Innovative management strategies for multimorbidity based on general practice medicine
Objective To explore the status quo of multi-chronic disease(Multimorbidity,MMD)and its related factors,and to guide the implementation of patients mutual assistance,physician-physician interaction and doctor-patient shared decision-making in the management of MMD in the Internet Age.Methods In 2019,6 376 respondents in the project of early screening and comprehensive intervention of cardiovascular high-risk population in Yongqiao District of Anhui Province were selected as research objects.Baseline information,physical examina-tion and laboratory test results were collected.Logistic regression and multiple correspondence analysis were used to study the related factors of MMD and Colaizzi 7-step analysis was used to analyze the data of a semi-structured interview.Results The detection rate of 11 chronic diseases in 6366 community population was 36.6％,with hy-pertension(54.7％)accounting for the highest proportion.The prevalence rate of MMD was 24.4％,with hyper-tension plus diabetes(63.0％),hypertension plus diabetes plus stroke(24.7％)accounting for the highest pro-portion.There were statistically significant differences in the prevalence of MMD among community populations with different awareness rates of hypertension,dyslipidemia,diabetes,hypertension control,diabetes control,and dyslipidemia control(all P＜0.05).Multivariate logistic regression analysis results showed that people with higher awareness rates of hypertension,diabetes and dyslipidemia had lower risk of MMD(all P＜0.05).The results of multiple correspondence analysis suggested that there were strong correlations among fatty liver,hyperlipidemia,hyperuricemia,dyslipidemia,angina pectoris,stroke,hypertension,cancer,diabetes,and COPD.A semi-struc-tured interview outline was used to conduct the interview,and four main problems were found,including low pa-tients'health beliefs,insuficient trust between doctors and patients,less energetic grassroots doctors and doctors in Grade Ⅲ level A hospitals,and weak service capacity of basic health centers.Conclusions The population who are old,males,with low educational background,and who smoke,live an irregular life,drink excessively,and seldom do exercise should be taken as the key objects for MMD screening and prevention.In the Internet Age,general practice of medicine promotes patient-patient mutual assistance,physician-physician interaction,and doc-tor-patient shared decision making,which can further improve healthcare services for community residents to a-chieve active control and prevention of chronic diseases.
General practiceMultimorbidityMultiple correspondence analysisInnovative manage-mentSemi-structured interviewInternet medicine
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