two or more health conditions1. Not taking comorbidities into account may lead to suboptimal care, worse clinical outcomes, and longer lengths of stay. Yet, clinical guidelines and point of care tools, e.g. UpToDate and DynaMed, focus on single conditions rather than the complexity of patients with comorbidities.  

In response to this problem, the College library is providing access to the new BMJ best practice comorbidities tool. The comorbidities tool provides treatment guidance on patients' acute conditions alongside pre-existing comorbidities. The content is based on the latest evidence and is presented in a way that is realistic for daily practice.

The comorbidities available for selection are common, costly, and carry a high risk of harm, and include hypertension, coronary artery disease, heart failure, stroke, depression, diabetes, asthma, COPD, chronic kidney disease, and dementia. 

An example of treatment modifications offered by BMJ best practice with comorbidities can be seen in the module on urinary tract infections in women with diabetes as a comorbidity. After selecting diabetes as a comorbidity, the section on first line therapy for acute infection in women under 65 in the community is supplemented with guidance on management of diabetes in this situation. For a quick look at another example without logging into the College website, the “Acute exacerbation of chronic obstructive pulmonary disease” module is free for anyone to review here.

To use BMJ Best Practice with the comorbidities tool, open BMJ Best Practice online on the College library web page or the BMJ Best Practice app. Where available, treatment options that are affected, or added, as a result of the patient's comorbidities are indicated by this icon: 

For more online clinical information resources to support practice, explore the library web page. Send an email to the library with questions or to request assistance including literature searches, article delivery, book loans, or workshops to build skills in finding medical evidence (medlib@cpsbc.ca).

  1. Clark A, Jit M, Warren-Gash C, Guthrie B, Wang HHX, Mercer SW, Sanderson C, McKee M, Troeger C, Ong KL, Checchi F, Perel P, Joseph S, Gibbs HP, Banerjee A, Eggo RM; Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health [Internet]. 2020 Aug [cited 2021 Mar 29];8(8):e1003-e1017. Available from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30264-3/fulltext