Briggs Adam D M, Göpfert Anya, Thorlby Ruth, Allwood Dominique, Alderwick Hugh
The Health Foundation, London, UK.
Warwick Medical School, University of Warwick, Coventry, West Midlands, UK.
Integr Healthc J. 2020 Feb 26;2(1):e000013. doi: 10.1136/ihj-2019-000013. eCollection 2020.
Over the past 12 months, there has been increasing policy rhetoric regarding the role of the National Health Service (NHS) in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change.
We reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health.
The evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health.
For ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants.
在过去12个月里，关于国民医疗服务体系（NHS）在预防疾病和改善人群健康方面的作用，政策层面的讨论日益增多。特别是，NHS长期计划将综合医疗系统（ICSs）和可持续性与转型伙伴关系（STPs）视为改善疾病预防的途径。在此，我们将英格兰NHS当前的综合医疗计划置于其历史背景中，并审视关于综合医疗与预防之间关系的证据。我们探讨NHS长期计划如何有助于预防疾病，并探究2019年ICS和STP计划在推动这一变革中的作用。
我们审视了综合医疗与疾病预防之间关系的相关证据，并分析了2016年STP计划中与疾病预防和人群健康相关的内容。
综合医疗程度越高预防疾病效果越好的证据不足。尽管2016年几乎所有STP计划都包含了预防或人群健康战略，但只有不到一半的计划明确说明了它们将如何与地方政府公共卫生团队合作，而且各计划在如何实现英格兰NHS预防重点方面的覆盖并不完整。计划大致侧重于针对疾病预防的个体层面方法，很少有计划描述针对健康社会决定因素的干预措施。
为了让ICS和STP切实预防疾病并改善人群健康，它们需要超越2016年的计划，填补长期计划中关于社会决定因素方面的空白。
