Challenges and perspectives of preventive medicine in primary care

Close metadata

An increase in life expectancy is accompanied by growth in the number of people who suffer from several chronic diseases, which is associated with a high risk of death and the cost of medical care. Multimorbidity is most commonly defined as the concurrence of two or more chronic diseases in an individual, which reduces human functional abilities and quality of life, often worsens prognosis, and requires elaboration of novel approaches to managing patients. The presence of several chronic diseases can accelerate the development of so-called frailty and vice versa. Frailty is considered to be a medical syndrome or condition due to several causes and factors, which is characterized by a decline in physical strength, endurance, and physiological functions of organs and systems, which enhances human vulnerability and increases the risk of death (a condition that is not a direct consequence of aging). Current clinical guidelines for the management of a patient with a certain disease/condition cannot be considered as the gold standard for the management of multimorbid/frail patients, which requires a revision of the paradigm of medicine as a branch aimed at preventing and treating specific cases of disease in primary health care, taking into account the patient’s individual characteristics. In this connection, a physician plays a leading role in the organization of medical services to a multimorbid patient, because a patient-centered approach is now considered as a key element of the quality of medical care.

Keywords:

multimorbidity

frailty

physician

P4 medicine

patient-centered approach

Authors:

Drapkina O.M.

Pervyĭ Moskovskiĭ gosudarstvennyĭ meditsinskiĭ universitet im. I.M. Sechenova, Klinika propedevtiki vnutrennikh bolezneĭ, gastroénterologii i gepatologii

SPIN RSCI: 4456-1297
Scopus AuthorID: 57208852308
ResearcherID: G-8443-2016
ORCID: 0000-0002-4453-8430

Samorodskaia I.V.

FGBU "Gosudarstvennyĭ nauchno-issledovatel'skiĭ tsentr profilakticheskoĭ meditsiny" Minzdrava Rossii, Moskva

SPIN RSCI: 6470-5709
Scopus AuthorID: 56165905100
ORCID: 0000-0001-9320-1503

Larina V.N.

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia

List of references:

