TABLE 10.

KAS 7: The PCC, if trained or experienced in diagnosing comorbid conditions, may initiate treatment of such conditions or make a referral to an appropriate subspecialist for treatment After detecting possible comorbid conditions, if the PCC is not trained or experienced in making the diagnosis or initiating treatment, the patient should be referred to an appropriate subspecialist to make the diagnosis and initiate treatment. (Grade C: recommendation.)

Aggregate evidence	Grade C
quality
Benefits	Clinicians are most effective when they know the limits of their practice to diagnose comorbid conditions and are aware of resources in their community.
Risks, harm, cost	Under-identification or inappropriate identification of comorbidities can lead to inadequate or inappropriate treatments.
Benefit-harm assessment	The importance of adequately identifying and addressing comorbidities outweighs the risk of inappropriate referrals or treatments.
Intentional vagueness	None.
Role of patient preferences	The families’ preferences and comfort need to be taken into consideration in identifying and treating or referring their patients with comorbidities, as they are likely to predict engagement and persistence with a treatment.
Exclusions	None.
Strength	Recommendation.
Key references	Pliszka et al150; Pringsheim et al151