多发病治疗负担：综合评价。

Treatment burden in multimorbidity: an integrative review.

机构信息

College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.

Center for World-leading Human-care Nurse Leaders for the Future by Brain Korea 21 (BK 21) four project, College of Nursing, Seoul National University, Seoul, South Korea.

出版信息

BMC Prim Care. 2024 Sep 28;25(1):352. doi: 10.1186/s12875-024-02586-z.

DOI:10.1186/s12875-024-02586-z

PMID:39342121

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11438421/

Abstract

BACKGROUND

People living with multimorbidity experience increased treatment burden, which can result in poor health outcomes. Despite previous efforts to grasp the concept of treatment burden, the treatment burden of people living with multimorbidity has not been thoroughly explored, which may limit our understanding of treatment burden in this population. This study aimed to identify the components, contributing factors, and health outcomes of treatment burden in people with multiple diseases to develop an integrated map of treatment burden experienced by people living with multimorbidity. The second aim of this study is to identify the treatment burden instruments used to evaluate people living with multimorbidity and assess the comprehensiveness of the instruments.

METHODS

This integrative review was conducted using the electronic databases MEDLINE, EMBASE, CINAHL, and reference lists of articles through May 2023. All empirical studies published in English were included if they explored treatment burden among adult people living with multimorbidity. Data extraction using a predetermined template was performed.

RESULTS

Thirty studies were included in this review. Treatment burden consisted of four healthcare tasks and the social, emotional, and financial impacts that these tasks imposed on people living with multimorbidity. The context of multimorbidity, individual's circumstances, and how available internal and external resources affected treatment burden. We explored that an increase in treatment burden resulted in non-adherence to treatment, disease progression, poor health status and quality of life, and caregiver burden. Three instruments were used to measure treatment burden in living with multimorbidity. The levels of comprehensiveness of the instruments regarding healthcare tasks and impacts varied. However, none of the items addressed the healthcare task of ongoing prioritization of the tasks.

CONCLUSIONS

We developed an integrated map illustrating the relationships between treatment burden, the context of multimorbidity, people's resources, and the health outcomes. None of the existing measures included an item asking about the ongoing process of setting priorities among the various healthcare tasks, which highlights the need for improved measures. Our findings provide a deeper understanding of treatment burden in multimorbidity, but more research for refinement is needed. Future studies are also needed to develop strategies to comprehensively capture both the healthcare tasks and impacts for people living with multimorbidity and to decrease treatment burden using a holistic approach to improve relevant outcomes.

TRIAL REGISTRATION

DOI: https://doi.org/10.17605/OSF.IO/UF46V.

摘要

背景

患有多种疾病的人会承受更多的治疗负担，这可能导致健康状况不佳。尽管之前已经努力理解治疗负担的概念，但人们对患有多种疾病的人的治疗负担仍未进行深入探索，这可能限制了我们对这一人群的治疗负担的理解。本研究旨在确定多种疾病患者的治疗负担的组成部分、影响因素和健康结果，以绘制出患有多种疾病的人所经历的治疗负担综合图谱。本研究的第二个目的是确定用于评估患有多种疾病的人的治疗负担的工具，并评估这些工具的全面性。

方法

本综合评价使用电子数据库 MEDLINE、EMBASE、CINAHL 和文章参考文献，检索时间截至 2023 年 5 月。如果研究探讨了成年患有多种疾病的人的治疗负担，则纳入所有发表在英文期刊上的实证研究。使用预定模板进行数据提取。

结果

本综述纳入了 30 项研究。治疗负担包括四项医疗保健任务以及这些任务给患有多种疾病的人带来的社会、情感和经济影响。多重疾病的背景、个人的情况以及内部和外部资源的可用性如何影响治疗负担。我们发现，治疗负担的增加会导致治疗不依从、疾病进展、健康状况和生活质量差以及照顾者负担。有三种工具用于测量患有多种疾病的人的治疗负担。这些工具在医疗保健任务和影响方面的全面程度有所不同。然而，没有一个项目涉及到不断调整各种医疗保健任务的优先级这一医疗保健任务。

结论

我们绘制了一张综合图谱，说明了治疗负担、多重疾病的背景、人们的资源以及健康结果之间的关系。现有的衡量标准都没有包含一个询问各种医疗保健任务之间持续优先级设定过程的项目，这突出了需要改进衡量标准。我们的研究结果更深入地了解了多重疾病中的治疗负担，但需要进一步研究来完善。未来的研究还需要开发策略，以全面捕捉患有多种疾病的人的医疗保健任务和影响，并采用整体方法来减轻治疗负担，从而改善相关结果。