Older People's Medicine Department, Norfolk and Norwich University Hospital NHS Foundation Trust, UK.
Norwich Medical School, University of East Anglia, UK.
Age Ageing. 2018 Jan 1;47(1):6-8. doi: 10.1093/ageing/afx159.
The concept of multimorbidity has risen in popularity over the past few years. Its use has led to, or coincided with, an increased recognition that patients often have more than one health problem which should not be treated in isolation. The motivation for more holistic, person-centred care that lies behind multimorbidity is to be welcomed. The 2016 National Institute for Health and Care Excellence multimorbidity management guideline helpfully makes recommendations in key areas that are important in the care of patients with complicated medical problems.However, we question the sustainability of the term for the following four reasons: (i) it is doctor and researcher centred rather than patient centred, focusing upon the number of diagnoses rather than the patient's lived experience, (ii) it is not a positive term for patients and is at odds with the move towards promoting active and healthy ageing, (iii) its non-specific nature means it holds little value in daily clinical practice and (iv) most definitions apply to a large segment of the population making it of limited use for health care planners. We argue that the complementary concepts of complexity and frailty would fit better with the delivery of patient centred care for people with multiple co-existing health problems and would be more useful to clinicians, commissioners and researchers.
过去几年来，多病共存的概念日益流行。这一概念的使用，使得人们更加认识到，患者往往同时存在不止一种健康问题，这些问题不应孤立对待。以多病共存为基础的、更全面、以患者为中心的护理理念是值得欢迎的。2016 年，国家卫生与保健卓越研究所（NICE）发布的多病共存管理指南，在为有复杂医疗问题的患者提供护理方面的重要领域提供了有益的建议。然而，我们对该术语的可持续性提出质疑，原因有四：（i）它以医生和研究人员为中心，而非以患者为中心，关注的是诊断数量，而非患者的生活体验；（ii）它对患者而言不是一个积极的术语，与促进积极健康老龄化的趋势背道而驰；（iii）其非特异性意味着它在日常临床实践中几乎没有价值；（iv）大多数定义适用于人口中的很大一部分，因此对医疗保健规划者的用处有限。我们认为，复杂性和脆弱性这两个互补的概念更符合为同时存在多种健康问题的患者提供以患者为中心的护理，并且对临床医生、决策者和研究人员更有用。
