Management of Chronic and Complex Conditions
Chronic Disease and Multimorbidity
Chronic care requires goal setting, monitoring, and coordination across conditions. For diabetes, know glycemic targets individualized by age and comorbidity, the role of A1c, and screening for complications such as retinopathy, nephropathy, and neuropathy. For hypertension, confirm with repeated measurements and address lifestyle before or alongside medication. For heart failure, distinguish reduced versus preserved ejection fraction because therapy differs. For COPD, stepwise inhaler therapy and smoking cessation are central.
Traps to Watch
Questions test whether you treat the patient rather than the number. Overly tight glycemic control in frail older adults increases hypoglycemia risk. Polypharmacy is a common theme: review medications and deprescribe when harms outweigh benefits. Watch for conditions that alter targets, such as CKD limiting metformin use or heart failure limiting certain medications. Coordination matters: ensure follow-up, labs, and referrals are arranged, not just prescriptions written.
Worked Example
An 82-year-old frail patient with diabetes has an A1c of 7.8%. Trap answer: "intensify therapy to reach 6.5%." Correct reasoning: a less strict target is appropriate for frail older adults to avoid hypoglycemia. Rule of thumb: individualize targets by life expectancy, comorbidity, and hypoglycemia risk, and review the medication list at every visit.