Upshur Ross E G
Professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health at the University of Toronto. He is also an assistant director of the Lunenfeld Tanenbaum Research Institute in the Sinai Health System and head of the Division of Clinical Public Health at the Dalla Lana School of Public Health at the University of Toronto. He can be reached by e-mail at:
Healthc Q. 2016;19(2):24-28. doi: 10.12927/hcq.2016.24695.
Ten years ago, complexity was not a term often used in primary care. In the last decade, however, the population seen in primary care has shifted, posing substantial challenges for both primary care providers and health systems. In this essay, I will document the approaches that evolved in an academic family practice environment to address the challenges posed by complex patients typified by multiple concurrent chronic conditions and social determinants challenges. I will describe the research that lead to the creation, implementation and evaluation of an inter-professional model of care and associated outcomes. I will describe how this work subsequently led to the evolution of clinical models and research projects designed to reframe the discourse around complexity as well as move forward on elaborating new policy, clinical and service delivery innovations. I will conclude with some thoughts about what I see as the major challenges in the short and immediate term for research and practice, drawing on 15 years of practice and research experience with complex populations.
十年前，复杂性并非基层医疗中常用的术语。然而，在过去十年里，基层医疗所面对的人群发生了变化，这给基层医疗服务提供者和卫生系统都带来了巨大挑战。在本文中，我将记录在一个学术性家庭医疗环境中逐渐形成的应对复杂患者所带来挑战的方法，这些复杂患者的典型特征是同时患有多种慢性病以及面临社会决定因素方面的挑战。我将描述促成一种跨专业护理模式的创建、实施和评估及其相关成果的研究。我将阐述这项工作如何随后推动了临床模式和研究项目的发展，这些项目旨在重新构建围绕复杂性的讨论，并在制定新政策、临床和服务提供创新方面取得进展。我将结合对复杂人群15年的实践和研究经验，对我认为在短期和近期研究及实践中面临的主要挑战发表一些看法作为结语。
