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 qualityGrade C
BenefitsClinicians 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, costUnder-identification or inappropriate identification of comorbidities can lead to inadequate or inappropriate treatments.
Benefit-harm assessmentThe importance of adequately identifying and addressing comorbidities outweighs the risk of inappropriate referrals or treatments.
Intentional vaguenessNone.
Role of patient preferencesThe 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.
ExclusionsNone.
StrengthRecommendation.
Key referencesPliszka et al150; Pringsheim et al151