Jordan J, Wright J, Wilkinson J, Williams R
Bradford Royal Infirmary, UK.
Qual Health Care. 1998 Jun;7(2):83-9. doi: 10.1136/qshc.7.2.83.
Assessing the health needs of a local population has been promoted as a key component in effective targeting of healthcare services and quality improvement. The understanding and experience of assessing health needs in general practice were investigated in three English districts.
To identify the issues surrounding the potential for assessing health needs in primary care.
Postal survey of 347 general practices in three health authorities. Telephone interviews with a random stratified sample of 35 general practitioners.
Although most practices identified assessing health needs as important, it is clear that this identification was typically based on an understanding of assessing needs as primarily focused on individual patient care, based on clinical priorities and involving practice held data. Most practices had not undertaken local consultation, whatever their understanding of assessing health needs. The few practices which had completed population oriented, proactive assessment of needs considered it to have led to tangible improvements in clinical or practice management. Overall, there was apparent confusion over the nature and purpose of assessing needs, although the principled aims and objectives of a population oriented, proactive component to primary care were generally upheld. The need for additional resources and support was identified. In four out of the five cases where specifically population based assessment of health needs had been undertaken, the local public health department had been involved.
The value of the concept of assessing health needs in primary care holds considerable uncertainty and ambivalence. The findings from this study show that any attempts to promote assessing needs into primary care which focus either primarily or exclusively on the provision of "education" are unduly simplistic. More fundamental questions about the perceived relevance and opportunities for assessing health needs should be considered if primary care groups are to meet future commissioning challenges.
评估当地居民的健康需求已被视为有效提供医疗服务和提高医疗质量的关键要素。在英国的三个地区对全科医疗中评估健康需求的理解和经验进行了调查。
确定围绕基层医疗中评估健康需求潜力的相关问题。
对三个卫生部门的347家全科诊所进行邮政调查。对35名全科医生进行随机分层抽样电话访谈。
尽管大多数诊所认为评估健康需求很重要，但很明显这种认识通常基于对评估需求的理解，主要集中在基于临床优先级和利用诊所现有数据的个体患者护理上。无论对评估健康需求的理解如何，大多数诊所都没有进行当地咨询。少数完成了以人群为导向的主动需求评估的诊所认为这带来了临床或诊所管理方面的切实改善。总体而言，尽管基层医疗中以人群为导向的主动评估的原则性目标通常得到认可，但对评估需求的性质和目的显然存在困惑。已确定需要额外的资源和支持。在进行了基于人群的健康需求评估的五个案例中，有四个案例当地公共卫生部门参与其中。
基层医疗中评估健康需求这一概念的价值存在很大的不确定性和矛盾性。本研究结果表明，任何将评估需求引入基层医疗的尝试，如果主要或仅仅侧重于提供“教育”，都过于简单化。如果基层医疗团体要应对未来的委托挑战，就应该考虑关于评估健康需求的感知相关性和机会的更基本问题。
