Department of Family and Community Medicine, St, Michael's Hospital, Toronto, Ontario, M5B 1X2, Canada.
BMC Fam Pract. 2011 Jun 29;12:62. doi: 10.1186/1471-2296-12-62.
Poverty is widely recognized as a major determinant of poor health, and this link has been extensively studied and verified. Despite the strong evidentiary link, little work has been done to determine what primary care health providers can do to address their patients' income as a risk to their health. This qualitative study explores the barriers to primary care responsiveness to poverty as a health issue in a well-resourced jurisdiction with near-universal health care insurance coverage.
One to one interviews were conducted with twelve experts on poverty and health in primary care in Ontario, Canada. Participants included family physicians, specialist physicians, nurse practitioners, community workers, advocates, policy experts and researchers. The interviews were analysed for anticipated and emergent themes.
This study reveals provider- and patient-centred structural, attitudinal, and knowledge-based barriers to addressing poverty as a risk to health. While many of its findings reinforce previous work in this area, this study's findings point to a number of areas front line primary care providers could target to address their patients' poverty. These include a lack of provider understanding of the lived reality of poverty, leading to a failure to collect adequate data about patients' social circumstances, and to the development of inappropriate care plans. Participants also pointed to prejudicial attitudes among providers, a failure of primary care disciplines to incorporate approaches to poverty as a standard of care, and a lack of knowledge of concrete steps providers can take to address patients' poverty.
While this study reinforces, in a well-resourced jurisdiction such as Ontario, the previously reported existence of significant barriers to addressing income as a health issue within primary care, the findings point to the possibility of front line primary care providers taking direct steps to address the health risks posed by poverty. The consistent direction and replicability of these findings point to a refocusing of the research agenda toward an examination of interventions to decrease the health impacts of poverty.
贫困被广泛认为是健康状况不佳的主要决定因素，这一关联已得到广泛研究和验证。尽管有强有力的证据表明，但很少有人致力于确定初级保健卫生提供者可以采取哪些措施来解决患者的收入问题，因为这会对他们的健康构成威胁。本定性研究探讨了在资源丰富的司法管辖区，初级保健对贫困作为健康问题的反应能力存在障碍，该地区拥有近乎普及的医疗保险。
在加拿大安大略省，对 12 名初级保健贫困与健康方面的专家进行了一对一访谈。参与者包括家庭医生、专科医生、执业护师、社区工作者、倡导者、政策专家和研究人员。对访谈进行了预期和新出现的主题分析。
本研究揭示了针对贫困作为健康风险的提供者和患者为中心的结构性、态度性和基于知识的障碍。虽然它的许多发现都强化了这一领域的先前工作，但本研究的结果指出了一线初级保健提供者可以针对解决患者贫困问题的几个领域。这些领域包括提供者对贫困生活现实的理解不足，导致对患者社会环境的相关数据收集不足，以及制定不适当的护理计划。参与者还指出了提供者之间存在偏见态度、初级保健学科未能将贫困问题作为护理标准纳入、以及提供者缺乏了解可采取的具体措施来解决患者贫困问题。
尽管在资源丰富的安大略省等司法管辖区，本研究证实了在初级保健中解决收入作为健康问题存在重大障碍，但这些发现表明，一线初级保健提供者有可能采取直接措施来解决贫困对健康构成的风险。这些发现具有一致的方向和可重复性，指向研究议程的重新聚焦，即研究减少贫困对健康影响的干预措施。
