Multimorbidity.
Multimorbidity.
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DOI：
10.1038/s41572-022-00376-4
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发表时间：
2022-07-14
期刊：
影响因子：
--
通讯作者：
Smith SM
中科院分区：
文献类型：
--
作者：
Skou ST;Mair FS;Fortin M;Guthrie B;Nunes BP;Miranda JJ;Boyd CM;Pati S;Mtenga S;Smith SM
多重发病（一个人同时存在≥2种病症）是一个日益严峻的全球挑战，对个人、护理人员和社会产生重大影响。它在社会经济贫困的社区中早十年发生，与过早死亡、功能和生活质量较差以及医疗保健利用率增加有关。多种疾病发展的潜在机制是复杂的、相互关联的和多层次的，但可以被认为与衰老和潜在的生物机制以及更广泛的健康决定因素有关，例如。社会经济剥夺。人们对预防知之甚少，但关注心理社会和行为因素，特别是人口层面的干预和结构变化，可能是有益的。大多数临床实践指南以及医疗保健培训和提供都侧重于单一疾病，导致护理有时不充分且可能有害。多发病需要以人为本的护理，优先考虑对个人及其护理人员最重要的事情，确保有效协调和最小化破坏性的护理，并与患者价值观保持一致。干预措施可能是复杂且多方面的。尽管有越来越多的研究检验多发病干预措施，但支持任何方法的证据仍然有限。迫切需要加大对多发病研究和培训的投资，并重新配置医疗保健支持多发病的管理。
Multimorbidity (≥2 co-existing conditions in an individual) is a growing global challenge with substantial impact on individuals, carers and society. It occurs a decade earlier in socioeconomically deprived communities, is associated with premature death, poorer function and quality of life, and increased health care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but can be considered related to aging and underlying biological mechanisms and to broader determinants of health, e.g. socioeconomic deprivation. Little is known about prevention, but focusing on psychosocial and behavioral factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and healthcare training and delivery focuses on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centered care, prioritizing what matters most to the individual and their carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with patient values. Interventions are likely to be complex and multifaceted. While an increasing number of studies examining multimorbidity interventions are available, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of healthcare supporting management of multimorbidity is urgently needed.
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