Study on the Health Management Service Pathway for Multimorbidity of Middle-aged and Older Adults in the Community

Multimorbidity has become an important characteristic of chronic diseases, jeopardizing the health of middle-aged and older adults, and posing new challenges to health management of chronic disease. There is a lack of guidelines and intervention programs for multimorbidity in China. In this study, we initially formulated a health management service pathway for multimorbidity among middle-aged and older adults in the community through the literature research method and focus group discussion method. Then, the constructed service pathway was evaluated and revised through the expert consultation method. Finally, a health management service pathway for the multimorbidity of middle-aged and older adults in the community with behavioral change techniques as the core. The pathway optimizes the implementation of multimorbidity health management, and standardizes its health monitoring, assessment and intervention process, providing a theoretical and practical guidance for primary care providers in the health management of multimorbidity.