Navickas Rokas, Petric Vesna-Kerstin, Feigl Andrea B, Seychell Martin
Ministry of Health, Republic of Slovenia, Ljubljana, Slovenia.
Directorate General for Health and Food Safety, European Commission, Brussels, Belgium.
J Comorb. 2016 Feb 17;6(1):4-11. doi: 10.15256/joc.2016.6.72. eCollection 2016.
Multimorbidity, which is defined as the co-occurrence of two or more chronic conditions, has moved onto the priority agenda for many health policymakers and healthcare providers. Patients with multimorbidity are high utilizers of healthcare resources and are some of the most costly and difficult-to-treat patients in Europe. Preventing and improving the way multimorbidity is managed is now a key priority for many countries, and work is at last underway to develop more sustainable models of care. Unfortunately, this effort is being hampered by a lack of basic knowledge about the aetiology, epidemiology, and risk factors for multimorbidity, and the efficacy and cost-effectiveness of different interventions. The European Commission recognizes the need for reform in this area and has committed to raising awareness of multimorbidity, encouraging innovation, optimizing the use of existing resources, and coordinating the efforts of different stakeholders across the European Union. Many countries have now incorporated multimorbidity into their own healthcare strategies and are working to strengthen their prevention efforts and develop more integrated models of care. Although there is some evidence that integrated care for people with multimorbidity can create efficiency gains and improve health outcomes, the evidence is limited, and may only be applicable to high-income countries with relatively strong and well-resourced health systems. In low- to middle-income countries, which are facing the double burden of infectious and chronic diseases, integration of care will require capacity building, better quality services, and a stronger evidence base.
共病被定义为两种或更多种慢性病同时出现，这已成为许多卫生政策制定者和医疗服务提供者优先关注的议程。共病患者是医疗资源的高使用者，也是欧洲一些最昂贵且最难治疗的患者。预防和改进共病的管理方式目前是许多国家的关键优先事项，并且最终正在开展工作以开发更具可持续性的护理模式。不幸的是，这项工作受到对共病的病因、流行病学和风险因素以及不同干预措施的疗效和成本效益缺乏基本知识的阻碍。欧盟委员会认识到这一领域改革的必要性，并致力于提高对共病的认识、鼓励创新、优化现有资源的利用以及协调欧盟不同利益相关者的努力。许多国家现在已将共病纳入其自身的医疗保健战略，并正在努力加强预防工作并开发更综合的护理模式。尽管有一些证据表明对共病患者的综合护理可以提高效率并改善健康结果，但证据有限，并且可能仅适用于卫生系统相对强大且资源充足的高收入国家。在面临传染病和慢性病双重负担的低收入和中等收入国家，护理整合将需要能力建设、更高质量的服务以及更坚实的证据基础。
