Belgian Health Care Knowledge Centre, Brussels, Belgium.
Health Policy. 2013 Jul;111(2):105-9. doi: 10.1016/j.healthpol.2013.04.010. Epub 2013 May 7.
The management of chronic diseases is a prime challenge of most 21st century health care systems. Many Western countries have invested heavily in care plans oriented towards specific conditions and diseases, such as dementia and cancer. The major downside of this narrowly focused approach is that treatment of multimorbidity is ignored. This paper describes the development and main stance of a national position that proposes streamlined reforms of the Belgian health care system to improve care for patients with multiple chronic diseases. We used a combination of methods to develop this stance: literature review and stakeholders' consultation. The latter identified areas for improvement: efficiency of the health care system, coordination of care, investments in human care resources, informal caregivers' support, better accessibility, and changes in the financial payment system. The position paper list 20 recommendations that are translated into about 50 action points to reform the health care system. Chronic care tailored to the patient's needs, including implementation of multidisciplinary teamwork, new functions, task delegation in primary care, and empowerment of the patient and informal caregivers are some major areas discussed. In addition, improved support, revised payment mechanisms, and setting up a quality system, along with the tailoring of patient care, can all facilitate delivery of high quality care in patients with chronic comorbidities.
慢性病管理是 21 世纪大多数医疗保健系统面临的主要挑战。许多西方国家在针对特定疾病和病症的护理计划上投入了大量资金，如痴呆症和癌症。这种狭隘重点的方法主要缺点是忽略了多种疾病的治疗。本文描述了一项国家立场的制定和主要立场，该立场建议简化比利时医疗保健系统的改革，以改善患有多种慢性疾病的患者的护理。我们使用了多种方法来制定这一立场：文献回顾和利益攸关方的咨询。后者确定了需要改进的领域：医疗保健系统的效率、护理协调、对人力资源的投资、对非正式护理人员的支持、更好的可及性以及财务支付系统的改变。立场文件列出了 20 项建议，这些建议转化为大约 50 项改革医疗保健系统的行动要点。根据患者的需求定制的慢性病护理，包括实施多学科团队合作、新功能、初级保健中的任务委托以及患者和非正式护理人员的赋权，是讨论的一些主要领域。此外，改善支持、修订支付机制、建立质量体系，以及定制患者护理，都可以促进为患有慢性合并症的患者提供高质量的护理。
