管理多種健康狀況
資料來源：Abbey Stanford / August 2022 / aidsmap / 財團法人台灣紅絲帶基金會編譯
圖片來源：Monkey Business Images / Shutterstock.com
關鍵點
• 如果您患有 HIV 和其他健康問題，您可能會發現醫療服務並沒有像您希望的那樣緊密結合。
• 您可以自己做很多事情來使事情更順利地進行，並防止出現問題。
• 您可以要求一名醫療保健專業人員協調您在不同服務中的照護。
許多愛滋病毒感染者還有其他健康問題。您可能需要看很多不同的醫生，並且為了您的醫療保健需要去不止一家診所。 例如，您的 HIV 診所可能會照顧您的 HIV，而您的 GP 可能會幫助您治療高血壓或糖尿病等疾病。 您可能還需要就其他疾病（例如關節炎或癌症）與專科醫生進行醫院預約。
本頁面提供有關管理多種慢性（長期）健康狀況的一般信息。 在頁面末尾有指向您可能會覺得有用的其他資料單的鏈接。
多種健康狀況的挑戰
對於患有多種健康狀況的人，醫療保健系統並不總是能順利運作。 管理來自不同醫療保健提供者的預約、藥物和建議可能很累人。
• 有時您的醫生可能不確定是什麼導致了您的症狀。 一些全科醫生對診斷 HIV 感染者的症狀缺乏信心，如果這些症狀可能是由 HIV 引起的。
• 感覺好像系統被設置為分別治療每一種情況或疾病。 醫生用來幫助他們做出決定的研究和指引通常僅基於患有一種疾病的人，而不是患有多種疾病的人。 這有時會讓醫生不確定如何最好地治療您。
• 可能並不總是很清楚誰「負責」您的照護。
• 關於保密和其他實際問題的規定，可能意味著您的信息不會像您希望的那樣在治療您的不同團隊之間共享。
協調您的照護
這些問題不僅僅影響 HIV 感染者。它們影響許多患有多種健康狀況的人，尤其是老年人。
在英國，國家健康與照護卓越研究所 (the National Institute for Health and Care Excellence , NICE) 為服用多種不同藥物或發現難以應對多種健康問題的人提供指導。 該指引說，您可以要求對您的醫療保健進行審查，以便更好地協調。 您可以請您的任何一位醫生開始這項審查。
審查應考慮對您來說最重要的內容。 它還應包括對您正在服用的所有藥物的審查。 然後，您和您的醫生應該就未來如何為您提供醫療保健的計畫達成一致。 這可能包括指定一名醫護人員協調您在不同服務中的照護並處理任何相互衝突的建議。
NICE 沒有說明誰應該承擔這個協調角色，但您可以詢問您的 HIV 醫生您的診所是否可以提供任何支持。 可能有社區護士或臨床護士專家可以幫助協調您的照護。
您的 HIV 診所可能會建議由具有更廣泛醫學背景的人擔任此角色。 這可以是您的 GP 或在 GP 診所工作的其他人，例如社區護士長或高級護士。 另一種選擇可能是專門從事老年人護理（老年醫學）的醫生或護士。 這是因為他們有管理患有多種健康狀況的人照護經驗。
您可能需要自己協調照護
您可能會發現照護並不像您希望的那樣協調。 而且，雖然理想情況下，專業人員會監督或協調您接受的所有照護，但可能很難找到願意或能夠做到這一點的人。
實際上，您可能需要積極主動。 您可能需要積極參與協調和組織您自己的醫療保健。 您可能會發現自己必須確保您的醫生之間共享信息，追踪您正在服用的藥物並跟進以檢查事情是否已經完成。
這對某些人來說比對其他人更容易。 例如，如果您不自信或感覺不適或脆弱，這可能會很困難。 但可能還有其他人，例如您的伴侶、家庭成員、密友或支持人員，可以介入為您做這件事。 他們可能很樂意為您提供幫助。
您如何管理多種健康狀況？
這裡有十個技巧可以幫助您管理多種健康狀況。
1. 了解您的健康狀況
盡可能多地查找有關您的狀況和治療方案以及您可以照顧自己健康的其他方式的信息。 了解可以獲得哪些幫助、支持和服務。 參加「專家患者」或「自我管理」計畫可能會幫助您做到這一點。 您對自己的健康了解得越多，您就會越有信心，也就越容易管理自己的健康。
2. 確定你的優先事項
花點時間想想什麼對你最重要。 這可能會減輕症狀或副作用，提供更多的聯合照護，或減少您的預約次數。
如果有必要，您可能會覺得您的一兩個健康狀況需要優先於其他健康狀況。 這可能是最難管理的情況或可能導致最多問題的情況。 它不一定是愛滋病毒，對許多人來說，愛滋病毒很容易治療。 讓您的醫療團隊了解您的優先事項。
