多病症の非常に高齢の集団における多病医と健康の結果:日本における遡及的なコホート研究
Takayuki Ando1, Takashi Sasaki2, Hirohisa Fujikawa3
1Center for General Medicine Education, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. takayuki.ando@keio.jp.
Scientific reports
|September 1, 2025
まとめ
複数の医者に診てもらうことは 患者の健康に 影響を及ぼします 死亡リスクを下げる一方で 入院と費用を増加させ 高齢者のための最適な範囲は 定期的に入院する施設2~3か所です
科学分野:
- ゲロントロジー
- 医療サービス研究
- 流行病学について
背景:
- 複数の定期的に訪問施設 (RVF) で定義されるポリドクタリングは,慢性疾患の高齢者集団で一般的です.
- 患者の治療成果と医療費への影響を理解することは 持続可能な医療に不可欠です
- 現存する研究は,RVFの数と様々な健康上の結果の間の微妙な関係を完全に捉えていないかもしれません.
研究 の 目的:
- 定期的な訪問施設 (RVF) の数と高齢者の患者のアウトカムとの関連を調べる.
- 死亡率,入院,医療費を最小限に抑えるために 最適なRVF数を決定する.
- 介護の調整と資源管理のための戦略を策定する.
主な方法:
- 日本の人口ベースのデータセットを使用した遡及コホート研究 (2014年4月 - 2022年12月).
- 参加基準:少なくとも2つの慢性疾患を有する75歳から89歳の患者2, 338, 965.
- 評価されたアウトカム:すべての原因による死亡率,入院 (出院ケアに敏感な状態 - ACSCを含む),および外来治療費,RVFの数によって分析された.
主要な成果:
- RVFのない患者は死亡リスクが最も高かった (HR: 3. 23),RVF≥5の患者は死亡リスクが最も低かった (HR: 0. 67).
- ACSCに関連した入院は,RVF ≥5で増加する U型リスクを示した (HR: 1. 13).
- 診療費は5例以上のRVFと1例のRVFの3. 21倍で,RVFの範囲は2〜3例のACSC入院を最小限に抑えた.
結論:
- ポリドクタリングは死亡率の低下と関連しているが,高齢者の入院と費用は増加している.
- ACSCに関連した入院を最小限に抑え,定期的な訪問施設の2〜3の最適な範囲は,利益とリスクをバランスさせるように見える.
- 医療戦略は 介護の調整と資源管理を最適化して 複数の慢性疾患を持つ高齢者を支援することに 焦点を当てるべきです
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