You Conglei, Zhao Jingyi, Fan Tengyang, Wang Lingling, Zhang Lijuan, Zhao Guohao, Tang Huan, Wang Na, Yang Xu, Yao Mi
Health Management Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 102208, China.
Department of General Practice, Miyun Hospital, Peking University First Hospital, Beijing, 101599, China.
BMC Prim Care. 2025 Aug 28;26(1):270. doi: 10.1186/s12875-025-02967-y.
Multimorbidity is a growing public health concern, especially in countries with aging populations. Although a tiered healthcare system has been implemented to improve primary care, managing patients with multimorbidity has been challenging.
This study conducted focus group discussions involving 21 patients with multimorbidity in Beijing via a flexible topic guide to explore their experiences. Participants were sampled from urban and rural areas, ensuring a diverse representation of demographics and health conditions. The data were analyzed using the framework method. The themes and subthemes were identified through iterative coding and discussion.
Four main themes emerged: (1) Living with multimorbidity, where patients view chronic conditions as an inevitable part of aging but struggle with self-management, particularly medication adherence and lifestyle modifications; (2) healthcare system challenges, driven by ineffective tiered policies and digital exclusion, especially among elderly patients; (3) financial burdens, with rural patients facing greater out-of-pocket costs due to insurance inequities and policy-induced strains; and (4) doctor-patient relationships, where communication gaps and a lack of continuity hinder patient-centered care. Patients emphasized the need for better care coordination, financial support, and empathetic communication.
This study underscores systemic gaps in China's healthcare system for multimorbidity care. To address these issues, policymakers should prioritize (1) strengthening primary care coordination through multidisciplinary teams, (2) expanding financial protection for chronic disease management to reduce urban-rural disparities, and (3) training providers in patient-centered communication and shared decision-making. These actionable steps can serve as a blueprint for LMICs aiming to build integrated, patient-centered systems for multimorbidity management.
多重疾病是一个日益严重的公共卫生问题，在人口老龄化国家尤为如此。尽管已经实施了分级医疗系统以改善初级保健，但管理患有多重疾病的患者一直具有挑战性。
本研究通过灵活的主题指南，在北京对21名患有多重疾病的患者进行了焦点小组讨论，以探索他们的经历。参与者来自城市和农村地区，确保人口统计学和健康状况的多样化代表性。使用框架方法对数据进行分析。通过迭代编码和讨论确定主题和子主题。
出现了四个主要主题：（1）与多重疾病共存，患者将慢性病视为衰老不可避免的一部分，但在自我管理方面存在困难，尤其是药物依从性和生活方式改变；（2）医疗系统挑战，由无效的分级政策和数字排斥驱动，尤其是在老年患者中；（3）经济负担，农村患者由于保险不平等和政策导致的压力面临更高的自付费用；（4）医患关系，沟通差距和缺乏连续性阻碍了以患者为中心的护理。患者强调需要更好的护理协调、经济支持和共情沟通。
本研究强调了中国医疗系统在多重疾病护理方面的系统性差距。为了解决这些问题，政策制定者应优先考虑：（1）通过多学科团队加强初级保健协调；（2）扩大慢性病管理的经济保护以减少城乡差距；（3）培训医疗服务提供者以进行以患者为中心的沟通和共同决策。这些可采取行动的步骤可为旨在建立综合的、以患者为中心的多重疾病管理系统的低收入和中等收入国家提供蓝图。
