Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 4136 Parran Hall, Pittsburgh, USA.
School of Medicine, University of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA, 15213, USA.
Harm Reduct J. 2017 Oct 24;14(1):70. doi: 10.1186/s12954-017-0196-4.
Harm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of the harm reduction literature focuses on the harms of drug use and on specific harm reduction strategies, such as syringe exchange, rather than on the harm reduction philosophy as a whole. Given that a harm reduction approach can address other risk behaviors that often occur alongside drug use and that harm reduction principles have been applied to harms such as sex work, eating disorders, and tobacco use, a natural evolution of the harm reduction philosophy is to extend it to other health risk behaviors and to a broader healthcare audience.
Building on the extant literature, we used data from in-depth qualitative interviews with 23 patients and 17 staff members from an HIV clinic in the USA to describe harm reduction principles for use in healthcare settings.
We defined six principles of harm reduction and generalized them for use in healthcare settings with patients beyond those who use illicit substances. The principles include humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. For each of these principles, we present a definition, a description of how healthcare providers can deliver interventions informed by the principle, and examples of how each principle may be applied in the healthcare setting.
This paper is one of the firsts to provide a comprehensive set of principles for universal harm reduction as a conceptual approach for healthcare provision. Applying harm reduction principles in healthcare settings may improve clinical care outcomes given that the quality of the provider-patient relationship is known to impact health outcomes and treatment adherence. Harm reduction can be a universal precaution applied to all individuals regardless of their disclosure of negative health behaviors, given that health behaviors are not binary or linear but operate along a continuum based on a variety of individual and social determinants.
减少伤害是指旨在减少健康行为的负面影响的干预措施，而不必完全消除有问题的健康行为。绝大多数减少伤害的文献都集中在药物使用的危害上，以及具体的减少伤害策略上，如注射器交换，而不是整体的减少伤害哲学。鉴于减少伤害的方法可以解决与药物使用同时发生的其他风险行为，并且减少伤害原则已经应用于性工作、饮食失调和吸烟等危害，减少伤害哲学的自然发展是将其扩展到其他健康风险行为和更广泛的医疗保健受众。
在现有文献的基础上，我们使用了来自美国一家艾滋病诊所的 23 名患者和 17 名工作人员的深入定性访谈数据，描述了在医疗保健环境中使用的减少伤害原则。
我们定义了减少伤害的六个原则，并将其推广到使用非法药物的患者以外的医疗保健环境中。这些原则包括人道主义、实用主义、个体主义、自主性、渐进主义和问责而不停顿。对于每个原则，我们给出了定义、描述了医疗保健提供者如何根据该原则提供干预措施，以及每个原则如何在医疗保健环境中应用的例子。
本文是第一篇提供全面的普遍减少伤害原则作为医疗服务提供的概念方法的论文之一。在医疗保健环境中应用减少伤害原则可能会改善临床护理结果，因为提供者与患者的关系质量已知会影响健康结果和治疗依从性。鉴于健康行为不是二元的或线性的，而是根据各种个人和社会决定因素沿着连续体运作，减少伤害可以作为一种普遍的预防措施应用于所有个体，而不论他们是否披露负面健康行为。
