Multimorbidite

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Multimorbidity a Concept for Family MedicineWithin Europe
Avrupa'da Aile Hekimliğinde Multimorbidite Konsepti
Jean Yves LE RESTEa, Paul VAN ROYENb
aDepartment of General Practice, Université de Bretagne Occidentale, Brest, FRANCE
bDepartment of Primary and Interdisciplinary Care, University of Antwerp, Faculty of Medicine and Health Sciences, BELGIUM
Le Reste JY, Van Royen P. Multimorbidity a concept for family medicine within Europe. Topsever P, editör. Multimorbidite. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.1-5.
Article Language: EN
ABSTRACT
Multimorbidity is a concept encompassing all medical conditions of a patient. The concept links to the European definition of Family Medicine (FM). However, the definition of multimorbidity was unclear. Consequently the European General Practice Research Network (EGPRN) considered the concept as important and set up a research group to clarify it. Using a step by step method the EGPRN operated a systematic review of literature to design a comprehensive definition of Multimorbidity, a Delphi consensus to translate it in 10 European languages, a European wide qualitative survey to explore how European FPs perceived and worked with this concept and, whether they would add new themes to it, a nominal group to draw a research agenda for FM and a pilot cohort survey to test if this broad concept was reducible. The main results are: 'Multimorbidity is defined as any combination of chronic disease with at least one other disease (acute or chronic) or bio-psychosocial factor (associated or not) or somatic risk factor. Any bio-psychosocial factor, any risk factor, the social network, the burden of diseases, the health care consumption and the patient's coping strategies may function as modifiers (of the effects of multimorbidity). Multimorbidity may modify the health outcomes and lead to an increased disability or a decreased quality of life or frailty'. The use of the Wonca's core competencies of FM and the dynamics of the doctor-patient relationship looked useful for FPs in detecting and managing Multimorbidity and patient's complexity. The concept seems reducible for clinical use.

Keywords: Multimorbidity; family practice
ÖZET
Multimorbidite, bir hastada birçok tıbbi durumu birarada bulunması demektir. Bu tanım, Avrupa Aile Hekimliği (FM)'ne aittir. Yine de çok net bir tanım değildir. Nitekim, Avrupa Genel Pratik Araştırma Network'ü (EGPRN) bu tanımın bir araştırma grubunca yapılmasını önermiştir. EGPRN organizasyonunda multimorbiditenin karşılaştırmalı tarifini yapmak için bir sistematik literatür taraması adım adım planlanmıştır. Delphi Konsensusu 10 Avrupa dilinin çevirisini üstlenmiştir, böylece tüm Avrupa'da aile hekimlerinin bu alandaki algılarının ve uygulamalarının incelenip araştırılması amacıyla kalitatif çalışma yapılması kararlaştırılmıştır. Bu konuya yeni temalar ekleyip eklemedikleri incelenecektir. Bir pilot kohort çalışması için nominal grup belirlenmiştir. Başlıca sonuçlar şu şekildedir: Multimorbidite, en az 1 ya da daha fazla akut/kronik hastalığın mevcut bir kronik hastalığa eşlik etmesi; ya da psikososyal faktörlerin (asosiye ya da değil) veya somatik risk faktörlerinin kombinasyonu şeklinde tarif edilebilir. Tabloyu herhangi bir biyo-psikososyal faktör, risk faktörü, sosyal ağlar bağlantılar, hastalık yükü, hastanın bakım hizmetleri ve hastanın kendi tutum davranışları, modifiyer olarak etkileyebilir. Multimorbidite dizabilitelerin/ engelliliklerin artışı ve yaşam kalitesinin düşmesi şeklinde tıbbi sonuçları etkiler. Aile hekimlerinin uzmanlıklarında Wonca kullanılması ve doktor-hasta ilişkilerinin dinamiklerinin yeniden gözden geçirilmesi gerekmektedir. Böylece multimorbiditenin yarattığı kompleks durumun yönetimi, klinik açıdan da kolaylaşacaktır.

Anahtar Kelimeler: Multimorbidite; aile hekimliği

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