3.找一個你可以合作的全科醫生
雖然有一位了解 HIV 知識的 GP 很好，但更重要的是他們善於與其他醫療保健提供者溝通和協調。 例如，尋找一位關注您的 HIV 診所的來信並願意與您的其他醫生討論您的照護的全科醫生。 這裡有更多關於在全科醫生處註冊的信息。
當您致電您的 GP 手術室時，您通常可以詢問一位特定的醫生，如果您願意與之交談。 如果您需要額外的時間來討論複雜的問題，請詢問是否可以延長預約時間。 詢問您的全科醫生是否可以在兩次預約之間通過電子郵件或電話聯繫他們。
4. 向您的 GP 披露您的 HIV 感染狀況
讓您的 GP 和其他醫療保健提供者了解感染 HIV 將使他們提供更好的醫療服務。 這將意味著他們了解您的 HIV 藥物，這使他們能夠安全地開出其他藥物。 他們在篩查和管理其他健康狀況時也將能夠考慮愛滋病毒。 告訴您的全科醫生您感染了 HIV 不應對您的照護產生負面影響。
5.多問問題
沒有愚蠢的問題。 向醫護人員詢問您不確定或擔心的事情將有助於他們了解對您來說重要的事情。 更好地理解將幫助您在照護中發揮更積極的作用，並感覺更有控制力。
在約會之前，寫下你想談的要點，這樣你就不會錯過任何重要的事情。 如果您聽不懂醫生在說什麼，請他們用另一種方式解釋。 在約診期間隨意做筆記。
6. 將您的醫療信息存檔
不同醫療保健提供者之間的溝通可能並不總是如您所願。 但是，如果您擁有盡可能多的信息，您將能夠在需要時提供詳細信息。
您可以要求將醫生寫給您的全科醫生或其他專業人士的關於您的照護的信件副本發送給您。 保留一份您服用的所有藥物和治療的清單也是值得的，這樣當您開了一種新藥時，您可以詢問藥物相互作用。 將此信息連同預約信和您獲得的任何測試結果一起放入文件或文件夾中。
一些醫院擁有在線平台，您可以透過該平台查看您的一些醫療記錄並將其展示給其他醫療保健專業人員。 還有一些電話應用程序可以讓您存儲健康信息。 找到適合您的系統。
7.注意藥物相互作用
藥物相互作用是指一種藥物影響另一種藥物的作用。 例如，一種藥物一起服用可能會增加另一種藥物的副作用。 您服用的藥物越多，發生藥物相互作用和副作用的風險就越大。
在開始服用新藥之前，請務必詢問您的醫生或藥劑師：新藥是否會與我已經服用的其他藥物發生相互作用？ 我應該注意哪些副作用？
在我們的 HIV 治療和藥物相互作用頁面上有更多關於此的信息。
8.堅持不懈並跟進
通常需要檢查進度。 如果您的 GP 已經轉介，或者他們已經收到其他提供者的回復，這可能是您可以期望獲得測試結果的時候。
您可能需要推動您需要的東西並不斷詢問，直到您得到回應。 如果您的治療計畫太複雜或太難管理，請說出來。 如果針對您的不同健康問題的計畫似乎沒有正確結合，請告訴別人。
9. 獲得支持
隨著您的健康需求變得更加複雜，您可能需要來自朋友、家人、支持團體和其他愛滋病病毒感染者的更多幫助。 當事情變得困難時，與其他人討論會很有幫助。 特別是，患有多種健康狀況或與您有相同狀況的其他人可能有處理您面臨的某些問題的經驗。 他們可能對如何改善您的照護有想法。
10. 照顧好你的心理和情緒健康
患有不止一種健康狀況並管理多次預約和治療可能是一項艱鉅的工作。 感覺不適、疼痛或不得不限制您的某些日常活動會讓您情緒低落。
您的情緒健康也需要照顧。 繼續與朋友和家人共度時光，參與您喜歡的活動並積極鍛煉身體，這些都對您的心理和情緒健康有益。 如果您感到情緒低落或有壓力，可以尋求專業幫助。
相關信息
如果您患有多種健康狀況，您可能還會發現以下信息有幫助：
• 充分利用您的 HIV 門診預約
• HIV 治療和藥物相互作用
• 在哪裡獲得 HIV 治療
• 移民如何獲得健康服務
• 查找您附近的 HIV 診所和服務
此頁面上次審核時間為 2022 年 8 月。下次審核時間為 2025 年 8 月。
Managing multiple health conditions
Abbey Stanford / August 2022 / aidsmap
Monkey Business Images/Shutterstock.com
Key points
•If you have HIV and other health conditions you may find that health services are not as joined up as you’d like.
