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Introduction The BMJ Best Practice Comorbidities Manager is a subscription-based, integrated clinical decision support tool designed to help healthcare professionals better manage common combinations of multiple chronic conditions, or multimorbidity, in their patients. The product aims to give healthcare professionals the ability to address and treat the acute symptoms of a disease or condition and includes immediate, relevant alterations to the treatment plan based on the patient’s underlying comorbidities. Healthcare professionals may use the tool to add one or more common comorbid conditions to a patient diagnosis or topic, which in turn changes the recommended treatment algorithm, depending on the comorbidities added. By including comorbidities into the clinical decision-making algorithm, the tool may also help to eliminate over-investigating or over-treating patients.1 Content As of this writing, there are currently 30 acute patient presentation topics listed in the Comorbidities Manager and the publisher reports that these will be increased to 50 in the next few months. Compared to the hundreds of topics in BMJ Best Practice, the Comorbidities Manager topics are currently integrated into a small slice of that knowledge base. The Comorbidities Manager front page informs users that the tool is available offline via the app, provides a link to its advisory panel, and asks users to check back for added updates to the topics. Topics range from the fairly common, such as “Acute exacerbation of chronic obstructive pulmonary disease,” to the somewhat esoteric, “Carbon monoxide poisoning.” Comorbidity topics open within the BMJ Best Practice topic’s Treatment algorithm page where a checklist of common comorbidities may be added. The comorbidities include Diabetes, Chronic kidney disease (CKD), Hypertension, Coronary artery disease, Heart failure, Stroke, COPD, Asthma, Depression, and Dementia. Other considerations include Suspected frailty and Tobacco dependence. 
Figure 1: Comorbidities Manager treatment algorithm options. Credit: BMJ Best Practice Comorbidities Manager Some of the comorbid conditions prompt related concerns for establishing goals of care and taking into account advance directives. Content is focused on treatment-related concerns and treatment recommendations range from acute severity, life-threatening exacerbation to mild or asymptomatic. "1st Line” treatments are highlighted in bright pink, with additional therapies in darker pink listed as Plus, or Consider, comorbidities are listed as part of these algorithm lists. A bright, pink +C indicates when Comorbidities Manager Treatment algorithm content is included. For instance, in a patient with Acute asthma exacerbation and Diabetes, some of the several treatment options with the +C include “monitor comorbidities during hospital stay,” “monitor and manage blood glucose during hospital admission,” and “examine your patient’s feet.” Detailed evidence and information for how best to monitor blood glucose levels and about appropriate target ranges is included. Accordion drop-down menus provide additional information which may be relevant to the patient. 
Figure 2: Comorbidities Manager options for patient with severe asthma exacerbation and diabetes. Credit: BMJ Best Practice Comorbidities Manager Features & Functionality As described above, users can access the content by navigating to the subscribed Comorbidities Manager content, found on the BMJ Best Practice interface under “Your profile” --> “Your extra features” --> “Comorbidities Manager.” However, the Comorbidities Manager is also fully integrated into the existing BMJ Best Practice topics and is likely designed to be accessed in this way as an alert to the extra content, rather than as a standalone product. An example of how this appears in a list of topics is shown in the screenshot below. 
Figure 3: Comorbidities Manager indicators for BMJ Best Practice topics. Credit: BMJ Best Practice Comorbidities Manager BMJ Best Practice topics are arranged in a format similar to how patient care is approached. An overview is provided as a brief Summary, followed by the headings Theory, Diagnosis, Management, Follow Up, and Resources. Users may access different information subheadings within these headings. For instance, the heading Management includes the subheadings, Recommendations, Treatment algorithm, Emerging, and Patient discussions. This last subheading, Patient discussions, is a handy communication reminder that gives important talking points to discuss with patients. Most of the 30 Comorbidity Manager topics are found within the Internal medicine or Hospital medicine specialties with some topics overlapping into the other specialties. When accessed through the BMJ Best Practice interface, the Comorbidities Manager tool opens to the side and the full details of the topic are displayed. The BMJ Best Practice page also includes Key diagnostic and Risk factors, Diagnostic tests to order, Tests to avoid, diagnostic Differentials, Clinical Guidelines, Treatment algorithm both Acute and Ongoing, Videos, Patient information sheets, a list of content Contributors, and a date of when it was last reviewed and last updated. 
Figure 4: Example of Comorbidities Manager integration into BMJ Best Practice page. Credit: BMJ Best Practice Comorbidities Manager Interestingly, COPD as a comorbidity is greyed out in the above example, which makes sense since it is the presenting condition. Asthma is also greyed out, probably because it requires specialist consultation with this comorbidity combination. Users are warned against using the Comorbidities Manager with patients who are pregnant, or children, and are told to use the standard treatment algorithm and seek specialist advice. The Comorbidities Manager is an instructive and effective reminder of important patient treatment concerns for residents and other busy clinicians to safely care for their patients with complex conditions. Prompting healthcare professionals to consider how patients’ comorbid conditions necessitates altering their treatment plan supports safe and comprehensive decision-making skills. The automated treatment algorithm changes depending on comorbidities to give quick, comprehensive information embedded into section headings for a relatively clean user interface. The current number of comorbidity topics is small in comparison to what could potentially be included. Business Model The BMJ Best Practice Comorbidities Manager is an add-on subscription to BMJ Best Practice. Check with your representative to determine subscription options and pricing. Breakthrough The BMJ Best Practice Comorbidities Manager is the first clinical decision support tool with an interactive treatment algorithm that integrates relevant comorbidity treatment information into a treatment plan.2 It will be of interest to hospital libraries and clinical librarians who support medical staff and residents in acute care hospitals or busy clinics. Though its integrated topic content is somewhat limited, it promises to be a valuable and instructive tool for supporting safe and comprehensive patient care. References Walsh K. BMJ Best Practice Comorbidities Manager. BMJ Best Practice Podcast. January 2, 2025. Available at: https://open.spotify.com/episode/6Jq5beEVE1ivAAYpPY897F?si=O-BwRegtTb6S1Zz4smnqwA. Accessed April 13, 2025. Rayman G, Akpan A, Cowie M, et al. Managing patients with comorbidities: future models of care. Future Healthc J. 2022;9(2):101-105. doi:10.7861/fhj.2022-0029
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