Thomas Paul, Meads Geoffrey, Moustafa Ahmet, Nazareth Irwin, Stange Kurt C, Donnelly Hess Gertrude
Clinical Director, Ealing Primary Care Trust, Middlesex, UK.
Qual Prim Care. 2008;16(6):425-32.
Practice-based commissioning (PBC) in the UK is intended to improve both the vertical and horizontal integration of health care, in order to avoid escalating costs and enhance population health. Vertical integration involves patient pathways to treat named medical conditions that transcend organisational boundaries and connect community-based generalists with largely hospital-sited specialists, whereas horizontal integration involves peer-based and cross-sectoral collaboration to improve overall health. Effective mechanisms are now needed to permit ongoing dialogue between the vertical and horizontal dimensions to ensure that medical and nonmedical care are both used to their best advantage. This paper proposes three different models for combining vertical and horizontal integration - each is a hybrid of internationally recognised ideal types of primary care organisation. Leaders of PBC should consider a range of models and apply them in ways that are relevant to the local context. General practitioners, policy makers and others whose job it is to facilitate horizontal and vertical integration must learn to lead such combined approaches to integration if the UK is to avoid the mistakes of the USA in over-medicalising health issues.
英国的基于实践的委托（PBC）旨在改善医疗保健的纵向和横向整合，以避免成本不断上升并提升人群健康水平。纵向整合涉及治疗特定疾病的患者就医途径，这些途径跨越组织边界，将社区全科医生与主要位于医院的专科医生联系起来；而横向整合则涉及基于同行和跨部门的协作，以改善整体健康状况。现在需要有效的机制来促进纵向和横向层面之间的持续对话，以确保医疗和非医疗护理都能发挥最大优势。本文提出了三种不同的纵向与横向整合相结合的模式——每种模式都是国际公认的理想基层医疗组织类型的混合体。PBC的领导者应考虑一系列模式，并以与当地情况相关的方式应用它们。如果英国要避免美国在过度医疗化健康问题上所犯的错误，全科医生、政策制定者以及其他负责促进横向和纵向整合的人员必须学会引领这种整合的综合方法。
