共病现象越来越引起重视，给全世界的医疗系统带来巨大挑战。共病与衰老有关。但是，现在许多研究证明其是一种社会形态。这种社会形态在社会经济高度落后的地区正在变得普遍且患病年龄也逐年降低。目前关于此方向的研究并不充足。多数指南均是根据单一症状制定。过多给药在共病患者中十分常见，其引起的药品-疾病和药品-药品之间相互影响正在增加。共病患者需要全面的护理。但是二级护理通常相当专业化，共病患者护理过程常被打断，护理工作量加倍，从而使得共病患者的治疗费用增加。共病患者的医疗费用高通常是由于高频率的初级与二级护理咨询和计划外的入院治疗造成。精神问题与身体状况的结合增加了护理的支出及其复杂性。精神疾病与生理疾病共患在物质匮乏地区尤为常见。全科医师和基层护理团队通过运用以患者为中心的多种方法在管理共病患者中扮演着重要的角色。为了提高患者的生活质量，会诊的时长和护理的连续性应该被充分地加强。为了有效地应对这些挑战，医疗系统组织和资金运用的方式需要做出巨大的改变。%Multimorbidity is a growing issue and poses a maJor challenge to health care systems around the world. Multimorbidity is related to ageing but many studies have now shown that it is also socially patterned,being more common and occurring at an earlier age in areas of high socioeconomic deprivation. There is lack of research on patients with multimorbidity, and thus guidelines are based on single - conditions. Polypharmacy is common in multimorbidity,increasing drug - disease and drug - drug interactions. Multimorbid patients need holistic care,but secondary care services are highly specialised and thus are often duplicative and fragmented and thus increase treatment burden in multimorbid patients. The cost of care is high in multimorbidity,due to high rates of primary and secondary care consultations and unplanned hospital admissions. The combination of mental and physical conditions increases complexity of care,and costs. Mental - physical multimorbidity is especially common in deprived areas. General practitioners and primary care teams have a key role in managing patients with multimorbidity,using a patient - centred generalist approach. Consultation length and continuity of care may need to be substantially enhanced in order to enable such patients. This will require a radical change in how health care systems are organised and funded in order to effectively meet the challenges of multimorbidity.
展开▼
