Rothman Arlyss Anderson, Wagner Edward H
University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118, USA.
Ann Intern Med. 2003 Feb 4;138(3):256-61. doi: 10.7326/0003-4819-138-3-200302040-00034.
An estimated 99 million Americans live with a chronic illness. Meeting the needs of this population is one of the major challenges facing the U.S. health care system today and in the future. Dozens of studies, surveys, and audits have revealed that sizable proportions of chronically ill patients have not received effective therapy and do not have optimal disease control. The consistent findings of generally substandard care for many chronic conditions have spurred proposals that care be shifted to specialists or disease management programs. Published evidence to date does not indicate any clear superiority of these alternatives to primary care. The defining features of primary care (that is, continuity, coordination, and comprehensiveness) are well suited to care of chronic illness. A rapidly growing body of health services research points to the design of the care system, not the specialty of the physician, as the primary determinant of chronic care quality. The future of primary care in the United States may depend on its ability to successfully redesign care systems that can meet the needs of a growing population of chronically ill patients.
据估计，9900万美国人患有慢性病。满足这一人群的需求是美国医疗保健系统目前及未来面临的主要挑战之一。数十项研究、调查和审计表明，相当大比例的慢性病患者没有得到有效的治疗，疾病也没有得到最佳控制。许多慢性病护理普遍不达标的一致调查结果促使人们提出将护理工作转移到专科医生或疾病管理项目的建议。迄今为止发表的证据并未表明这些替代方案相对于初级护理有任何明显优势。初级护理的定义特征（即连续性、协调性和全面性）非常适合慢性病护理。越来越多的卫生服务研究指出，护理系统的设计而非医生的专业领域是慢性病护理质量的主要决定因素。美国初级护理的未来可能取决于其能否成功重新设计护理系统，以满足日益增多的慢性病患者群体的需求。
