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意大利关于多病共存和多重用药人群管理的指南。

Italian guidelines on management of persons with multimorbidity and polypharmacy.

机构信息

Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Via Giano della Bella 34, 00161, Rome, Italy.

Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.

出版信息

Aging Clin Exp Res. 2022 May;34(5):989-996. doi: 10.1007/s40520-022-02094-z. Epub 2022 Mar 6.

Abstract

Multimorbidity and polypharmacy are emerging health priorities and the care of persons with these conditions is complex and challenging. The aim of the present guidelines is to develop recommendations for the clinical management of persons with multimorbidity and/or polypharmacy and to provide evidence-based guidance to improve their quality of care. The recommendations have been produced in keeping with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Overall, 14 recommendations were issued, focusing on 4 thematic areas: (1.) General Principles; (2.) target population for an individualized approach to care; (3.) individualized care of patients with multimorbidity and/or polypharmacy; (4.) models of care. These recommendations support the provision of individualized care to persons with multimorbidity and/or polypharmacy as well as the prioritization of care through the identification of persons at increased risk of negative health outcomes. Given the limited available evidence, recommendations could not be issued for all the questions defined and, therefore, some aspects related to the complex care of patients with multimorbidity and/or polypharmacy could not be covered in these guidelines. This points to the need for more research in this field and evidence to improve the care of this population.

摘要

多种疾病并存和多种药物并用是当前突显的健康问题,此类患者的医疗照护非常复杂且具有挑战性。本指南旨在为多种疾病并存和/或多种药物并用患者的临床照护制定推荐意见,并提供循证指导,以改善其医疗照护质量。推荐意见是按照推荐评估、制定与评价分级(GRADE)制定的。本指南共提出 14 项推荐意见,重点关注 4 个主题领域:(1)一般原则;(2)采取个体化照护方法的目标人群;(3)多种疾病并存和/或多种药物并用患者的个体化照护;(4)照护模式。这些推荐意见支持为多种疾病并存和/或多种药物并用患者提供个体化照护,并通过确定有不良健康结局风险增加的人群来确定照护重点。鉴于现有证据有限,并非所有定义的问题都能提出推荐意见,因此,本指南无法涵盖与多种疾病并存和/或多种药物并用患者的复杂照护相关的一些方面。这表明需要在该领域开展更多研究并提供证据,以改善该人群的医疗照护。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1586/9135855/7eabf73ef6f6/40520_2022_2094_Fig1_HTML.jpg

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