Department of Political Communication, Guangming School of Journalism and Communication, China University of Political Science and Law, Beijing, China.
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Public Health. 2021 Dec 20;9:760792. doi: 10.3389/fpubh.2021.760792. eCollection 2021.
China and many developing countries has placed high expectations on the general practice healthcare system in terms of lowering medical costs and improving the health status of the multimorbid population in recent years. However, the prevalence of multimorbidity among inpatients attending the general practice department of hospitals and its policy implications are largely unknown. The current study aimed to analyze the prevalence of comorbidities among inpatients attending the general practice department of the tertiary Grade-A Hospitals in China, and put forward evidence-based policy recommendations. Between December 2016 and November 2020, 351 registered general practitioners from 27 tertiary hospitals were selected, and their direct admissions were evaluated. The rate and composition ratio were used for descriptive analysis of the clinical and epidemiological characteristics of multimorbidity. A backward stepwise algorithm was used to explore independent variables. The absence of multicollinearity and plausible interactions among variables were tested to ensure the robustness of the logistic regression model. The pyramid diagram was used to show the link between gender and the involved human body system in multimorbidity. Multimorbidity was present in 93.1% of the 64, 395 patients who were admitted directly. Multimorbidity was significantly more prevalent in patients aged 45-59 years (OR=3.018, 95% CI=1.945-4.683), 60-74 years (OR = 4.349, 95% CI = 2.574-7.349), ≥75 years (OR = 7.804, 95% CI = 3.665-16.616), and those with body mass index (BMI) ≥ 28 kg/m (OR = 3.770, 95% CI = 1.453-9.785). The circulatory system was found to be the most commonly involved human body system in multimorbidity, accounting for 79.2% (95% CI = 78.8-79.5%) of all cases. Significant gender inequity was further observed in the involved human body system in multimorbidity. Multimorbidity is likely common among the inpatients attending the general practice department of hospitals in China and many developing countries, with significant gender inequity in the involved human body systems. Effective countermeasures include establishing a GP-PCIC multimorbidity prevention and control model and enhancing the multimorbidity of elderly and obese patients at both the clinical and healthy lifestyle levels. The diagnosis and treatment capabilities of GPs on the circulatory, endocrine, metabolic, digestive, and respiratory systems should be prioritized.
近年来，中国和许多发展中国家都对基层医疗保健系统寄予厚望，希望其能够降低医疗成本并改善多病共存人群的健康状况。然而，医院全科医学部门住院患者的多病共存患病率及其政策意义在很大程度上尚不清楚。本研究旨在分析中国三级甲等医院全科医学部门住院患者的共病患病率，并提出循证政策建议。
2016 年 12 月至 2020 年 11 月，从 27 家三级医院中选择了 351 名注册全科医生，并对其直接收治的患者进行评估。采用率和构成比对多病共存的临床和流行病学特征进行描述性分析。采用向后逐步算法探索自变量。检验变量之间是否存在多重共线性和合理的相互作用，以确保逻辑回归模型的稳健性。采用金字塔图显示性别与多病共存中涉及的人体系统之间的联系。
64395 名直接收治的患者中，93.1%存在多病共存。45-59 岁（OR=3.018，95%CI=1.945-4.683）、60-74 岁（OR=4.349，95%CI=2.574-7.349）、≥75 岁（OR=7.804，95%CI=3.665-16.616）和 BMI≥28kg/m（OR=3.770，95%CI=1.453-9.785）患者的多病共存患病率显著更高。循环系统是多病共存中最常涉及的人体系统，占所有病例的 79.2%（95%CI=78.8-79.5%）。在多病共存涉及的人体系统中还进一步观察到显著的性别不平等。
在中国和许多发展中国家，医院全科医学部门的住院患者中多病共存可能很常见，且在涉及的人体系统方面存在显著的性别不平等。有效对策包括建立全科医生-初级保健医生综合慢性病防治模式，在临床和健康生活方式层面加强老年和肥胖患者的多病共存防治。应优先提高全科医生对循环、内分泌、代谢、消化和呼吸系统疾病的诊断和治疗能力。
