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为什么循证实践没有改善美国少数族裔的医疗保健?

Why isn't evidence based practice improving health care for minorities in the United States?

机构信息

Department of Nursing, University of Massachusetts Boston, Boston, MA, USA.

出版信息

Appl Nurs Res. 2013 Nov;26(4):263-8. doi: 10.1016/j.apnr.2013.05.004. Epub 2013 Aug 6.

DOI:10.1016/j.apnr.2013.05.004
PMID:23928122
Abstract

Achieving health equity by improving the health care of all racial/ethnic groups is one of the key goals of Healthy People 2020. The implementation of evidence based practice (EBP) has been a major recommendation to achieve health equity in hopes of eliminating the subjectivity of clinical decision making. However, health disparities among racial/ethnic minorities are persistent in spite of the adoption of standardized care based on evidence. The EBP with racial and ethnic minorities is often seen as a possible cause of health and health care disparities. Three potential issues of using EBP to reduce health disparities have been identified: (1) a lack of data for EBP with ethnic/racial minority populations; (2) limited research on the generalizability of the evidence based on a European-American middle-class; and (3) sociocultural considerations in the context of EBP. Using EBP to reduce disparities in health care and health outcomes requires that nurse professionals should know how to use relevant evidence in a particular situation as well as to generate knowledge and theory which is relevant to racial/ethnic minorities. In addition, EBP implementation should be contextualized within the sociocultural environments in which patients are treated rather than solely focusing on the health problems.

摘要

通过改善所有种族/民族群体的医疗保健来实现健康公平,是“健康人民 2020”的主要目标之一。实施循证实践(EBP)一直是实现健康公平的主要建议,希望消除临床决策的主观性。然而,尽管采用了基于证据的标准化护理,但种族/少数民族的健康差距仍然存在。EBP 与少数族裔群体的结合,往往被视为造成健康和医疗保健差距的一个可能原因。在使用 EBP 来减少健康差距方面,已经确定了三个潜在的问题:(1)针对少数族裔/种族群体的 EBP 缺乏数据;(2)基于欧洲裔中产阶级的证据的普遍性研究有限;(3)EBP 背景下的社会文化因素。使用 EBP 来减少医疗保健和健康结果方面的差距,要求护理专业人员应该知道如何在特定情况下使用相关证据,以及如何产生与少数族裔相关的知识和理论。此外,EBP 的实施应该在患者接受治疗的社会文化环境中进行,而不仅仅是关注健康问题。

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