Cashman Suzanne, Hale Janet, Candib Lucy, Nimiroski Tara Ann, Brookings Deborah
Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Educ Health (Abingdon). 2004 Nov;17(3):313-22. doi: 10.1080/13576280400002486.
Increasingly, health care facilities worldwide, particularly those that comprise the safety-net, are finding themselves understaffed and challenged to meet patients' needs. Identifying additional sources of support and resources is critical for facilities to be able to sustain current and develop new initiatives to improve patients' health.
We present one community health center's reliance on a partnership with an academic medical/nursing institution to develop and initiate a depression screening and treatment project. Incorporating students to help implement or pilot a needed clinical service for a high prevalence condition presents significant rewards as well as challenges. Nevertheless, an academic-community partnership has the potential to initiate systems change at the clinical level.
Using a service-learning modality, medical and nursing students worked with health center providers to initiate a pilot depression screening and treatment program based on the chronic disease model. Implementation of this initiative succeeded in poising the health center for participation in a large, federally supported collaborative on depression in primary care. While students gained insight into some of the challenges faced by safety net providers and their patients, discontinuity in student availability led to uneven pacing in project implementation.
Curricula that employ a service-learning framework can enable health care facilities world-wide to gain additional resources for needed initiatives. Students' learning experiences can provide an excellent mutually beneficial opportunity as a "jumpstart" for new evidence-based clinical initiatives and demonstration projects. Such programs can help meet the needs of patients while enhancing students' education. However, students can neither make up for staffing shortages nor be expected to maintain programs. In order to be successful for the long term, service-learning projects must skirt the pitfalls of the inherent logistical incompatibilities e.g. schedules and length of commitment, between academic institutions and health care facilities.
全球范围内，医疗保健机构，尤其是那些构成安全网的机构，越来越发现自身人员不足，难以满足患者需求。识别额外的支持和资源来源对于这些机构维持现有项目并开展新举措以改善患者健康状况至关重要。
我们介绍了一个社区健康中心如何依赖与一所学术医疗/护理机构的合作关系来开展并启动一个抑郁症筛查与治疗项目。让学生协助实施或试点针对高发性疾病的必要临床服务既带来了显著回报，也带来了挑战。然而，学术-社区伙伴关系有潜力在临床层面引发系统变革。
通过服务学习模式，医学和护理专业学生与健康中心的提供者合作，基于慢性病模式启动了一个抑郁症筛查与治疗试点项目。该举措的实施成功使健康中心有机会参与一项由联邦政府支持的关于初级保健中抑郁症的大型合作项目。虽然学生深入了解了安全网提供者及其患者所面临的一些挑战，但学生可用性的不连续性导致项目实施进度不均衡。
采用服务学习框架的课程可以使全球范围内的医疗保健机构为所需项目获得额外资源。学生的学习经历可以为新的循证临床举措和示范项目提供一个极好的互利“开端”。此类项目可以在满足患者需求的同时加强学生教育。然而，学生既无法弥补人员短缺，也不应期望他们维持项目。为了长期取得成功，服务学习项目必须避免学术机构与医疗保健机构之间在诸如时间表和承诺时长等固有后勤不兼容性方面的陷阱。
