First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
Eur J Intern Med. 2019 Mar;61:9-14. doi: 10.1016/j.ejim.2018.11.009. Epub 2018 Dec 6.
Modern medicine, still largely focused on single diseases, is unprepared for managing clinical complexity (CC), which is an emerging issue. Ageing of the general population has favoured the occurrence of chronic diseases, which generate multimorbidity that has been considered for many years the main feature of CC. However, more recent studies have shown that CC is something more and different and originates from the dynamic interaction among the patient's intrinsic factors (age, gender, multimorbidity, frailty) as well as contextual factors (socioeconomic, behavioural, cultural, and environmental). The result of these interactions is non-linear and unpredictable behaviour, which is difficult to manage both in clinical practice and in the organisation of care. Up to now, the prevalent approach has consisted of breaking down and separately analysing each CC component. Consequently, only incomplete strategies to improve health outcomes have been developed, such as limited patient-centred algorithms, deprescription of therapies, and local clinical governance interventions. Medical education has a pivotal role in transmitting the knowledge of complexity, making it realistically understandable and manageable. Future research should aim at implementing our knowledge of CC, developing new tools for its quantitation, and finding new solutions to improve important health outcomes at a sustainable cost.
现代医学仍然主要关注单一疾病，对于管理临床复杂性 (CC) 尚未做好准备，CC 是一个新出现的问题。人口老龄化使慢性病的发生更为常见，多年来，这些慢性病被认为是 CC 的主要特征。然而，最近的研究表明，CC 不仅仅是多种疾病共存，而且源自于患者内在因素（年龄、性别、多种疾病、虚弱）和情境因素（社会经济、行为、文化和环境）之间的动态交互。这些相互作用的结果是非线性和不可预测的行为，无论是在临床实践中还是在护理组织中，都难以管理。到目前为止，流行的方法一直是分解和分别分析每个 CC 组成部分。因此，仅制定了一些不完善的改善健康结果的策略，例如有限的以患者为中心的算法、减少治疗方案以及局部临床管理干预。医学教育在传播复杂性知识方面起着关键作用，使其能够真实地被理解和管理。未来的研究应该旨在实施我们对 CC 的认识，开发新的工具来对其进行定量，并寻找新的解决方案，以可持续的成本改善重要的健康结果。
