多病共存慢性病个性化健康教育模式的探讨

曹琳; 杨振华; 肖卫忠

doi:10.16766/j.cnki.issn.1674-4152.003014

多病共存慢性病个性化健康教育模式的探讨

doi: 10.16766/j.cnki.issn.1674-4152.003014

曹琳¹,
杨振华¹,
肖卫忠^{1, 2, ,}

1.
北京大学第三医院全科医学科，北京 100191
2.
北京大学第三医院神经内科

基金项目:

2021年全国全科医学教育教学研究课题 B-YXGP20210201-01

详细信息

通讯作者:
肖卫忠，E-mail: weizhongx@sina.com

中图分类号: R473.59 R193
计量
- 文章访问数: 113
- HTML全文浏览量: 50
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-06
- 网络出版日期: 2023-08-26

Discussion on the personalized health education model for chronic diseases with multimorbidity

1.
General Practice Department, Peking University Third Hospital, Beijing 100191, China

摘要

摘要: 近年来多病共存患病率逐年增加，与单种慢性病患者相比其疾病负担更重、预后更差，已成为全球医疗卫生难题。针对多病共存患者的复杂病情，以疾病为中心的被动医疗服务模式难以满足患者主动健康的需要，以及更好地改善患者疾病预后、提高其生活质量。目前国内外没有多病共存个性化健康教育的统一模式，但单种慢性病健康教育处方的简单叠加，并不适用于病情复杂的多病共存患者。在此背景下，需要建立一种科学可行的多病共存患者个性化健康教育模式，在充分评估患者临床资料、运动睡眠、营养膳食、精神心理、疾病负担等的基础上，对患者的药物治疗、健康行为和生活方式进行个性化的健康教育指导，最后在长期随访过程中不断评价健康教育效果，调整患者的健康教育方案。随着我国医药卫生体制改革的推进，分级诊疗制度、家庭签约服务等基本公共卫生服务建设基本完善，全科医生已有能力进行包括个性化健康教育在内的多病共存综合健康管理服务。因此，针对多病共存患者的共性问题，本文综合国内外慢性病健康教育的相关研究，从健康教育评估、处方制订、效果评价三方面对多病共存的个性化健康教育模式进行探讨，以期为制订我国多病共存健康教育处方提供参考。
- 多病共存 /
- 慢性病 /
- 健康教育 /
- 教育模式
Abstract: Chronic diseases with multimorbidity refers to one person concurrently suffers from two or more chronic diseases. Recent years have witnessed an increasing prevalence of multimorbidity, which results in a heavier burden and a worse patient prognosis compared with a single chronic disease, becoming a global healthcare challenge. In view of the complex medical conditions of patients with multimorbidity, the disease-centered passive care model is difficult to meet the proactive care needs of these patients, and to better their prognosis and quality of life. There is still no a unified personalized health education model for multimorbidity, but the health education model derived from simply merged health education prescriptions for single chronic diseases is not suitable for patients with multimorbidity. Thus, it is necessary to establish a scientific and feasible personalized health education model for patients with multimorbidity, which can provide the patients with personalized health education guidance involving pharmacological treatment, health behaviors and lifestyle based on a thorough assessment of their clinical data, exercise and sleep quality, nutritional status and diet, mental and psychological status and disease burden. The health education plan can be adjusted according to its effectiveness continuously evaluated during a long-term follow-up. In China, with the promotion of healthcare and pharmaceutical reform, the development of hierarchical medical system and family doctor services and other public health services has been improved basically, and general practitioners are capable to provide comprehensive health management services including personalized health education for patients with multimorbidity. Considering the common health problems in patients with multimorbidity, we reviewed studies on chronic disease health education, and discussed three aspects (health education assessment, health prescription development, effectiveness assessment) that should be focused on in the development of a personalized health education model for multimorbidity, with a view to providing a reference for the formulation of health education prescriptions for Chinese patients with multimorbidity.
- Multimorbidity /
- Chronic diseases /
- Health education /
- Education model

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参考文献(44)

