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  1. How does the physician approach a patient with multiple comorbidities? How are they different than other patients?

  2. How do multiple comorbidities affect a patient's prognosis?

  3. How does the physician take prognosis into account when formulating treatment plans for patients?

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Case 97-1

A 79-year-old woman with moderately severe chronic diseases (obstructive pulmonary disease, osteoporosis, osteoarthritis, type 2 diabetes mellitus, and hypertension) was admitted to the hospital for a complicated urinary tract infection. She had recently moved to the area and needed to establish primary care following discharge. Her newly assigned primary care physician requested that “good maintenance medications” be prescribed for her chronic diseases prior to discharge. However, if the relevant clinical practice guidelines were followed, the patient would be prescribed 12 medications (her cost $406 per month) along with a complicated nonpharmacological regimen (see Table 97-1). The patient did not find these recommendations to be practical.

Table 97-1 Treatment Regimen Based on Clinical Practice Guidelines for a Hypothetical 79-Year-Old Woman with Hypertension, Diabetes Mellitus, Osteoporosis, Osteoarthritis, and COPD*

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