•There’s a lot you can do yourself to make things work more smoothly and to prevent problems.
•You can ask for one healthcare professional to co-ordinate your care across different services.
Many people living with HIV have other health conditions as well. You may need to see a number of different doctors and go to more than one clinic for your healthcare needs. For example, your HIV clinic may look after your HIV, while your GP may help with conditions such as high blood pressure or diabetes. You might also need to have hospital appointments with specialists for other conditions, such as arthritis or cancer.
This page gives general information about managing multiple chronic (long-term) health conditions. There are links to other factsheets you might find helpful at the end of the page.
Challenges of multiple health conditions
The healthcare system doesn’t always work smoothly for people with several health conditions. It can be tiring to manage appointments, medications and recommendations from different healthcare providers.
•Sometimes your doctor might not be sure what is causing your symptoms. Some GPs lack confidence in diagnosing symptoms in people with HIV, in case they could be caused by HIV.
•It might feel as if the system is set up to treat each condition or disease separately. The research and guidelines that doctors use to help them make decisions are usually based on people with just one condition rather than people with multiple conditions. This can sometimes leave doctors unsure of how best to treat you.
•It might not always be clear who is ‘in charge’ of your care.
•Rules about confidentiality and other practical issues might mean that information about you isn’t shared as much as you’d like between the different teams who are treating you.
Co-ordinating your care
These problems don’t just affect people with HIV. They affect lots of people with multiple health conditions, particularly older people.
In the UK, the National Institute for Health and Care Excellence (NICE) has guidance for people who are taking a lot of different medications or who are finding it hard to cope with multiple health problems. The guidance says that you can ask to have your healthcare reviewed so that it is better co-ordinated. You can ask any of your doctors to start this review.
The review should take into account what is most important to you. It should also include a review of all the medications you are taking. You and your doctor should then agree on a plan for how health care will be provided for you in the future. This could include naming a healthcare worker who will co-ordinate your care across different services and deal with any conflicting advice.
NICE doesn’t say who should take on this co-ordinating role, but you could ask your HIV doctor if your clinic can offer any support. There may be a community nurse or clinical nurse specialist who could help co-ordinate your care.
Your HIV clinic may suggest that this role is taken by someone with a broader medical background. This could be your GP or someone else working at the GP practice, such as a community matron or senior nurse. Another option could be a doctor or nurse who specialises in the care of older people (geriatric medicine). This is because they have experience in managing the care of people with multiple health conditions.
You may need to co-ordinate care yourself
You may find that care is not as co-ordinated as you’d like. And, while ideally a professional would oversee or co-ordinate all the care you receive, it may be hard to find someone willing or able to do this.
Realistically, you might need to be proactive. You may need to get quite involved in co-ordinating and organising your own health care. You might find yourself having to make sure that information is shared between your doctors, keeping track of the medications you’re taking and following up to check that things have been done.
This is easier for some people than for others. For example, it can be hard if you are not self-confident or when you’re feeling unwell or vulnerable. But there may be someone else, such as your partner, a family member, a close friend or a support worker, who could step in to do this for you. They will probably be pleased to be able to help you.
How do you manage multiple health conditions?
Here are ten tips to help you manage multiple health conditions.
