Cueto-Manzano Alfonso Martín, Cortés-Sanabria Laura, Martínez-Ramírez Héctor Ramón, Márquez-Herrera Roxana Michel, Solórzano-Rodríguez Erika Carolina, Rojas-Campos Enrique
Rev Med Inst Mex Seguro Soc. 2017;55(Suppl 2):S134-42.
Multidisciplinary attention models include the joined and coordinated participation of different professionals within the health team (physicians, nurses, social workers, dietitians, physical trainers, among others). A multidisciplinary approach facilitates and improves management of patients from early chronic kidney disease (CKD) in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients and should be adapted to the resources and health systems; its systematic implementation can help to improve patient care and prevent/slow the progression of CKD.
多学科关注模式包括健康团队中不同专业人员（医生、护士、社会工作者、营养师、体能训练师等）的联合与协作参与。多学科方法有助于并改善初级卫生保健环境中早期慢性肾脏病（CKD）患者的管理。这种方法是一种改善综合护理、启动并维持健康行为、促进团队合作、消除实现目标的障碍以及改善护理流程的策略。多学科干预可能包括由健康专业人员指导的教育过程、使用自助小组以及制定CKD管理计划。CKD患者复杂且分散的护理管理与不良预后相关，这凸显了从早期阶段就在该疾病管理中实施多学科方法的重要性。多学科策略应关注患者需求，并应适应资源和卫生系统；其系统实施有助于改善患者护理并预防/减缓CKD的进展。
