Experts Agree on 31 Key Recommendations for Caring for People with Multiple Long-Term Conditions

An international panel of experts has endorsed a set of 31 consensus-based recommendations for the management of multiple long-term conditions (MLTC), according to a study published in BMC Medicine. The work combined a systematic review of clinical guidelines with a modified Delphi process, a structured method for building agreement among experts across successive survey rounds. The resulting recommendations are intended to help healthcare professionals and policymakers design strategies to improve the quality of care for patients living with several chronic conditions at once.

The study began with a systematic guideline review in which the researchers extracted every recommendation on the management of MLTC. This process yielded 297 recommendations drawn from 14 guidelines. Because such a large volume of overlapping guidance is difficult to use in practice, the team synthesized these into 65 recommendations that could be assessed individually by the expert panel. Establishing consensus on which recommendations are relevant was framed by the authors as a prerequisite for later evaluations of whether the recommendations are feasible and should be prioritized for implementation.

To assemble the panel, the researchers used a snowball recruitment approach, in which identified experts suggested further candidates. This produced 53 professional experts on MLTC from 25 countries who agreed to take part in two online Delphi survey rounds. Agreement for inclusion was defined in advance: a recommendation was considered to have reached consensus if at least 70% of respondents rated it 7 or higher on an 11-point numeric rating scale, where 0 meant not important and 10 meant extremely important. Open-ended questions allowed participants to add comments and propose additions.

In the first round, 42 experts participated, a response rate of 78%, and consensus was reached on the relevance of 32 recommendations. Eleven recommendations that did not achieve consensus in that round were carried forward, alongside four newly formulated recommendations based on the participants’ open-ended responses. In the second round, 40 experts took part, a response rate of 74%. Consensus was reached on five recommendations in total during this round, bringing the final count of consensus-based recommendations to 37.

As a final step, the researchers refined the 37 consensus-based recommendations into a list of 31, organized across six categories: an approach to care addressing MLTC, comprehensive assessment, patient-centred consultation, an individualized care plan, monitoring and follow-up, and collaboration and coordination. According to the authors, these key recommendations represent broadly endorsed advice supporting healthcare professionals and policymakers in designing strategies to improve care quality for patients with MLTC.

The study’s background notes that existing recommendations for managing MLTC aim to support patient-centred, goal-oriented and coordinated care, and that previous systematic reviews and consensus studies have informed MLTC management, with new guidance becoming available over time. Despite this accumulating guidance, the authors report that challenges persist in implementing recommendations into routine clinical practice, which motivated the effort to establish which recommendations an international group of experts considers most relevant.

The article, titled “Recommendations for managing multiple long-term conditions: a systematic guideline review and modified Delphi study,” was published open access on 29 October 2026 and is authored by 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 and the MLTC DELPHI consortium. Because the findings reflect expert consensus on the relevance of guideline recommendations rather than direct evidence of clinical outcomes, the authors position the list as a foundation for subsequent work on feasibility and implementation priority rather than as a finished implementation strategy.

Subject of Research: Consensus recommendations for managing multiple long-term conditions

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

Article References: Tuinhof, H. A., Gans, E. A., Vermeulen, K. M., Kwast-Hoekstra, D. D., Duvivier, R. J., Burgers, J. S., Verhoeff, M., van Munster, B. C., The MLTC DELPHI consortium, Basto-Abreu, A., Jónsdóttir, A. B., Ramírez-Morros, A., Dunvald, A.-C. D., Bernabé-Ortiz, A., Jureviciene, E., Ku, G. M. V., Berntsen, G. K. R., Mikkola, I., Václavík, J., … Wang, Z. (2026). Recommendations for managing multiple long-term conditions: a systemaftic guideline review and modified Delphi study. BMC Medicine. https://doi.org/10.1186/s12916-026-05304-x

Image Credits: AI Generated

DOI: 10.1186/s12916-026-05304-x

Keywords: multiple long-term conditions, multimorbidity, clinical guidelines, modified Delphi study, consensus, patient-centred care, care coordination, systematic guideline review, implementation, BMC Medicine, Recommendations, managing