[1]	FAN J N, SUN Z J, YU C Q, et al. Multimorbidity patterns and association with mortality in 0.5 million Chinese adults[J]. Chin Med J(Engl), 2022, 135(6): 648-657.
[2]	DE SOUZA A S S, BRAGA J U. Trends in the use of health services and their relationship with multimorbidity in Brazil, 1998—2013[J]. BMC Health Serv Res, 2020, 20(1): 1080. doi: 10.1186/s12913-020-05938-4
[3]	ZHAO Y, ATUN R, OLDENBURG B, et al. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data[J]. Lancet Glob Health, 2020, 8(6): e840-e849. doi: 10.1016/S2214-109X(20)30127-3
[4]	HANLON P, HANNIGAN L, RODRIGUEZ-PEREZ J, et al. Representation of people with comorbidity and multimorbidity in clinical trials of novel drug therapies: an individual-level participant data analysis[J]. BMC Med, 2019, 17(1): 201. doi: 10.1186/s12916-019-1427-1
[5]	JVRISSON M, PISAREV H, UUSKULA A, et al. Physical-mental health comorbidity: a population-based cross-sectional study[J]. PLoS One, 2021, 16(12): e0260464. DOI: 10.1371/journal.pone.0260464.
[6]	PAN T X, MERCER S W, ZHAO Y, et al. The association between mental-physical multimorbidity and disability, work productivity, and social participation in China: a panel data analysis[J]. BMC Public Health, 2021, 21(1): 376. doi: 10.1186/s12889-021-10414-7
[7]	THE LANCET. Making more of multimorbidity: an emerging priority[J]. Lancet, 2018, 391(10131): 1637. doi: 10.1016/S0140-6736(18)30941-3
[8]	HEAD A, FLEMING K, KYPRIDEMOS C, et al. Multimorbidity: the case for prevention[J]. J Epidemiol Community Health, 2021, 75(3): 242-244.
[9]	吕书红, 李长宁, 吴敬, 等. 2009—2018年国家基本公共卫生服务健康教育实施状况分析[J]. 中国健康教育, 2021, 37(12): 1082-1086, 1120. doi: 10.16168/j.cnki.issn.1002-9982.2021.12.005 LYU S H, LI C N, WU J, et al. Progress in the implementation of health education in the essential public health services program in China, 2009-2018[J]. Chinese Journal of Health Education, 2021, 37(12): 1082-1086, 1120. doi: 10.16168/j.cnki.issn.1002-9982.2021.12.005
[10]	FOO K M, SUNDRAM M, LEGIDO-QUIGLEY H. Facilitators and barriers of managing patients with multiple chronic conditions in the community: a qualitative study[J]. BMC Public Health, 2020, 20(1): 273. doi: 10.1186/s12889-020-8375-8
[11]	DAMARELL R A, MORGAN D D, TIEMAN J J. General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research[J]. BMC Fam Pract, 2020, 21(1): 131. doi: 10.1186/s12875-020-01197-8
[12]	ANGKURAWARANON C, PAPACHRISTOU NADAL I, MALLINSON P A C, et al. Scalable solution for delivery of diabetes self-management education in Thailand (DSME-T): a cluster randomised trial study protocol[J]. BMJ Open, 2020, 10(10): e036963. DOI: 10.1136/bmjopen-2020-036963.
[13]	姚元龙, 史威力, 冯娴, 等. 老年共病的研究管理策略[J]. 中华全科医学, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574 YAO Y L, SHI W L, FENG X, et al. Research management strategies for multimorbidity in elderly patients[J]. Chinese Journal of General Practice, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574
[14]	KUDESIA P, SALIMAROUNY B, STANLEY M, et al. The incidence of multimorbidity and patterns in accumulation of chronic conditions: a systematic review[J]. J Multimorb Comorb, 2021, 11: 26335565211032880. DOI: 10.1177/26335565211032880.
[15]	WETTERLING T. Pathogenesis of multimorbidity-what is known?[J]. Z Gerontol Geriatr, 2021, 54(6): 590-596. doi: 10.1007/s00391-020-01752-z
[16]	BLASCHKE S, CARL J, ELLINGER J, et al. The role of physical activity-related health competence and leisure-time physical activity for physical health and metabolic syndrome: a structural equation modeling approach for German office workers[J]. Int J Environ Res Public Health, 2021, 18(19): 10153. DOI: 10.3390/ijerph181910153.