1. Learn about your health conditions
Find as much information as you can about your conditions and your treatment options, as well as other ways you can take care of your health. Find out what help, support and services are available. Taking part in an ‘expert patient’ or ‘self-management’ programme may help you to do this. The more you know about your health, the more confident you will become and the easier it will be to manage your health.
2. Work out your priorities
Spend some time thinking about what matters most to you. This might be reducing symptoms or side effects, having more joined-up care, or reducing the number of appointments you have.
You may feel that there are one or two of your health conditions which need to be prioritised over other ones, if necessary. This might be the condition that is most complicated to manage or the one which could cause the most problems. It won’t necessarily be HIV, which for many people is quite straightforward to treat. Let your medical teams know what your priorities are.
3. Find a GP you can work with
Although it’s good to have a GP who is knowledgeable about HIV, it can be more important that they are good at communicating and co-ordinating with other healthcare providers. For example, finding a GP who pays attention to letters from your HIV clinic and is willing to discuss your care with your other doctors. There is more information about registering with a GP here.
When you call your GP surgery you can often ask for a specific doctor if there is one you’d prefer to speak to. If you need extra time to discuss complex issues, ask if you can have a longer appointment. Ask your GP if you can contact them by email or by phone in-between appointments.
4. Disclose your HIV status to your GP
Letting your GP and other healthcare providers know about having HIV will let them provide better medical care. It will mean they are aware of your HIV medication, which allows them to prescribe other medicines safely. They will also be able to consider HIV when they are screening for and managing other health conditions. Telling your GP that you have HIV should not negatively affect your care.
5. Ask lots of questions
There is no such thing as a silly question. Asking healthcare workers about the things you are unsure or worried about will help them understand what matters to you. Having a better understanding will help you play a more active role in your care and feel more in control.
Before an appointment, write down the points you want to talk about so that you don’t miss anything important. If you can’t understand what the doctor is saying, ask them to explain it another way. Feel free to take notes during your appointment.
6. Keep a file for your medical information
Communication between different healthcare providers may not always be as good as you’d like it to be. But if you have as much information as possible, you’ll be able to provide details when they’re needed.
You can ask to be sent copies of letters that doctors write about your care to your GP or to other professionals. It’s also worth keeping a list of all the medicines and treatments you take, so that when you’re prescribed a new medication you can ask about drug interactions. Put this information in a file or a folder, along with appointment letters and any test results you get.
Some hospitals have online platforms which allow you to see some of your medical records and show them to other healthcare professionals. There are also phone apps which allow you to store health information. Find a system which works for you.
7. Be aware of drug interactions
A drug interaction is when one medicine affects how another medicine works. For example, taken together, one medicine may increase the side effects of another medicine. The more medication you take, the bigger the risk of experiencing drug interactions and side effects.
Before starting a new medicine, always ask your doctor or pharmacist: Could the new medication interact with the other medications I am already taking? What side effects should I be aware of?
There’s more information on this on our page HIV treatment and drug-drug interactions.
8. Be persistent and follow things up
It’s often necessary to check on progress. This might be when you can expect to have test results, if your GP has made a referral, or if they’ve heard back from another provider.
You may need to push for what you need and keep asking until you get a response. Speak up if your treatment plans are too complex or too difficult to manage. Let somebody know if it seems the plans for your different health problems are not properly joined up.
9. Get support
As your health needs become more complex, you may need more help from friends, family, support groups and other people living with HIV. When things get difficult, it can be helpful to talk things through with other people. In particular, other people who are living with multiple health conditions or the same conditions as you may have experience of dealing with some of the problems you are facing. They might have ideas about how you could improve your care.
10. Take care of your mental and emotional health
Living with more than one health condition and managing multiple appointments and treatments can be hard work. Feeling unwell, being in pain or having to limit some of your day-to-day activities can bring you down.
Your emotional wellbeing needs looking after too. Continuing to spend time with friends and family, getting involved in activities you enjoy and being physically active are all good for your mental and emotional health. Professional help is available if you are feeling down or stressed.
Related information
If you’re living with multiple health conditions you might also find the following information helpful:
•Getting the most out of your HIV clinic appointment
•HIV treatment and drug-drug interactions
•Where to get HIV treatment
•Access to NHS for migrants
•Find HIV clinics and services near you
This page was last reviewed in August 2022. It is due for review in August 2025.