Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
Nursing Department, Guizhou Provincial People's Hospital, Guiyang, Guizhou, People's Republic of China.
Clin Interv Aging. 2023 Oct 16;18:1723-1735. doi: 10.2147/CIA.S425576. eCollection 2023.
To summarize adverse healthcare outcomes experienced by older adults with multimorbidity and barriers perceived by stakeholders regarding the healthcare systems primarily designed to address individual health conditions. Healthcare elements that aim to provide coordinated, continuous, and comprehensive services for this population were also identified.
We applied the methodology framework developed by Arksey and O'Malley to guide the review. The three-step search strategy was used to identify relevant English reviews that focused on adverse healthcare outcomes and barriers encountered by older adults with multimorbidity and other stakeholders regarding the single-disease-focused healthcare systems, as well as those concentrated on healthcare elements that aim to provide coordinated, continuous, and comprehensive services for older adults with multimorbidity. Five electronic databases, including PubMed/Medline, CINAHL, Web of Science Core Collection, Cochrane Library, and Embase, were systematically searched from database inception to February 2022. A standardized table was used to extract data. Thematic analysis was then conducted under the guidance of the Rainbow Model of Integrated Care and the Chronic Care Model.
Twenty reviews were included in this study. Therapeutic competitions, high healthcare service utilization, and high healthcare costs were three adverse healthcare outcomes experienced by patients. Both patients and healthcare professionals faced various barriers. Other stakeholders, including informal caregivers, healthcare managers, and policymakers, also perceived several barriers. Numerous healthcare elements were identified that may contribute to optimized services. The elements most frequently mentioned included the implementation of shared decision-making, comprehensive geriatric assessments, and individual care plans.
This study conducted a comprehensive overview of the current knowledge related to healthcare for older adults with multimorbidity. In the future, it is necessary to develop more coordinated, continuous, and comprehensive healthcare service delivery models based on the healthcare needs of older adults with multimorbidity and the specific characteristics of different countries.
总结多病共存的老年人所经历的不良医疗保健结果，以及主要针对单一疾病的医疗保健系统的利益相关者所感知到的障碍，这些系统旨在解决个体健康问题。还确定了旨在为这一人群提供协调、连续和全面服务的医疗保健要素。
我们应用了 Arksey 和 O'Malley 开发的方法学框架来指导综述。使用三步搜索策略来确定重点关注多病共存的老年人的不良医疗保健结果和障碍以及其他利益相关者对单一疾病为重点的医疗保健系统的相关英文综述，以及那些专注于旨在为多病共存的老年人提供协调、连续和全面服务的医疗保健要素。从数据库成立到 2022 年 2 月，系统地在五个电子数据库中搜索了 PubMed/Medline、CINAHL、Web of Science 核心合集、Cochrane 图书馆和 Embase。使用标准化表格提取数据。然后在综合关怀彩虹模型和慢性关怀模型的指导下进行主题分析。
本研究共纳入 20 篇综述。患者经历的三种不良医疗保健结果是治疗竞争、高医疗保健服务利用率和高医疗保健成本。患者和医疗保健专业人员都面临各种障碍。包括非正式照顾者、医疗保健管理人员和政策制定者在内的其他利益相关者也认为存在一些障碍。确定了许多可能有助于优化服务的医疗保健要素。最常提到的要素包括实施共同决策、全面老年评估和个人护理计划。
本研究对多病共存的老年人的医疗保健相关知识进行了全面概述。未来，有必要根据多病共存的老年人的医疗保健需求和不同国家的具体特点，制定更协调、连续和全面的医疗保健服务提供模式。
