Specchia Maria Lucia, de Belvis Antonio Giulio, Capizzi Silvio, Veneziano Maria Assunta, Kheiraoui Flavia, Morelli Luca, Ferriero Anna Maria, Cadeddu Chiara, Ricciardi Walter
Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma.
Ig Sanita Pubbl. 2013 Jul-Aug;69(4):427-44.
Public Health (PH) and Primary Health Care (PHC) need to be better integrated, at different levels of the healthcare system, in order to improve health and social outcomes. The aim of this study was to review international models and approaches supporting the integration of PH and PHC and to classify these according to their main focus. A literature search was performed using the main scientific databases, to identify national and international journal publications regarding models to support integration between PH and PHC. The final set of the documents provided a broad coverage of the topic. Four models of integration were identified: general integration, chronic disease prevention, targeted prevention or care delivery and infection control. Models differed in their levels of implementation, stages of development and focus. This review, by classifying the main characteristics and results of the experiences retrieved, indicates a relatively scarce use of integration models in the global health care landscape, with the exception of Canada. In fact, Canada has been a leader in developing models of integrated health systems that combine tailored approaches to influence personal health behaviour and community-oriented approaches to influence the health of the population. The review also revealed a general lack of experience in evaluating the sustainability of integration between PH and PHC, not only in terms of cost-effectiveness, but also in terms of better health and work conditions and self-perceived quality of care in the population. Collaboration between PH and PHC seems to be an important strategy for achieving principles of equity and access in health care and for ensuring a more equal distribution of health care services.
为改善健康和社会成果，公共卫生（PH）与初级卫生保健（PHC）需要在医疗体系的不同层面得到更好的整合。本研究旨在回顾支持PH与PHC整合的国际模式和方法，并根据其主要侧重点进行分类。通过使用主要科学数据库进行文献检索，以识别关于支持PH与PHC整合模式的国内和国际期刊出版物。最终的文献集广泛涵盖了该主题。确定了四种整合模式：一般整合、慢性病预防、针对性预防或护理提供以及感染控制。这些模式在实施水平、发展阶段和侧重点上存在差异。通过对检索到的经验的主要特征和结果进行分类，本综述表明，除加拿大外，整合模式在全球医疗领域的应用相对较少。事实上，加拿大在开发综合卫生系统模式方面一直处于领先地位，这些模式结合了量身定制的方法来影响个人健康行为以及以社区为导向的方法来影响人群健康。该综述还揭示，在评估PH与PHC整合的可持续性方面普遍缺乏经验，不仅在成本效益方面，而且在改善健康和工作条件以及人群自我感知的护理质量方面也是如此。PH与PHC之间的合作似乎是实现医疗保健公平和可及原则以及确保更平等分配医疗服务的一项重要策略。
