Glasgow R E, Wagner E H, Kaplan R M, Vinicor F, Smith L, Norman J
AMC Cancer Research Center, Denver, CO 80214, USA.
Ann Behav Med. 1999 Spring;21(2):159-70. doi: 10.1007/BF02908297.
It is increasingly acknowledged that diabetes and other chronic illnesses are major public health problems. Medicare and many managed health care organizations have recognized the enormous personal and societal costs of uncontrolled diabetes in terms of complications, patient quality of life, and health care system resources. However, the current system of reactive acute-episode focused disease care practiced in many settings does not adequately address this public health problem. An alternative proactive, population-based approach to chronic illnesses such as diabetes is proposed and illustrated. This multilevel systems approach addresses supportive and inhibitory social-environmental factors at multiple levels (personal, family, health care team, work, neighborhood, community). Key disciplines contributing to a population-based approach to diabetes include epidemiology, behavioral science, health care services, public health, health economics, and quality of life professions. Current and potential contributions of each of these disciplines are illustrated and an integrative, population-based systems approach to diabetes management and prevention of complications is proposed. This approach is also seen as applicable to other chronic illnesses.
人们越来越认识到糖尿病和其他慢性疾病是重大的公共卫生问题。医疗保险和许多管理式医疗保健组织已经认识到，就并发症、患者生活质量和医疗保健系统资源而言，糖尿病控制不佳会带来巨大的个人和社会成本。然而，目前许多医疗机构采用的以反应性急性发作疾病护理为重点的现行体系并不能充分解决这一公共卫生问题。本文提出并举例说明了一种针对糖尿病等慢性疾病的替代性、积极主动的、基于人群的方法。这种多层次系统方法在多个层面（个人、家庭、医疗团队、工作场所、社区邻里、社区）应对支持性和抑制性社会环境因素。对基于人群的糖尿病防治方法有贡献的关键学科包括流行病学、行为科学、医疗保健服务、公共卫生、卫生经济学和生活质量专业。文中阐述了这些学科各自当前和潜在的贡献，并提出了一种综合的、基于人群的糖尿病管理和并发症预防系统方法。这种方法也被视为适用于其他慢性疾病。
