Сочетанная патология: дискуссионные вопросы терминологии, учета и влияния на выбор тактики ведения пациента - Журнал Терапевтический архив № 8 Вопросы лечения 2018

Сочетанная патология: дискуссионные вопросы терминологии, учета и влияния на выбор тактики ведения пациента

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Аннотация

В статье представлены дискуссионные вопросы терминологии и учета сопутствующей сочетанной патологии по данным литературы. Обсуждаются определения терминов «коморбидность», «полиморбидность» и «мультиморбидность». Рассмотрены аспекты их возникновения и различия между понятиями. Возможно, для практической работы и проведения эпидемиологических исследований необходимо использование разных терминов. С целью выявления распространенности взаимосвязи между болезнями и состояниями в эпидемиологических исследованиях допустимо применение терминов «коморбидность» (при наличии патогенетической связи) и «полиморбидность» (при отсутствии патогенетической связи). Для клинической практики более рациональным видится применение термина «мультиморбидность», который, в отличие от клинического диагноза, включает не только сам диагноз, но и взаимосвязь между отдельными диагнозами, симптомами/синдромами, проблемы с мобильностью, самообслуживанием и др. Представлен алгоритм ведения и оптимизации лечения пациентов с учетом мультиморбидности.

Ключевые слова: мультиморбидность, полиморбидность, коморбидность, хронические заболевания.

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The purpose of the present review is to bring into focus the issues regarding terminological and registration aspects of multimorbidity we come across in the modern literature. Key questions regarding the definitions for the most widely used terms «comorbidity», «polymorbidity» and «multimorbidity» are discussed. We also considered the aspects of their origin and distinctive features between the concepts. The interaction between illnesses can exacerbate one another, modify the clinical picture and course of illnesses, the nature and severity of complications, lead to a progressive worsening of the prognosis and quality of life in patients. It has been proposed that the terms of “comorbidity» (in case of presence of the pathogenesis interrelation) or “polimorbidity» (in case of absence of the pathogenesis interrelation) are the most appropriate diagnostic and treatment patterns for practice and epidemiological study. «Multimorbidity» seems to be a more appropriate term for clinical practice usage, because it involves not only diagnosis but also interaction between diagnosises, symptoms/syndromes, the mobility or self-care problems et al. The algorithm of the managing patients with multimorbidity is presented.

Keywords: multimorbidity, polymorbidity, comorbidity, chronic diseases.

Список литературы

1. 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 Oct;28(5):516-523. doi: 10.1093/fampra/cmr013
2. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009 Jul-Aug;7(4):357-363. doi: 10.1370/afm.983
3. Ording A, Sorensen H. Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs. Clin Epidemiol. 2013;5:199-203. doi: 10.2147/CLEP.S45305
4. Wallace E, Guthrie B, Lewi C, Fahey T, Smith S. Managing patients with multimorbidity in primary care. BMJ. 2015;350. doi: 10.1136 /bmj.h176
5. Mercer S, Smith S, Wyke S. Multimorbidity in primary care: developing the research agenda. Fam Pract. 2009;26(2):79-80. doi: 10.1093/ fampra/cmp020
6. Clinical assessment and management of multimorbidity: summary of NICE guidance. BMJ. 2016;354:i4843 doi: org/10.1136/bmj.i4843
7. Kirchhof P, Benussi S, Dipak Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO). Eur Heart J. 2016;37:2893-2962. doi: 10.1093/eurheartj/ehw210
8. Pefoyo A, Bronskill S, Gruneir A, Calzavara A, Thavorn K, Petrosyan Y, Maxwell C, Bai Y, Wodchis W. The Increasing Burden and Complexity of Multimorbidity. BMC Public Health. 2015;15(415). doi: 10.1186/ s12889-015-1733-2
9. Glynn L, Valderas J, 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. doi: 10.1093/ fampra/cmr013
10. Van Oostrom S, Picavet H, van Gelder B, Lemmens L, Hoeymans N, van Dijk C, Verheij R, Schellevis F, Baan C. Multimorbidity and comorbidity in the Dutch population – data from general practices. BMC Public Health. 2012;12:715. doi: 10.1186/1471-2458-12-715
11. Fortin M, Dubois M, Hudon C, Soubhi H, Almirall J. Multimorbidity and quality of life: a closer look. Health Qual Life Outcomes. 2007;5:52. doi: 10.1186/1477-7525-5-52
12. Fortin M, Hudon C, Haggerty J, Akker MV, Almirall J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res. 2010;10:111. doi: 10.1186/1472-6963-10-111
13. O'Kelly S, Smith S, Lane S, Teljeur C, O'Dowd T. Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting. Respir Med. 2011;105(2):236-242. doi: 10.1016/j. rmed.2010.07.019
14. Uijen A, van de Lisdonk E. Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008;14 Suppl 1:28-32. doi: 10.1080/13814780802436093
15. Agborsangaya C, Lau D, Lahtinen M, Cooke T, Johnson J. Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health. 2012;12:201. doi: 1471-2458-12-201
16. Rocca W, Boyd C, Grossardt B, Bobo W, Rutten L, Roger V. Prevalence of multimorbidity in a geographically defined american population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc. 2014;89(10):1336-1349. doi: 10.1016/j.mayocp.2014.07.010
17. Вёрткин А.Л. Коморбидность: история, современное представление, профилактика и лечение. Кардиоваскулярная терапия и профилактика. 2015;14(2):74-79 [Vyortkin AL. Comorbidity: history, modern presentation, prevention and treatment. Kardiovaskulyarnaya Terapiya i Profilaktika. 2015;14(2):74-79 (In Russ.)]. doi: 10.15829/ 1728-8800-2015-2-74-79
18. Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43. doi: S0140-6736(12)60240-2
19. Laux G, Kuehlein T, Rosemann T, Szecsenyi J. Co- and multimorbidity patterns in primary care based on episodes of care: results from the German CONTENT project. BMC Health Serv Res. 2008;8:14.
doi: 10.1186/1472-6963-8-14
20. Mahmoudpour S, Baranova E, Souverein P, et al. on behalf of the
PREDICTION-ADR consortium. Determinants of Angiotensin Converting Enzyme-inhibitor (ACEI) intolerance and angioedema in the UK Clinical Practice Research Datalink. Br J Clin Pharmacol. 2016;82(6): 1647-1659. doi: 10.1111/bcp.13090

