Feng Xiyu, Sarma Haribondhu, Kelly Matthew
Department of Applied Epidemiology National Centre of Epidemiology and Population Health The Australian National University Canberra Australia.
Public Health Chall. 2024 Jul 15;3(3):e218. doi: 10.1002/puh2.218. eCollection 2024 Sep.
Multimorbidity, the coexistence of two or more chronic conditions, presents a growing global challenge, particularly in low- and middle-income countries such as Southeast Asia. This trend necessitates the development of sustainable integrated care models to prevent and manage multimorbidity effectively. However, progress in this area has been hampered, especially in underdeveloped regions, by various barriers, including the epidemiology of multimorbidity, how to get different specialists and doctors to work together most availably and manage the multiple medication issues and how to develop cost-effective approaches to reduce the health burden of multimorbidity. Preventive measures in Southeast Asia, which could tackle multiple components which commonly comprise multimorbidity, include enhancing health literacy and health promotion through school- and community-based educational activities, primary healthcare and related policies on employing taxes on tobacco, alcohol and sugary beverages. The social determinants of health-encompassing poverty and low education may also influence research on multimorbidity. Moreover, stakeholder engagements involving national governments, World Health Organization (WHO) and Association of Southeast Asian Nations (ASEAN) are crucial. Management strategies focus on integrated care models, including patient-centred primary healthcare, digital healthcare technologies, and medication management to control polypharmacy. Although research on multimorbidity in Southeast Asia is increasing, translating findings into practical measures was limited. Future efforts should prioritize evidence-based approaches to prevent and manage multimorbidity effectively, addressing challenges like health system focusing on single chronic disease treatment independently, resource limitations, healthcare provider shortages and individual adherence issues. These ways promise to enhance the quality of life and health outcomes in this region.
多重疾病，即两种或更多种慢性病共存，是一个日益严峻的全球性挑战，在东南亚等低收入和中等收入国家尤为突出。这种趋势使得有必要开发可持续的综合护理模式，以有效预防和管理多重疾病。然而，这一领域的进展受到了各种障碍的阻碍，特别是在欠发达地区，这些障碍包括多重疾病的流行病学、如何让不同专科医生最有效地协同工作并处理多种用药问题，以及如何制定具有成本效益的方法来减轻多重疾病的健康负担。东南亚的预防措施可以解决通常构成多重疾病的多个方面问题，包括通过学校和社区教育活动、初级医疗保健以及对烟草、酒精和含糖饮料征税等相关政策来提高健康素养和促进健康。包括贫困和低教育水平在内的健康社会决定因素也可能影响对多重疾病的研究。此外，涉及各国政府、世界卫生组织（WHO）和东南亚国家联盟（ASEAN）的利益相关者参与至关重要。管理策略侧重于综合护理模式，包括以患者为中心的初级医疗保健、数字医疗技术以及控制多药联用的药物管理。尽管东南亚对多重疾病的研究正在增加，但将研究结果转化为实际措施的情况有限。未来的努力应优先采用基于证据的方法，以有效预防和管理多重疾病，应对诸如卫生系统独立专注于单一慢性病治疗、资源限制、医疗服务提供者短缺以及个体依从性问题等挑战。这些方法有望提高该地区的生活质量和健康成果。
