Advancing multimorbidity management in primary care: a narrative review.
Advancing multimorbidity management in primary care: a narrative review.
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在初级保健中推进多元管理：叙述性综述。
DOI：
10.1017/s1463423622000238
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发表时间：
2022-07-01
影响因子：
1.6
通讯作者：
Angkurawaranon, Chaisiri
中科院分区：
文献类型：
--
作者：
Aramrat, Chanchanok;Choksomngam, Yanee;Jiraporncharoen, Wichuda;Wiwatkunupakarn, Nutchar;Pinyopornpanish, Kanokporn;Mallinson, Poppy Alice Carson;Kinra, Sanjay;Angkurawaranon, Chaisiri
多发病，定义为两个或两个以上的慢性疾病共存于同一个人，正在成为一个关键的健康问题，在初级保健。与单一疾病患者相比，多发病患者使用医疗保健的比率更高，死亡率更高，生活质量更差。探索如何推进多发病管理的证据，重点是初级保健。初级保健是管理大量多发性硬化症患者的地方，被认为是许多卫生系统的守门人。使用PubMed、科克伦、世界卫生组织数据库和Google scholar组成的4个主要电子数据库进行叙述性综述。在第一轮审查中，优先审查了总结目前在管理多期业务方面的问题和挑战的审查文件。采用归纳法进行专题分析，以建立一个如何推进管理的框架。第二轮的审查集中在原始文章提供的证据在初级保健的背景下。该审查发现，在初级保健中推进多学科管理需要卫生系统方法和以患者为中心的方法。卫生系统方法包括三个主要领域：㈠改善获得保健的机会，㈡促进普遍性，㈢提供决策支助系统。对于以病人为中心的方法，四个关键方面是必不可少的多元管理：（一）促进医患关系，（二）优先考虑健康问题和共享决策，（三）支持自我管理，（四）整合护理。在初级保健中的多因素管理的进步需要将多因素管理指南的概念与以患者为中心的概念和慢性病护理模式相结合。这种简单的整合提供了一个总体框架，用于推进医疗保健系统，连接个性化护理计划的过程，并将护理与其他提供者，家庭成员和社区相结合。
Multimorbidity, defined as the coexistence of two or more chronic conditions in the same individual, is becoming a crucial health issue in primary care. Patients with multimorbidity utilize health care at a higher rate and have higher mortality rates and poorer quality of life compared to patients with single diseases. To explore evidence on how to advance multimorbidity management, with a focus on primary care. Primary care is where a large number of patients with multimorbidity are managed and is considered to be a gatekeeper in many health systems. A narrative review was conducted using four major electronic databases consisting of PubMed, Cochrane, World Health Organization database, and Google scholar. In the first round of reviews, priority was given to review papers summarizing the current issues and challenges in the management of multimorbidity. Thematic analysis using an inductive approach was used to build a framework on how to advance management. The second round of review focused on original articles providing evidence within the primary care context. The review found that advancing multimorbidity management in primary care requires a health system approach and a patient-centered approach. The health systems approach includes three major areas: (i) improves access to care, (ii) promotes generalism, and (iii) provides a decision support system. For the patient-centered approach, four key aspects are essential for multimorbidity management: (i) promoting doctor-patient relationship, (ii) prioritizing health problems and sharing decision-making, (iii) supporting self-management, and (iv) integrating care. Advancement of multimorbidity management in primary care requires integrating concepts of multimorbidity management guidelines with concepts of patient-centered and chronic care models. This simple integration provides an overarching framework for advancing the health care system, connecting the processes of individualized care plans, and integrating care with other providers, family members, and the community.