________________________________________________

1. 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 Oct;28(5):516-523. doi: 10.1093/fampra/cmr013
2. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009 Jul-Aug;7(4):357-363. doi: 10.1370/afm.983
3. Ording A, Sorensen H. Concepts of comorbidities, multiple morbidities, complications, and their clinical epidemiologic analogs. Clin Epidemiol. 2013;5:199-203. doi: 10.2147/CLEP.S45305
4. Wallace E, Guthrie B, Lewi C, Fahey T, Smith S. Managing patients with multimorbidity in primary care. BMJ. 2015;350. doi: 10.1136 /bmj.h176
5. Mercer S, Smith S, Wyke S. Multimorbidity in primary care: developing the research agenda. Fam Pract. 2009;26(2):79-80. doi: 10.1093/ fampra/cmp020
6. Clinical assessment and management of multimorbidity: summary of NICE guidance. BMJ. 2016;354:i4843 doi: org/10.1136/bmj.i4843
7. Kirchhof P, Benussi S, Dipak Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Endorsed by the European Stroke Organisation (ESO). Eur Heart J. 2016;37:2893-2962. doi: 10.1093/eurheartj/ehw210
8. Pefoyo A, Bronskill S, Gruneir A, Calzavara A, Thavorn K, Petrosyan Y, Maxwell C, Bai Y, Wodchis W. The Increasing Burden and Complexity of Multimorbidity. BMC Public Health. 2015;15(415). doi: 10.1186/ s12889-015-1733-2
9. Glynn L, Valderas J, 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. doi: 10.1093/ fampra/cmr013
10. Van Oostrom S, Picavet H, van Gelder B, Lemmens L, Hoeymans N, van Dijk C, Verheij R, Schellevis F, Baan C. Multimorbidity and comorbidity in the Dutch population – data from general practices. BMC Public Health. 2012;12:715. doi: 10.1186/1471-2458-12-715
11. Fortin M, Dubois M, Hudon C, Soubhi H, Almirall J. Multimorbidity and quality of life: a closer look. Health Qual Life Outcomes. 2007;5:52. doi: 10.1186/1477-7525-5-52
12. Fortin M, Hudon C, Haggerty J, Akker MV, Almirall J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res. 2010;10:111. doi: 10.1186/1472-6963-10-111
13. O'Kelly S, Smith S, Lane S, Teljeur C, O'Dowd T. Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting. Respir Med. 2011;105(2):236-242. doi: 10.1016/j. rmed.2010.07.019
14. Uijen A, van de Lisdonk E. Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008;14 Suppl 1:28-32. doi: 10.1080/13814780802436093
15. Agborsangaya C, Lau D, Lahtinen M, Cooke T, Johnson J. Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health. 2012;12:201. doi: 1471-2458-12-201
16. Rocca W, Boyd C, Grossardt B, Bobo W, Rutten L, Roger V. Prevalence of multimorbidity in a geographically defined american population: patterns by age, sex, and race/ethnicity. Mayo Clin Proc. 2014;89(10):1336-1349. doi: 10.1016/j.mayocp.2014.07.010
17. [Vyortkin AL. Comorbidity: history, modern presentation, prevention and treatment. Kardiovaskulyarnaya Terapiya i Profilaktika. 2015;14(2):74-79 (In Russ.)]. doi: 10.15829/ 1728-8800-2015-2-74-79
18. Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43. doi: S0140-6736(12)60240-2
19. Laux G, Kuehlein T, Rosemann T, Szecsenyi J. Co- and multimorbidity patterns in primary care based on episodes of care: results from the German CONTENT project. BMC Health Serv Res. 2008;8:14.
doi: 10.1186/1472-6963-8-14
20. Mahmoudpour S, Baranova E, Souverein P, et al. on behalf of the
PREDICTION-ADR consortium. Determinants of Angiotensin Converting Enzyme-inhibitor (ACEI) intolerance and angioedema in the UK Clinical Practice Research Datalink. Br J Clin Pharmacol. 2016;82(6): 1647-1659. doi: 10.1111/bcp.13090

Авторы

И.И. Чукаева 1 , И.В. Самородская 2, В.Н. Ларина 1

1 ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России, Москва, Россия;
2 ФГБУ «Государственный научно-исследовательский центр профилактической медицины Минздрава России», Москва, Россия

________________________________________________

I.I. Chukayeva 1 , I.V. Samorodskaya 2, V.N. Larina 1

1 N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia;
2 State Research Center for Preventive Medicine, Ministry of Health of Russia, Moscow, Russia

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