Herzig Lilli, Mueller Yolanda, Haller Dagmar M, Zeller Andreas, Neuner-Jehle Stefan, Déruaz-Luyet Anouk, Cohidon Christine, Streit Sven, Burnand Bernard, Zuchuat Jean-Christophe
Chief of Research Department, Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, Lausanne, Switzerland.
Chief of Research Department, Department of Family Medicine, General Medicine and Public Health Care Centre, University of Lausanne, Lausanne, Switzerland.
BJGP Open. 2019 Jan 23;3(1):bjgpopen18X101622. doi: 10.3399/bjgpopen18X101622. eCollection 2019 Apr.
Managing multiple chronic and acute conditions in patients with multimorbidity requires setting medical priorities. How family practitioners (FPs) rank medical priorities between highly, moderately, or rarely prevalent chronic conditions (CCs) has never been described. The authors hypothesised that there was no relationship between the prevalence of CCs and their medical priority ranking in individual patients with multimorbidity.
To describe FPs' medical priority ranking of conditions relative to their prevalence in patients with multimorbidity.
DESIGN & SETTING: This cross-sectional study of 100 FPs in Switzerland included patients with ≥3 CCs on a predefined list of 75 items from the International Classification of Primary Care 2 (ICPC-2); other conditions could be added. FPs ranked all conditions by their medical priority.
Priority ranking and distribution were calculated for each condition separately and for the top three priorities together.
The sample contained 888 patients aged 28-98 years (mean 73), of which 48.2% were male. Included patients had 3-19 conditions (median 7; interquantile range [IQR] 6-9). FPs used 74/75 CCs from the predefined list, of which 27 were highly prevalent (>5%). In total, 336 different conditions were recorded. Highly prevalent CCs were only the top medical priority in 66%, and the first three priorities in 33%, of cases. No correlation was found between prevalence and the ranking of medical priorities.
FPs faced a great diversity of different conditions in their patients with multimorbidity, with nearly every condition being found at nearly every rank of medical priority, depending on the patient. Medical priority ranking was independent of the prevalence of CCs.
管理患有多种疾病的患者的多种慢性和急性疾病需要确定医疗优先级。家庭医生（FPs）如何在高度、中度或罕见流行的慢性病（CCs）之间对医疗优先级进行排序，此前从未有过描述。作者假设，在患有多种疾病的个体患者中，慢性病的流行率与其医疗优先级排序之间没有关系。
描述家庭医生根据慢性病在患有多种疾病的患者中的流行率对疾病进行的医疗优先级排序。
这项对瑞士100名家庭医生的横断面研究纳入了国际初级保健分类2（ICPC - 2）预定义列表中75项中有≥3种慢性病的患者；也可添加其他疾病。家庭医生根据医疗优先级对所有疾病进行排序。
分别计算每种疾病以及前三个优先级的优先级排序和分布情况。
样本包括888名年龄在28 - 98岁（平均73岁）的患者，其中48.2%为男性。纳入的患者患有3 - 19种疾病（中位数7；四分位间距[IQR] 6 - 9）。家庭医生使用了预定义列表中的74/75种慢性病，其中27种高度流行（>5%）。总共记录了336种不同的疾病。在66%的病例中，高度流行的慢性病仅为最高医疗优先级，在33%的病例中为前三个优先级。未发现流行率与医疗优先级排序之间存在相关性。
家庭医生在患有多种疾病的患者中面临着各种各样不同的疾病情况，几乎每种疾病在几乎每个医疗优先级排名中都有发现，这取决于患者个体。医疗优先级排序与慢性病的流行率无关。
