School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
Foundation President, International Society for Systems and Complexity Sciences for Health, Waitsfield, Vermont.
J Eval Clin Pract. 2021 Oct;27(5):1187-1193. doi: 10.1111/jep.13521. Epub 2021 Feb 15.
Multimorbidity - the occurrence of two or more long-term conditions in an individual - is a major global concern, placing a huge burden on healthcare systems, physicians, and patients. It challenges the current biomedical paradigm, in particular conventional evidence-based medicine's dominant focus on single-conditions. Patients' heterogeneous range of clinical presentations tend to escape characterization by traditional means of classification, and optimal management cannot be deduced from clinical practice guidelines. In this article, we argue that person-focused care based in complexity science may be a transformational lens through which to view multimorbidity, to complement the specialism focus on each particular disease. The approach offers an integrated and coherent perspective on the person's living environment, relationships, somatic, emotional and cognitive experiences and physiological function. The underlying principles include non-linearity, tipping points, emergence, importance of initial conditions, contextual factors and co-evolution, and the presence of patterned outcomes. From a clinical perspective, complexity science has important implications at the theoretical, practice and policy levels. Three essential questions emerge: (1) What matters to patients? (2) How can we integrate, personalize and prioritize care for whole people, given the constraints of their socio-ecological circumstances? (3) What needs to change at the practice and policy levels to deliver what matters to patients? These questions have no simple answers, but complexity science principles suggest a way to integrate understanding of biological, biographical and contextual factors, to guide an integrated approach to the care of people with multimorbidity.
多发病 - 个体中出现两种或多种长期病症 - 是一个主要的全球性问题，给医疗保健系统、医生和患者带来了巨大的负担。它挑战了当前的生物医学范式，特别是传统的基于证据的医学对单一病症的主导关注。患者临床表现的异质性往往无法通过传统的分类方法来描述，并且不能从临床实践指南中推断出最佳的管理方法。在本文中，我们认为基于复杂性科学的以人为中心的护理可能是一种变革性的视角，可以用来观察多发病，以补充对每种特定疾病的专业关注。该方法提供了一个关于个体生活环境、人际关系、躯体、情感和认知体验以及生理功能的综合一致的视角。其基本原则包括非线性、临界点、涌现、初始条件的重要性、情境因素和共同进化以及模式化结果的存在。从临床角度来看，复杂性科学在理论、实践和政策层面都具有重要意义。出现了三个基本问题：（1）对患者而言重要的是什么？（2）如何在考虑到患者社会生态环境的限制下，整合、个性化和优先考虑对整个人的护理？（3）为了向患者提供重要的护理，需要在实践和政策层面上进行哪些改变？这些问题没有简单的答案，但复杂性科学原则为整合对生物、传记和情境因素的理解提供了一种方法，以指导对多发病患者的综合护理方法。
