May Carl R, Eton David T, Boehmer Kasey, Gallacher Katie, Hunt Katherine, MacDonald Sara, Mair Frances S, May Christine M, Montori Victor M, Richardson Alison, Rogers Anne E, Shippee Nathan
Faculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton SO17 1BJ, UK.
BMC Health Serv Res. 2014 Jun 26;14:281. doi: 10.1186/1472-6963-14-281.
In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding - and sometimes preventing - disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment.
As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization.
Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts.
在本文中，我们概述了治疗负担理论，这是一种关于病人、其社会网络与医疗服务之间关系的新模型。医疗服务面临着照顾患有长期疾病和危及生命疾病的不断增长的人口的挑战，为此，它们将旨在管理症状、延缓（有时是预防）疾病进展的日常工作委托给病人及其社交网络。这是病人角色的新的主动工作，病人对此承担着越来越多的责任：它基于自我护理、自我赋权和自我实现的理念，以及可从诊所转移到社区的新技术和治疗方式。这些对病人提出了新要求，他们可能会将其体验为治疗负担。
随着负担的累积，一些病人不堪重负，其后果可能是个体病人的医疗结果不佳、照顾者压力增加，以及医疗服务的需求和成本上升。面对这些挑战，我们需要更好地理解病人在应对疾病负担和治疗负担的要求时所利用的资源，以及这些资源与医疗利用的相互作用方式。
治疗负担理论旨在理解行动能力如何与源自医疗保健的工作相互作用。治疗负担理论是一种结构模型，专注于病人及其网络所做的工作。因此，它有助于我们理解不同医疗环境和临床背景下医疗利用和依从性的差异。