[17]	CLELAND C, FERGUSON S, ELLIS G, et al. Validity of the international physical activity questionnaire (IPAQ) for assessing moderate-to-vigorous physical activity and sedentary behaviour of older adults in the United Kingdom[J]. BMC Med Res Methodol, 2018, 18(1): 176. doi: 10.1186/s12874-018-0642-3
[18]	HENRIKSEN C, PAUR I, PEDERSEN A, et al. Agreement between GLIM and PG-SGA for diagnosis of malnutrition depends on the screening tool used in GLIM[J]. Clin Nutr, 2022, 41(2): 329-336. doi: 10.1016/j.clnu.2021.12.024
[19]	李虹, 黎明, 陈鑫, 等. 基于微信平台的视频化健康教育对颈椎病患者居家功能锻炼的影响[J]. 现代医药卫生, 2022, 38(8): 1394-1397. doi: 10.3969/j.issn.1009-5519.2022.08.032 LI H, LI M, CHEN X, et al. The influence of video health education based on wechat platform on home functional exercise for patients with cervical spondylosis[J]. Journal of Modern Medicine & Health, 2022, 38(8): 1394-1397. doi: 10.3969/j.issn.1009-5519.2022.08.032
[20]	DE BEURS E, CARLIER I, VAN HEMERT A. Psychopathology and health-related quality of life as patient-reported treatment outcomes: evaluation of concordance between the Brief Symptom Inventory (BSI) and the Short Form-36 (SF-36) in psychiatric outpatients[J]. Qual Life Res, 2022, 31(5): 1461-1471. doi: 10.1007/s11136-021-03019-5
[21]	GEDA N R, JANZEN B, PAHWA P. Chronic disease multimorbidity among the Canadian population: prevalence and associated lifestyle factors[J]. Arch Public Health, 2021, 79(1): 60. doi: 10.1186/s13690-021-00583-7
[22]	丁政, 李翔宇, 陈欢, 等. 电子烟、加热烟草产品和水烟烟碱依赖量表的研究进展[J]. 烟草科技, 2021, 54(8): 100-112. https://www.cnki.com.cn/Article/CJFDTOTAL-YCKJ202108013.htm DING Z, LI X Y, CHEN H, et al. Research progress on nicotine dependence scales for e-cigarettes, heated tobacco products and waterpipes[J]. Tobacco Science & Technology, 2021, 54(8): 100-112. https://www.cnki.com.cn/Article/CJFDTOTAL-YCKJ202108013.htm
[23]	胡光玲, 乔昕悦, 张林虹, 等. 心房颤动患者睡眠质量与生活质量的相关性分析[J]. 中华全科医学, 2021, 19(1): 24-26, 41. doi: 10.16766/j.cnki.issn.1674-4152.001720 HU G L, QIAO X Y, ZHANG L H, et al. Correlation analysis of sleep quality and life quality in patients with atrial fibrillation[J]. Chinese Journal of General Practice, 2021, 19(1): 24-26, 41. doi: 10.16766/j.cnki.issn.1674-4152.001720
[24]	RAN L, CHEN Q, ZHANG J Y, et al. The multimorbidity of hypertension and osteoarthritis and relation with sleep quality and hyperlipemia/hyperglycemia in China' s rural population[J]. Sci Rep, 2021, 11(1): 17046. DOI: 10.1038/s41598-021-96523-0.
[25]	LEE E S, KOH H L, HO E Q, et al. Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes[J]. BMJ Open, 2021, 11(5): e041219. DOI: 10.1136/bmjopen-2020-041219.
[26]	BEYRER J, MANJELIEVSKAIA J, BONAFEDE M, et al. Validation of an International Classification of Disease, 10th revision coding adaptation for the Charlson Comorbidity Index in United States healthcare claims data[J]. Pharmacoepidemiol Drug Saf, 2021, 30(5): 582-593. doi: 10.1002/pds.5204
[27]	ETON D T, LEE M K, ST SAUVER J L, et al. Known-groups validity and responsiveness to change of the Patient Experience with Treatment and Self-management (PETS vs. 2.0): a patient-reported measure of treatment burden[J]. Qual Life Res, 2020, 29(11): 3143-3154. doi: 10.1007/s11136-020-02546-x
