Table 3. Minor therapeutic conflicts identified in 166 emergency patients with multimorbity*.
| Type of therapy recommended by CPG | Medical conflict | Number of conflicts | Percentage of study population |
| Steroid | 53 | ||
| Arterial hypertension | 16 | 9.6% | |
| Diabetes mellitus | 13 | 7.8% | |
| Osteoporosis | 9 | 5.4% | |
| Affective disorder | 5 | 3.0% | |
| Sleeping disorder | 5 | 3.0% | |
| Obesity | 3 | 1.8% | |
| Acute congestive heart failure | 2 | 1.2% | |
| Diuretic | 28 | ||
| Renal failure† | 23 | 13.9% | |
| Infection | 3 | 1.8% | |
| Hyperparathyroidism | 2 | 1.2% | |
| Antihypertensive agents | 26 | ||
| PAD | 15 | 9.0% | |
| Gastrointestinal bleeding | 8 | 4.8% | |
| Sepsis | 3 | 1.8% | |
| Immunosuppression | 19 | ||
| Renal failure† | 15 | 9.0% | |
| Gastroenteritis | 2 | 1.2% | |
| Carrier of multiresistant bacteria | 1 | 0.6% | |
| Thrombocytes <50 G/L | 1 | 0.6% | |
| Beta-blocker | 12 | ||
| PAD | 4 | 2.4% | |
| Acute congestive heart failure | 4 | 2.4% | |
| Heart block (first-degree) | 2 | 1.2% | |
| Asthma | 2 | 1.2% | |
| Chemotherapy | 10 | ||
| Renal failure† | 7 | 4.2% | |
| Esophagitis or GERD | 2 | 1.2% | |
| Skin lesion | 1 | 0.6% | |
| Aspirin | 9 | ||
| Esophagitis or GERD | 8 | 4.8% | |
| Peptic ulcer | 1 | 0.6% | |
| Opioid | 5 | ||
| COPD | 2 | 1.2% | |
| Prostate hyperplasia | 2 | 1.2% | |
| Constipation | 1 | 0.6% | |
| Compression stockings | 2 | ||
| PAD | 2 | 1.2% | |
| Fluid replacement | 2 | ||
| Mitral insufficiency | 2 | 1.2% | |
| Estrogen replacement | 2 | ||
| Arterial hypertension | 2 | 1.2% | |
| Oxygen | 2 | ||
| COPD | 2 | 1.2% | |
| Benzodiazepine | 1 | ||
| Encephalopathy | 1 | 0.6% | |
| NSAID | 1 | ||
| Esophagitis or GERD | 1 | 0.6% | |
| ACE inhibitor | 1 | ||
| Hyperpotassemia | 1 | 0.6% |
CPG = Clinical practice guideline.
PAD = peripheral artery disease; GERD = gastroesophageal reflux disease; COPD = chronic obstructive pulmonary disease; ACE = angiotensin-converting enzyme; NSAID = nonsteroidal anti-inflammatory drug.
*Minor therapeutic conflict was defined as a where clinical practice guidelines recommend a treatment of one medical condition that is relatively contraindicated because of a co-existing condition, but where the treatment is possible without adverse effects if certain precautions are taken.
†
Renal failure defined as an estimated GFR [glomerular filtration rate] <60 mL/min from MDRD [Modification of Diet in Renal Disease Study Group] equation.