■在撒哈拉以南非洲,多重性疾病(存在两种或多种慢性健康状况)的患病率正在迅速增加。专注于单一提出投诉的医院护理途径并不能解决这个紧迫的问题。这有可能导致频繁的医院再入院,增加卫生系统和自付费用,并可能导致过早的残疾和死亡。我们的目标是在马拉维和坦桑尼亚的多中心前瞻性队列研究中描述住院患者的多发病率。
■临床:确定成人医疗入院中多种疾病的患病率并测量患者的预后。健康经济:测量入院后90天发生的经济成本和与健康相关的生活质量(HRQoL)的变化。情况分析:定性描述多病患者通过卫生系统的途径。
■临床:确定入院后90天的无再入院生存率和疾病控制指标。卫生经济:从患者和卫生系统的角度来看,目前的经济成本,根据不同疾病的存在细分分析成本和HRQoL。情况分析:了解与自身疾病相关的健康素养和多病患者及其照顾者的护理经验。
■这是一项针对成人(≥18岁)急性内科住院的前瞻性纵向队列研究,在四家医院进行了嵌套的健康经济和情况分析:1)伊丽莎白女王中心医院,布兰太尔,马拉维;2)奇拉祖鲁地区医院,马拉维;3)海区医院,BomaNg\'ombe,坦桑尼亚;4)Muhimbili国家医院,达累斯萨拉姆,坦桑尼亚。随访时间为入院后90天。我们将在紧急演示后24小时内使用连续招聘,并在四个地点进行分层招聘。我们将使用即时测试来完善疾病病理的估计。我们将对患者进行定性访谈,看护者,医疗保健提供者和决策者;与患者和护理人员的焦点小组讨论,以及对医院护理途径的观察。
■在撒哈拉以南非洲,多发病率(定义为患有两种或两种以上慢性健康状况的人)由于高传染性而增加(例如,人类免疫缺陷病毒(HIV))和非传染性(例如,高血压和糖尿病)疾病负担。随着人们寿命延长,多发病会增加,并且可能因艾滋病毒和艾滋病毒药物而恶化。患者延迟寻求帮助,直到他们病重,这意味着医院是慢性病医疗保健服务的关键,然而,医院临床医生通常只关注单一疾病。未能识别和治疗多种疾病可能会导致频繁的再入院,高成本,可预防的残疾和死亡。
这项队列研究是一项三阶段研究中的第一项,其总体目标是设计和测试一个系统,以识别在撒哈拉以南非洲医院寻求急诊护理时患有多种疾病的患者。这可以改善早期疾病治疗(减少死亡),确保更好的后续行动和预防残疾,再入院和超额成本。该队列研究旨在确定多患病率,结果和成本。结果将帮助我们与主要利益相关者共同创造最具成本效益的方式,在随机试验中测试此策略之前为患者提供更好的护理。
■在马拉维和坦桑尼亚,我们将确定住院患者的多发病率(重点是高血压,糖尿病,HIV和慢性肾脏疾病),通过加强医院科室治疗急性入院患者的诊断测试。在医疗保健专业人士的帮助下,我们将发现如何最好地将患者与长期护理联系起来并改善自我管理。在绘制卫生系统路径之后,我们将与利益相关者合作(政策制定者,医护人员代表,社区和患者组)共同开发干预措施,以改善多病患者的预后。这项研究将使我们能够收集临床,卫生经济和卫生系统数据为这一过程提供信息。
UNASSIGNED: The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub-Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania.
UNASSIGNED: Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system.
UNASSIGNED: Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers.
UNASSIGNED: This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng\'ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways.
UNASSIGNED: In sub-Saharan Africa, multimorbidity (defined as people living with two or more chronic health conditions) is increasing due to high infectious ( e.g., human immunodeficiency virus (HIV)) and non-communicable ( e.g., high blood pressure and diabetes) disease burdens. Multimorbidity increases as people live longer and can be worsened by HIV and HIV-medications. Patients delay seeking help until they are severely ill, meaning hospitals are key to healthcare delivery for chronic diseases, however hospital clinicians often focus on a single disease. Failure to identify and treat multimorbidity may lead to frequent readmissions, high costs, preventable disability and death.
UNASSIGNED: This cohort study is the first in a three-phase study with the overarching goal to design and test a system to identify patients suffering from multimorbidity when they seek emergency care in sub-Saharan African hospitals. This could improve early disease treatment (reducing death), ensure better follow-up and prevent disability, readmission and excess costs. The cohort study aims to determine multimorbidity prevalence, outcomes and costs. The results will help us co-create with key stakeholders the most cost-effective way to deliver improved care for patients before testing this strategy in a randomised trial.
UNASSIGNED: In Malawi and Tanzania, we will identify multimorbidity among patients admitted to hospital (focusing on high blood pressure, diabetes, HIV and chronic kidney disease), by enhancing diagnostic tests in hospital departments treating acutely admitted medical patients. With the help of healthcare professional, patients and community groups we will find how best to link patients to long-term care and improve self-management. After mapping health system pathways, we will work with stakeholders (policymakers, healthcare worker representatives, community and patient groups) to co-develop an intervention to improve outcomes for patients with multimorbidity. This study will allow us to collect clinical, health economic and health system data to inform this process.