摘要
慢性病共病是指个体同时患有2种及以上的慢性疾病。共病患者常联用多种药物治疗,给社区全科医生的科学用药决策带来了挑战。本文分析了社区共病药物治疗决策困境形成的原因与影响因素,并提出了一种动态的综合性决策框架,即共病药物治疗决策框架(MDMF)。该框架由社区全科医生接诊共病患者的5个阶段构成,包括“健康问题回顾”“用药综合评估”“医患共同决策”“药物治疗记录”和“安排随访计划”。MDMF能够促使社区全科医生为共病患者制定个体化的药物治疗方案,但也对其诊疗能力提出了一定要求。因此,建议对社区全科医生开展以MDMF为核心的培训、提供决策辅助支持,并采取合理的激励与监督措施,推动社区医疗机构提供以患者为中心的药物治疗方案,提升药物治疗的安全性和有效性,减轻患者的治疗负担。
Multimorbidity refers to an individual suffering from two or more chronic diseases simultaneously.Patients with multimorbidity refers often require the concurrent use of multiple medications,posing a challenge to community general practitioners in making scientific medication decisions.This paper analyzes the reasons and influencing factors that lead to the dilemmas in medication decision-making for patients with multimorbidity in the community.It also proposes a dynamic and comprehensive decision-making framework known as the Medication Decision-making for Multimorbidity Framework(MDMF).The framework consists of five stages in the process of community general practitioners treating patients with multimorbidity,which include"Health problems review""Comprehensive medication assessment""Shared decision-making""Medication therapy recording",and"Follow-up arrangement".The MDMF facilitates the development of individualized medication therapy for patients with multimorbidity by community general practitioners,but it also places certain demands on their capabilities.Therefore,it is recommended to provide training for community general practitioners centered on the MDMF,offer decision-making support,and implement reasonable incentives and supervision measures.This is expected to promote primary care institutions to provide patient-centered medication therapy,enhance its safety and efficacy,and alleviate the treatment burden on patients.
作者
夏瑀
罗原
李峥嵘
周馨媚
童钰铃
赵洋
徐志杰
XIA Yu;LUO Yuan;LI Zhengrong;ZHOU Xinmei;TONG Yuling;ZHAO Yang;XU Zhijie(Department of General Practice,Peking University Shenzhen Hospital,Shenzhen 518036,China;Xiaoying Community Health Service Center of Shangcheng District,Hangzhou 310009,China;Department of Pharmacy,Linyi People's Hospital,Linyi 276000,China;Department of General Practice,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;The George Institute for Global Health,University of New South Wales,Sydney 2050,Australia;School of Population and Global Health,University of Melbourne,Melbourne 3010,Australia)
出处
《中国全科医学》
CAS
北大核心
2025年第1期103-110,118,共9页
Chinese General Practice
基金
全球脑健康倡议基金(P01258)
浙江省医药卫生科技计划(2023KY748)。
关键词
慢性病共病
药物治疗决策
决策模型
社区卫生服务
全科医生
Multiple chronic conditions
Medication decision-making
Decision-making model
Community health services
General practitioners
