Warnky David, Balachandra Swathi S, Prasad Ramakrishna, Sykes Kevin J, Lall Dorothy, Bhojani Upendra M
Department of Family and Community Medicine, University of Kansas Medical Center, Kansas City, United States.
Department of Family Medicine, Academy of Family Physicians India, Bangalore, Karnataka, India.
J Family Med Prim Care. 2021 Nov;10(11):4253-4259. doi: 10.4103/jfmpc.jfmpc_971_21. Epub 2021 Nov 29.
As social position rises, health improves. Alma Ata set the stage for community-oriented primary care (COPC), and family medicine is perfectly positioned to integrate Social Determinants of Health. India presents a unique environment for innovations in family medicine.
This study aimed to (1) assess the ability of different primary care practices to address the social determinants of health (SDoH); (2) identify key obstacles and supports; and (3) provide practical insights to family physicians and other primary care providers (PCPs) for the integration of SDoH and clinical primary care.
A diverse sample of primary healthcare practices were selected in southern India for investigation. Data collection involved observation and informal interviews.
The researchers used general observation and informal interviews to collect data. Investigators used a basic interview guide to structure conversations and formal journal entries were recorded immediately following each visit.
Thematic analysis was conducted with NVIVO software to categorize major themes.
Seventeen primary healthcare practices were observed; eleven were formally enrolled for interviews. Four inputs and three outputs of socially oriented primary care practices were identified. The inputs include leadership style, appropriate staffing, funding structures, and patient panels. Social interventions, community contact, and treasuring community empowerment were the major outputs.
Community health lies at the heart of strengthening primary healthcare. Establishing practices that bridge the gap between clinical primary care and SDoH initiatives need to be prioritized. This study fosters agency for family physicians and PCPs to engage with local communities and lead the path toward this integration.
随着社会地位的提高，健康状况也会改善。阿拉木图为以社区为导向的初级保健（COPC）奠定了基础，而家庭医学在整合健康的社会决定因素方面具有得天独厚的优势。印度为家庭医学创新提供了独特的环境。
本研究旨在（1）评估不同初级保健实践应对健康社会决定因素（SDoH）的能力；（2）确定关键障碍和支持因素；（3）为家庭医生和其他初级保健提供者（PCP）在整合SDoH与临床初级保健方面提供实用见解。
在印度南部选取了多样化的初级医疗保健实践样本进行调查。数据收集包括观察和非正式访谈。
研究人员通过一般观察和非正式访谈收集数据。调查人员使用基本访谈指南来构建对话，并在每次访问后立即记录正式的日志条目。
使用NVIVO软件进行主题分析，以对主要主题进行分类。
观察了17个初级医疗保健实践；11个正式纳入访谈。确定了以社会为导向的初级保健实践的四个输入和三个输出。输入包括领导风格、适当的人员配备、资金结构和患者群体。社会干预、社区联系和珍视社区赋权是主要输出。
社区健康是加强初级医疗保健的核心。需要优先建立弥合临床初级保健与SDoH倡议之间差距的实践。本研究促进了家庭医生和PCP与当地社区互动并引领这种整合之路的能力。
