Department of Acute and Continuing Care, School of Health and Social Care, University of Greenwich, Avery Hill Campus, London, SE9 2UG, UK.
Nutrients. 2012 Nov 13;4(11):1709-22. doi: 10.3390/nu4111709.
This paper examines the impact of the changes to health and social care on enteral feeding in the community, outlines implications for practice and offers recommendations to ameliorate the challenges. It is now clear that there have been significant changes especially in the last 10 years in health and social care provisions in the UK with an overarching effect on enteral nutrition in the community. Advances in technology, increasing demand and treatment costs, the need for improvement in quality, economic challenges, market forces, political influences and more choices for patients are some of the factors driving the change. Government’s vision of a modern system of health and social care is based on initiatives such as clinically led commissioning, establishment of Monitor, shifting care from acute hospitals to community settings, integrating health and social care provisions, Quality, Innovation, Productivity and Prevention (QIPP) program and the concept of “Big Society”. These strategies which are encapsulated in various guidelines, policies and legislation, including the health and social care Act, 2012 are clarified. The future challenges and opportunities brought on by these changes for healthcare professionals and patients who access enteral nutrition in the community are discussed and recommendations to improve practice are outlined.
本文探讨了医疗保健变化对社区肠内喂养的影响，概述了对实践的影响，并提出了改善这些挑战的建议。现在已经很清楚，尤其是在过去 10 年中，英国的医疗保健服务发生了重大变化，对社区中的肠内营养产生了深远的影响。技术进步、需求和治疗成本的增加、提高质量的需求、经济挑战、市场力量、政治影响以及为患者提供更多选择等，都是推动这一变化的因素。政府对现代化医疗保健体系的愿景基于临床主导的委托、建立监测机构、将护理从急性医院转移到社区环境、整合医疗保健服务、质量、创新、生产力和预防（QIPP）计划以及“大社会”概念等举措。这些策略被包含在各种指南、政策和法规中，包括 2012 年的《卫生和社会保健法案》。本文还讨论了这些变化为在社区中接受肠内营养的医疗保健专业人员和患者带来的未来挑战和机遇，并提出了改善实践的建议。
