Peckham Stephen, Hann Alison, Kendall Sally, Gillam Steve
1Professor of Health Policy,Centre for Health Services Studies,University of Kent,Canterbury,UK.
3Senior Lecturer,Public Health, Policy and Social Sciences,Swansea University,Swansea,UK.
Prim Health Care Res Dev. 2017 Nov;18(6):529-540. doi: 10.1017/S1463423617000494. Epub 2017 Aug 11.
This paper reports the findings of a scoping review on the organisation and delivery of health improvement activities in general practice and the primary healthcare team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices and how individual practices and the primary healthcare team organise such public health activities and how these contribute to health improvement. Our focus was on health promotion and prevention activities and aimed to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary healthcare team. Many of the research studies reviewed had some details about the type, process, location or who provided the intervention. Little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches with practices engaging in both primary and secondary prevention. Although many GPs do not take a population approach and focus on individual patients some do see health promotion as an integral part of practice - whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Based on our analysis we conclude that there is insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care.
本文报告了一项关于全科医疗及基层医疗团队中健康改善活动的组织与实施情况的范围综述结果。该项目旨在研究谁来提供这些干预措施、它们位于何处、在实践中采用了哪些方法，以及各个诊所和基层医疗团队如何组织此类公共卫生活动，以及这些活动如何促进健康改善。我们关注的是健康促进和预防活动，旨在确定目前关于全科医疗及更广泛的基层医疗团队中健康改善活动的知识范围。许多被综述的研究都包含了关于干预措施的类型、过程、地点或提供者的一些细节。文献中很少关注研究组织背景对服务提供方式的影响，或者这如何影响全科医疗中健康改善干预措施的有效性。我们发现，关注的焦点主要是个体预防方法，诊所同时开展一级和二级预防。尽管许多全科医生不采用群体方法，而是专注于个体患者，但也有一些医生将健康促进视为实践的一个组成部分——无论是作为个体的一级或二级健康改善方法，还是作为基于诊所的改善患者健康的方法。基于我们的分析，我们得出结论，没有足够的充分证据支持全科医疗和初级保健中开展的许多健康改善干预措施。
