1 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
2 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK.
J R Soc Med. 2018 Dec;111(12):453-461. doi: 10.1177/0141076818803443. Epub 2018 Oct 4.
To model cost and benefit of a national community health worker workforce.
Modelling exercise based on all general practices in England.
United Kingdom National Health Service Primary Care.
Not applicable.
Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake.
We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients.
Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease.
A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.
建立国家社区卫生工作者队伍的成本效益模型。
基于英格兰所有全科医生的建模练习。
英国国民保健制度初级保健。
不适用。
全科医生人口统计学、人口密度、家庭规模、工资标准以及筛查和免疫接种率的公开可用数据。
我们估计了所需的社区卫生工作者人数、预期工作量以及对患者的可能收益。
保守建模表明，需要 110585 名社区卫生工作者来覆盖英格兰的全科医生注册人口，每年的成本为 22.22 亿英镑。假设社区卫生工作者可以接触并成功转介 20%的合格未筛查或未免疫人群，预计在各自的审查期内，可额外进行 753592 例宫颈癌筛查、365166 例乳腺癌筛查和 482924 例结肠癌筛查。每年可额外有 16398 名儿童在 12 个月时接受麻疹、腮腺炎、风疹联合疫苗第一针接种，24716 名儿童在五岁时接受麻疹、腮腺炎、风疹联合疫苗第二针接种。社区卫生工作者还将为患有慢性病的患者提供家庭健康促进和生活方式支持。
将规模适度的社区卫生工作者队伍纳入初级保健可能是一项有价值的政策选择。需要进行试点研究以确定在英国国民保健制度初级保健中的可行性和影响。
