针对注射吸毒者的初级保健服务点的可及性、可接受性、健康影响和成本影响:文献叙述性综合。

The accessibility, acceptability, health impact and cost implications of primary healthcare outlets that target injecting drug users: a narrative synthesis of literature.

机构信息

School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia.

出版信息

Int J Drug Policy. 2012 Mar;23(2):94-102. doi: 10.1016/j.drugpo.2011.08.005. Epub 2011 Oct 12.

Abstract

BACKGROUND

Injecting drug users (IDUs) are at increased risk of health problems ranging from injecting-related injuries to blood borne viral infections. Access to primary healthcare (PHC) is often limited for this marginalised group. Many seek care at emergency departments and some require hospital admission due to late presentation. The costs to both the individual and the health system are such that policymakers in some settings have implemented IDU-targeted PHC centres, with a number of models employed. However, there is insufficient evidence on the effectiveness of these centres to inform health service planning. A systematic review examining such interventions is not possible due to the heterogeneous nature of study designs. Nevertheless, an integrative literature review of IDU-targeted PHC may provide useful insights into the range of operational models and strategies to enhance the accessibility and acceptability of these services to the target population.

METHODS

Available literature describing the impact of IDU-targeted PHC on health outcomes, cost implications and operational challenges is reviewed. A narrative synthesis was undertaken of material sourced from relevant journal publications, grey literature and policy documents.

RESULTS

Several models have proven accessible and acceptable forms of PHC to IDUs, improving the overall healthcare utilisation and health status of this population with consequent savings to the health system due to a reduction in visits to emergency departments and tertiary hospitals.

CONCLUSIONS

Although such findings are promising, there remains a dearth of rigorous evaluations of these targeted PHC, with the public health impact of such outlets yet to be systematically documented.

摘要

背景

注射吸毒者(IDU)面临着从与注射相关的伤害到血液传播病毒感染等各种健康问题的风险增加。这一边缘化群体获得初级保健(PHC)的机会往往有限。许多人在急诊部门寻求治疗,由于就诊时间较晚,一些人需要住院治疗。个人和卫生系统的成本都很高,以至于一些地方的政策制定者已经实施了针对 IDU 的 PHC 中心,采用了多种模式。然而,由于研究设计的异质性,没有足够的证据来证明这些中心的有效性,因此无法进行系统评价。尽管如此,对 IDU 为目标人群的 PHC 进行综合文献回顾,可能会为了解各种运营模式和策略提供有用的见解,以提高这些服务的可及性和可接受性。

方法

回顾了描述 IDU 为目标的 PHC 对健康结果、成本影响和运营挑战的影响的现有文献。对从相关期刊出版物、灰色文献和政策文件中获取的资料进行了叙述性综合。

结果

已经证明了几种模式是 IDU 可获得和可接受的 PHC 形式,提高了该人群的整体医疗保健利用率和健康状况,从而减少了急诊部门和三级医院的就诊次数,为卫生系统节省了成本。

结论

尽管这些发现很有希望,但针对这些特定的 PHC 进行严格评估的研究仍然很少,这些服务对公共卫生的影响尚未得到系统记录。

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