[28]	胡小素, 胡何晶, 张文丽, 等. 健康教育处方在门诊电子病历系统信息化开发及临床应用[J]. 中国公共卫生, 2021, 37(2): 315-318. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202102027.htm HU X S, HU H J, ZHANG W L, et al. Development and application of outpatient medical record system-based electronic prescription on health education for outpatients[J]. Chinese Journal of Public Health, 2021, 37(2): 315-318. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202102027.htm
[29]	OHNO K, TOMORI K, SAWADA T, et al. Examining minimal important change of the Canadian Occupational Performance Measure for subacute rehabilitation hospital inpatients[J]. J Patient Rep Outcomes, 2021, 5(1): 133. doi: 10.1186/s41687-021-00405-y
[30]	BAKAKAI P M, HORACE A, DAWSON N, et al. Defining pediatric polypharmacy: a scoping review[J]. PLoS One, 2018, 13(11): e0208047. DOI: 10.1371/journal.pone.0208047.
[31]	FORSLUND T, CARLSSON A C, LJUNGGREN G, et al. Patterns of multimorbidity and pharmacotherapy: a total population cross-sectional study[J]. Fam Pract, 2021, 38(2): 132-140. doi: 10.1093/fampra/cmaa056
[32]	JØRRING PALLESEN A V, KRISTIANSEN M, WEATENDORP R G J, et al. Polypharmacy occurrence and the related risk of premature death among older adults in Denmark: a nationwide register-based cohort study[J]. PLoS One, 2022, 17(2): e0264332. DOI: 10.1371/journal.pone.0264332.
[33]	ANDERSON E, DURSTINE J L. Physical activity, exercise, and chronic diseases: a brief review[J]. Sports Med Health Sci, 2019, 1(1): 3-10.
[34]	HARRIS L K, SKOU S T, JUHL C B, et al. Recruitment and retention rates in randomised controlled trials of exercise therapy in people with multimorbidity: a systematic review and meta-analysis[J]. Trials, 2021, 22(1): 396. doi: 10.1186/s13063-021-05346-x
[35]	MILLER V, WEBB P, MICHA R, et al. Defining diet quality: a synthesis of dietary quality metrics and their validity for the double burden of malnutrition[J]. Lancet Planet Health, 2020, 4(8): e352-e370.
[36]	BASSAGANYA-RIERA J, BERRY E M, BLAAK E E, et al. Goals in Nutrition Science 2020—2025[J]. Front Nutr, 2021, 7: 606378. DOI: 10.3389/fnut.2020.606378.
[37]	SINGH-MANOUX A, FAYOSSE A, SABIA S, et al. Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: a cohort study[J]. PLoS Med, 2018, 15(5): e1002571. DOI: 10.1371/journal.pmed.1002571.
[38]	ELLERBECK E F, NOLLRN N, HUTCHESON T D, et al. Effect of long-term nicotine replacement therapy vs standard smoking cessation for smokers with chronic lung disease: a randomized clinical trial[J]. JAMA Netw Open, 2018, 1(5): e181843. DOI: 10.1001/jamanetworkopen.2018.1843.
[39]	BILLINGS M E, HALE L, JOHNSON D A. Physical and social environment relationship with sleep health and disorders[J]. Chest, 2020, 157(5): 1304-1312.
[40]	GULIA K K, KUMAR V M. Sleep disorders in the elderly: a growing challenge[J]. Psychogeriatrics, 2018, 18(3): 155-165.
[41]	MARTINEZ-PEREZ P, OROZCO-BELTRÁN D, POMARES-GOMEZ F, et al. Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in type 2 diabetes patients in Spain[J]. Aten Primaria, 2021, 53(2): 101942. DOI: 10.1016/j.aprim.2020.09.007.
[42]	TURCI A M, NOGUEIRA C G, OSBORNE R, et al. Assessing health empowerment-Brazilian cross-cultural adaptation and validity testing of the health education impact questionnaire (heiQ) among people with chronic low back pain[J]. Braz J Phys Ther, 2021, 25(4): 460-470.
[43]	ROMANOWICZ M, OESTERLE T S, CROARKIN P E, et al. Measuring patient satisfaction in an outpatient psychiatric clinic. What factors play a role?[J]. Ann Gen Psychiatry, 2022, 21(1): 2.
[44]	LAKATAMITOU I, LAMBRINOU E, KYRIAKOU M, et al. The Greek versions of the TeamSTEPPS teamwork perceptions questionnaire and Minnesota satisfaction questionnaire "short form"[J]. BMC Health Serv Res, 2020, 20(1): 587.