Lord J
School of Human and Health Sciences, Harold Wilson Building, University of Huddersfield, Huddersfield, West Yorkshire HD1 3DH, UK.
Postgrad Med J. 2003 Oct;79(936):553-60. doi: 10.1136/pmj.79.936.553.
This review examines the origins of primary care and the pressures currently faced in terms of patient expectation, regulation, accountability, and work force shortages. It recognises the appropriateness of adding to the burden in primary care further by the shift both of more services and more medical education from secondary care. Some conclusions are drawn concerning potential solutions including skill mix changes, centralisation of services, a change in attitudes to professional mistakes, increased protected development time, evidence based education, and academic, leadership, and feedback skills for general practitioners. Six recommendations are offered as a prescription for organisational and educational change.
本综述探讨了初级保健的起源以及目前在患者期望、监管、问责制和劳动力短缺方面所面临的压力。它认识到，将更多服务和更多医学教育从二级保健转移，会进一步加重初级保健的负担，这是合理的。得出了一些关于潜在解决方案的结论，包括技能组合的改变、服务的集中化、对专业失误态度的转变、增加受保护的发展时间、循证教育以及全科医生的学术、领导和反馈技能。提出了六项建议，作为组织和教育变革的良方。
