Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, Massachusetts 02115, United States of America (USA).
Ventura County Medical Center, Ventura, California, USA.
Bull World Health Organ. 2020 Nov 1;98(11):766-772. doi: 10.2471/BLT.20.252056. Epub 2020 Aug 27.
Primary health care provides the framework for delivering the socially-informed, comprehensive and patient-centred care underlying robust health-care systems and is, therefore, central to achieving universal health coverage. Family physicians are best placed to embody primary health care's dual focus on community and population health because they are often employed in rural or district hospitals with limited human resources, particularly a lack of specialists. Here we want to illustrate how additional training for family physicians, the key clinicians in primary care, can play a critical role in reducing disparities in access to surgical, obstetric and anaesthesia care in low- and middle-income countries and in rural or remote settings. Examples are given of how training programmes can be developed in low-resource settings to equip family physicians with life-saving surgical skills and of how family physicians in high-income countries can be trained in the surgical skills essential for working overseas in low-income settings. Policy-makers should promote surgical practice among family physicians by supporting family medicine programmes that include additional surgical skills training and by expanding opportunities and incentives for family physicians to serve in rural areas. Moreover, national surgical plans should include a primary health care strategy for surgical care and, globally, family physicians should be considered in discussions of surgical care. Finally, surgeons, anaesthesiologists, obstetricians and family physicians should be encouraged to collaborate in ensuring that all patients, regardless of place of residence, receive safe and timely surgical care.
初级卫生保健为提供社会信息、全面和以患者为中心的医疗服务提供了框架，是建立健全卫生保健系统的基础，因此也是实现全民健康覆盖的核心。家庭医生最适合体现初级卫生保健对社区和人群健康的双重关注，因为他们通常在人力资源有限的农村或地区医院工作，特别是缺乏专家。在这里，我们想说明对家庭医生（初级保健的主要临床医生）进行额外培训如何在减少中低收入国家和农村或偏远地区获得外科、产科和麻醉护理方面的差距方面发挥关键作用。我们举例说明了如何在资源有限的环境中制定培训计划，使家庭医生具备挽救生命的外科技能，以及如何培训高收入国家的家庭医生，使他们具备在低收入环境中海外工作所需的外科技能。政策制定者应通过支持包括额外外科技能培训的家庭医学方案来促进家庭医生的外科实践，并为家庭医生在农村地区服务提供更多机会和激励。此外，国家外科计划应包括一项针对外科护理的初级卫生保健战略，在全球范围内，应考虑将家庭医生纳入外科护理的讨论。最后，应鼓励外科医生、麻醉师、产科医生和家庭医生合作，确保所有患者，无论居住地点如何，都能获得安全和及时的外科护理。
