Engelman Alina, Case Ben, Meeks Lisa, Fetters Michael D
Health Sciences, California State University, East Bay, Hayward, California, USA.
Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Fam Med Community Health. 2019 Mar 22;7(2):e000076. doi: 10.1136/fmch-2018-000076. eCollection 2019.
Healthcare guidelines play a prominent role in the day-to-day practice of primary care providers, and health policy research leads to the formation of these guidelines. Health policy research is the multidisciplinary approach to public policy explaining the interaction between health institutions, special interests and theoretical constructs. In this article, we demonstrate how primary care providers can conduct high-impact health policy research using Eugene Bardach's eightfold policy analysis framework in a primary care context. In a medical case, a woman with a history of total hysterectomy had scheduled a visit for a Papanicolaou (Pap) smear screening test as part of a well-woman health check-up with a family medicine resident. Conflicting recommendations on Pap smear screening after total hysterectomy sparked an investigation using the US Preventive Services Task Force criteria for conducting a health policy analysis. We illustrate broadly how clinical care dilemmas can be examined by using Bardach's broadly applicable health policy framework in order to inform meaningful policy change. Bardach's framework includes (1) defining the problem, (2) assembling evidence, (3) constructing alternatives, (4) selecting criteria, (5) projecting outcomes, (6) confronting trade-offs, (7) decision-making and (8) sharing the results of the process. The policy analysis demonstrated insufficient evidence to recommend Pap test screening after hysterectomy and the findings contributed to national recommendations. By following Bardach's steps, primary care researchers have a feasible and powerful tool for conducting meaningful health policy research and analysis that can influence clinical practice.
医疗保健指南在初级保健提供者的日常实践中发挥着重要作用，而卫生政策研究促成了这些指南的形成。卫生政策研究是一种针对公共政策的多学科方法，解释了卫生机构、特殊利益集团和理论结构之间的相互作用。在本文中，我们展示了初级保健提供者如何在初级保健背景下使用尤金·巴达赫的八步政策分析框架进行具有重大影响的卫生政策研究。在一个医疗案例中，一名有全子宫切除术病史的女性安排了一次就诊，进行巴氏涂片筛查测试，这是与一名家庭医学住院医生进行的健康女性体检的一部分。全子宫切除术后巴氏涂片筛查的相互矛盾的建议引发了一项调查，该调查使用了美国预防服务工作组的标准来进行卫生政策分析。我们广泛地说明了如何通过使用巴达赫广泛适用的卫生政策框架来审视临床护理困境，以便为有意义的政策变革提供信息。巴达赫的框架包括：（1）界定问题；（2）收集证据；（3）构建备选方案；（4）选择标准；（5）预测结果；（6）面对权衡；（7）做出决策；（8）分享过程结果。政策分析表明，没有足够的证据推荐子宫切除术后进行巴氏试验筛查，研究结果为国家建议做出了贡献。通过遵循巴达赫的步骤，初级保健研究人员拥有了一个可行且强大的工具，用于进行有意义的卫生政策研究和分析，从而影响临床实践。
