Taylor David, Bury Michael
Department of Practice and Policy, The School of Pharmacy, University of London, UK.
Sociol Health Illn. 2007 Jan;29(1):27-45. doi: 10.1111/j.1467-9566.2007.00516.x.
During the last century demographic and epidemiological transitions have had a radical impact upon health and health service provision. A considerable body of research on the sociological aspects of living with chronic illness has accumulated. Debate has focused on how social environments shape disability-related experiences, and the extent to which individual responses define health outcomes. Through the establishment of the Expert Patients Programme (EPP) in 2001, the Department of Health has sought to enhance NHS patients' self-management capacities. This paper discusses three areas relevant to this: the policy formation process leading up to the EPP's present stage of development; the evidence base supporting claims made for its effectiveness; and the significance of psychological concepts such as self-efficacy in approaches to improving public health. The conclusion discusses NHS developments in primary care and public involvement in health and healthcare, and the implications that initiatives such as the EPP carry for the future. It is argued that to facilitate a constructive process of 'care transition' in response to epidemiological and allied change, awareness of cognitive/psychological factors involved in illness behaviours should not draw attention away from the social determinants and contexts of health.
在上个世纪，人口结构和流行病学转变对健康及医疗服务提供产生了根本性影响。关于慢性病患者社会学方面的大量研究已经积累起来。争论集中在社会环境如何塑造与残疾相关的经历，以及个体反应在多大程度上决定健康结果。通过在2001年设立专家患者计划（EPP），卫生部试图提高国民保健服务（NHS）患者的自我管理能力。本文讨论与此相关的三个领域：导致EPP发展到当前阶段的政策形成过程；支持其有效性主张的证据基础；以及自我效能等心理概念在改善公共卫生方法中的重要性。结论部分讨论了NHS在初级保健方面的发展以及公众参与健康和医疗保健的情况，以及EPP等举措对未来的影响。有人认为，为了促进应对流行病学及相关变化的建设性“护理过渡”过程，对疾病行为中涉及的认知/心理因素的认识不应转移对健康的社会决定因素和背景的关注。