Palomo L, Rubio C, Gérvas J. The comorbidity in primary care. Gac Sanit. 2006;20(Suppl 1):182-191.
Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, Murphy AW. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011;28(5):516-523. https://doi.org/10.1093/fampra/cmr013
Ording A, Sorensen H. Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs. Clin Epidemiol. 2013;5:199-203. https://doi.org/10.2147/CLEP.S45305
Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith S. Managing patients with multimorbidity in primary Managing patients with multimorbidity in primary care. BMJ. 2015;350: h176. https://doi.org/10.1136/bmj.h176
National Guideline Centre. Multimorbidity: clinical assessment and management. London (UK): National Institute for Health and Care Excellence. NICE. 2016;23. (NICE guideline; no. 56).
Shamurova YuYu, Kalev OF, Tyukov YuA. Polypathia in male patients: scale of problem. Problemy Sotsial’noy Gigieny. Zdravookhraneniya i Istorii Meditsiny. 2008;3:25-27. (In Russ.)].
Kraemer HC. Statistical issues in assessing comorbidity. Stat Med. 1995;14:721-723.
Van den Akker M, Buntinx F, Roos S, Knottnerus JA. Comorbidity or multimorbidity: what’s in a name? A review of the literature. Eur J Gen Pract. 1996;2:65-67.
Pefoyo A, Bronskill S, Gruneir A, Galzavara A, Thavorn K, Petrosyan Y, Maxwell C, Bai Y, Wodchis W. The Increasing Burden and Complexity of Multimorbidity. BMC Public Health. 2015;15:415. https://doi.org/10.1186/s12889-015-1733-2
Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005;3(3):223-228. https://doi.org/10.1370/afm.272
Fortin M, Dubois MF, Hudon C, Soubhi H, Almirall J. Multimorbidity and quality of life: a closer look. Health Qual Life Outcomes. 2007;5:52. https://doi.org/1477-7525-5-52
Fortin M, Hudon C, Haggerty J, Akker M, Almirall J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res. 2010;10:111. https://doi.org/10.1186/1472-6963-10-111
Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, Murphy A. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Fam Pract. 2011;28(5):516-523. https://doi.org/10.1093/fampra/cmr013
Uijen AA, van de Lisdonk EH. Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008;14(Suppl 1):28-32. https://doi.org/10.1080/13814780802436093
Wolff J, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002;162(20):2269-2276.
De Groot V, Beckerman H, Lankhorst G, Bouter L. How to measure comorbidity. J Clin Epidemiol. 2003;56(3):221-229.
Sarfati D. Review of methods used to measure comorbidity in cancer populations: no gold standard exists. J Clin Epidemiol. 2012;65(9):924-933. https://doi.org/10.1016/j.jclinepi.2012.02.017
Yurkovich M, Avina-Zubieta JA, Thomas J, Gorenchtein M, Lacaille D. A systematic review identifies valid comorbidity indices derived from administrative health data. J Clin Epidemiol. 2015;68(1):3-14. https://doi.org/10.1016/j.jclinepi.2014.09.010
van Oostrom S, Picavet HS, van Gelder BM, Lemmens LC, Hoeymans N, van Dijk CE, Verheij RA, Schellevis FG, Baan CA. Multimorbidity and comorbidity in the Dutch population — data from general practices. BMC Public Health. 2012;30:12:715. https://doi.org/10.1186/1471-2458-12-715
Beard J, Officer A, de Carvalho I, Sadana R, Pot A, Michel J, Lloyd-Sherlock P, Epping-Jordan J, Peeters G, Mahanani W, Thiyagarajan J, Chatterji S. The World report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387:2145-2154. https://doi.org/10.1016/S0140-6736(15)00516-4
Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 Countries. J Gerontol A Biol Sci Med Sci. 2009;64A(6):675-681. https://doi.org/10.1093/gerona/glp012
Vetrano D, Calderón-Larrañaga A, Marengoni A, et al. An international perspective on chronic multimorbidity: approaching the elephant in the room. The Journals of Gerontology: series A, glx178. https://doi.org/10.1093/gerona/glx178
Peters M, Joehanes R, Pilling L, et al. The transcriptional landscape of age in human peripheral blood. Nature Communications. 2015;6:8570. https://doi.org/10.1038/ncomms9570
Lansbury L, Roberts H, Clift E, Herklots A, Robinson N, Sayer A. Use of the electronic Frailty Index to identify vulnerable patients: a pilot study in primary care. Br J Gen Pract. 2017;67(664):e751-e756. https://doi.org/10.3399/bjgp17X693089
WHO performance status scale. In: dictionary of pharmaceutical medicine. Springer, Vienna. 2009;194. https://link.springer.com/chapter/10.1007/978-3-211-89836-9_1473
Kersting S, Neppelenbroek S, Visser H, et al. Clinical practice guidelines for diagnosis and treatment of chronic lymphocytic leukemia in the Netherland. Clin. Lymphoma Myeloma Leuk. 2018;181:52-57. https://doi.org/10.1016/j.clml.2017.09.015
Averill R, Goldfield N, Eisenhandler J, Muldoon J, Hughes J, Neff J, Gay J, Gregg L, Gannon D, Shafir B, Bagadia F, Steinbeck B. Development and evaluation of clinical risk groups. Final report to the National Institutes of standards and technology. US Dep Commerce. https://solutions.3m.com/3MContentRetrievalAPI/BlobServlet?lmd=1225920653000&assetId=%201180606514454&assetType=MMM_Image&blobAttribute=ImageFile
ANMCO/SIC/SICI-GISE/SICCH Consensus document: risk stratification in elderly patients undergoing cardiac surgery and TAVI. Eur Heart J Suppl. 2017. 19 (Suppl D):D354-D369. https://doi.org/10.1093/eurheartj/sux012
ESC/EACTS Guidelines for the management of valvular heart disease: The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). https://doi.org/10.1093/eurheartj/ehx391
Shishkin SV, Boyarsky SG, Vlasov VV, Zasimova LS, Kolosnitsyna MG, Kuznetsov PP. Zdravookhraneniye: necessary answers to time calls. M.: HSE; 2018. (In Russ.)
May C, Montori V, Mair F. We need minimally disruptive medicine. BMJ. 2009;11:339:b2803. https://doi.org/10.1136/bmj.b2803
Serrano V, Spencer-Bonilla G, Boehmer KR, Montori VM. Minimally disruptive medicine for patients with diabetes. Curr Diab Rep. 2017;17(11):104. https://doi.org/10.1007/s11892-017-0935-7
Kavarana MN, Sade RM. Ethical issues in cardiac surgery. Future Cardiol. 2012;8(3):451-465. https://doi.org/10.2217/fca.11.91

Close metadata