Saberifiroozi Mehdi
Professor of Internal Medicine and Gastroenterology, Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences.
Middle East J Dig Dis. 2017 Oct;9(4):189-200. doi: 10.15171/mejdd.2017.73.
Liver cirrhosis is a major chronic disease in the field of digestive diseases. It causes more than one million deaths per year. Despite established evidence based guidelines, the adherence to standard of care or quality indicators are variable. Complete adherence to the recommendations of guidelines is less than 50%. To improve the quality of care in patients with cirrhosis, we need a more holistic view. Because of high rate of death due to cardiovascular disease and neoplasms, the care of comorbid conditions and risk factors such as smoking, hypertension, high blood sugar or cholesterol, would be important in addition to the management of primary liver disease. Despite a holistic multidisciplinary approach for this goal, the management of such patients should be patient centered and individualized. The diagnosis of underlying etiology and its appropriate treatment is the most important step. Definition and customizing the quality indicators for quality measure in patients are needed. Because most suggested quality indicators are designed for measuring the quality of care in decompensated liver cirrhosis, we need special quality indicators for compensated and milder forms of chronic liver disease as well. Training the patients for participation in their own management, design of special clinics with dedicated health professionals in a form of chronic disease model, is suggested for improvement of quality of care in this group of patients. Special day care centers by a dedicated gastroenterologist and a trained nurse may be a practical model for better management of such patients.
肝硬化是消化系统疾病领域的一种主要慢性病。它每年导致超过100万人死亡。尽管有既定的循证指南，但对医疗标准或质量指标的遵循情况参差不齐。完全遵循指南建议的比例不到50%。为提高肝硬化患者的医疗质量，我们需要更全面的视角。由于心血管疾病和肿瘤导致的高死亡率，除了原发性肝病的管理外，对合并症以及吸烟、高血压、高血糖或高胆固醇等危险因素的护理也很重要。尽管为此目标采取了全面的多学科方法，但此类患者的管理应以患者为中心并个体化。潜在病因的诊断及其适当治疗是最重要的步骤。需要定义并定制针对患者质量衡量的质量指标。由于大多数建议的质量指标是为衡量失代偿期肝硬化的医疗质量而设计的，我们也需要针对代偿期和较轻形式的慢性肝病的特殊质量指标。建议对患者进行自我管理培训，以慢性病模式设立配备专业医护人员的专科诊所，以提高这类患者的医疗质量。由专科胃肠病学家和经过培训的护士设立的特殊日间护理中心可能是更好管理这类患者的实用模式。
