Rogers Anne, Bury Michael, Kennedy Anne
Primary Care Research Group, University of Manchester, United Kingdom.
Int J Health Serv. 2009;39(4):725-47. doi: 10.2190/HS.39.4.h.
Policymakers have associated the increasing prevalence and incidence of chronic illness with the threat of unsustainable demands for medical services, requiring deployment of effective demand-management strategies. In this article, the authors consider the rise in policy interest in self-management and examine the metaphors, discourse, official statements, policy developments, and goals shaping the field of chronic illness, especially surrounding the promotion and uptake of self-skills training in England's Expert Patients Programme (EPP). They discuss the shift in relationship between individuals and the state since the 1960s and 1970s; the rise in importance of self-management in relation to an aging population; the evidence and rhetoric associated with policy development; and the relationship of self-care to the notion of the "responsible patient," as seen in policy implementation and EPP course promotion. The authors also draw on qualitative research to examine the transmission of ideology and rhetoric in self-skills training. Self-management policies are part of a shift from patient rights to individual responsibilities, a shift that may be less persuasive than its supporters imagine.
政策制定者已将慢性病患病率和发病率的上升与医疗服务需求不可持续的威胁联系起来，这就需要部署有效的需求管理策略。在本文中，作者探讨了政策对自我管理兴趣的上升，并审视了塑造慢性病领域的隐喻、话语、官方声明、政策发展及目标，尤其是围绕英格兰“专家患者计划”（EPP）中自我技能培训的推广与采用情况。他们讨论了自20世纪60年代和70年代以来个人与国家关系的转变；自我管理在老龄化人口背景下重要性的提升；与政策发展相关的证据和言辞；以及在政策实施和EPP课程推广中所体现的自我护理与“责任患者”概念的关系。作者还利用定性研究来考察自我技能培训中意识形态和言辞的传播。自我管理政策是从患者权利向个人责任转变的一部分，这一转变可能并不像其支持者想象的那样具有说服力。
