Buetow Stephen, Getz Linn, Adams Peter
Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
J Eval Clin Pract. 2008 Oct;14(5):761-6. doi: 10.1111/j.1365-2753.2007.00938.x.
General practice is increasingly expected to deliver population care to individual patients. The feasibility and ethics of this policy shift have been challenged.
Our aim is to suggest how to deliver population care while protecting personal care.
We outline and discuss concepts of these types of care, their relation to the prevailing discourse regarding intervention benefits, and arguments for individualized population care.
Individualized population care can enable general practice to meet the health targets of individual patients in the light of population-based goals. It unifies the concepts of personal care and whole population care. Personal care focuses on the individual good in particular consultations. Whole population care focuses on the overall health good of a population without reference to the individuality of each population member. These types of care constitute elements of a continuum that varies in purpose and objects of focus. The limitations of a crude dichotomy of personal care and population care are made explicit in a series of five arguments that lend support to the concept of individualized population care.
We advocate a constructive but critical attitude towards the idea of population-based interventions in everyday general practice. Traditional personal care and whole population care can theoretically be integrated into individualized population care. However, this presupposes clinical-epidemiological expertise and moral awareness in practising clinicians.
人们越来越期望全科医疗为个体患者提供群体保健服务。这一政策转变的可行性和伦理道德受到了质疑。
我们的目的是提出在保护个体医疗的同时如何提供群体保健服务。
我们概述并讨论了这些类型医疗的概念、它们与当前关于干预效益的论述的关系以及个体化群体保健的论据。
个体化群体保健能够使全科医疗根据基于群体的目标实现个体患者的健康目标。它将个体医疗和全体人群医疗的概念统一起来。个体医疗在特定会诊中关注个体的利益。全体人群医疗关注人群的整体健康利益,而不考虑每个群体成员的个体情况。这些类型的医疗构成了一个连续统一体的要素,其目的和关注对象各不相同。在一系列支持个体化群体保健概念的五个论据中,明确了个体医疗和群体医疗简单二分法的局限性。
我们倡导在日常全科医疗中对基于群体的干预理念持建设性但批判性的态度。传统的个体医疗和全体人群医疗理论上可以整合到个体化群体保健中。然而,这以执业临床医生具备临床流行病学专业知识和道德意识为前提。