Department of General Practice, Université de Bretagne Occidentale, Brest, France.
J Am Med Dir Assoc. 2013 May;14(5):319-25. doi: 10.1016/j.jamda.2013.01.001. Epub 2013 Feb 12.
Multimorbidity is a new concept encompassing all the medical conditions of an individual patient. The concept links into the European definition of family medicine and its core competencies. However, the definition of multimorbidity and its subsequent operationalization are still unclear. The European General Practice Research Network wanted to produce a comprehensive definition of multimorbidity.
Systematic review of literature involving eight European General Practice Research Network national teams. The databases searched were PubMed, Embase, and Cochrane (1990-2010). Only articles containing descriptions of multimorbidity criteria were selected for inclusion. The multinational team undertook a methodic data extraction, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.
The team identified 416 documents, selected 68 abstracts, included 54 articles, and found 132 definitions with 1631 different criteria. These criteria were aggregated into 11 themes that led to the following definition: Multimorbidity is defined as any combination of chronic disease with at least one other disease (acute or chronic) or biopsychosocial factor (associated or not) or somatic risk factor. Any biopsychosocial factor, any risk factor, the social network, the burden of diseases, the health care consumption, and the patient's coping strategies may function as modifiers (of the effects of multimorbidity). Multimorbidity may modify the health outcomes and lead to an increased disability or a decreased quality of life or frailty.
This study has produced a comprehensive definition of multimorbidity. The resulting improvements in the management of multimorbidity, and its usefulness in long term care and in family medicine, will have to be assessed in future studies.
多种疾病是一个涵盖个体患者所有疾病状况的新概念。该概念与欧洲家庭医学的定义及其核心能力相联系。然而，多种疾病的定义及其后续操作化仍不清楚。欧洲普通实践研究网络希望制定一个全面的多种疾病定义。
系统综述文献，涉及 8 个欧洲普通实践研究网络国家团队。搜索的数据库是 PubMed、Embase 和 Cochrane（1990-2010 年）。仅选择包含多种疾病标准描述的文章进行纳入。多国团队根据系统评价和荟萃分析的首选报告项目指南进行了系统的数据提取。
团队确定了 416 份文件，选择了 68 份摘要，纳入了 54 篇文章，并找到了 132 个定义和 1631 个不同的标准。这些标准被汇总成 11 个主题，从而产生了以下定义：多种疾病被定义为任何慢性疾病与至少另一种疾病（急性或慢性）或生物心理社会因素（相关或不相关）或躯体风险因素的组合。任何生物心理社会因素、任何风险因素、社会网络、疾病负担、医疗保健消费以及患者的应对策略都可能作为调节剂（多种疾病的影响）。多种疾病可能会改变健康结果，导致残疾增加、生活质量下降或虚弱。
这项研究提出了一个全面的多种疾病定义。未来的研究必须评估多种疾病管理的改进及其在长期护理和家庭医学中的有用性。
