Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Pavillon Z7-local 3007, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
Health Res Policy Syst. 2024 Jul 3;22(1):75. doi: 10.1186/s12961-024-01171-1.
Many people face problems about physical, mental, and social dimensions of health, and may have complex needs. They often experience a mismatch between their needs and the ability of the healthcare system to meet them, resulting in under- or overutilization of the healthcare system. On one hand, improving access to community-based primary healthcare for hard-to-reach populations should bring all healthcare and social services to one point of contact, near the community. On the other hand, better addressing the unmet needs of people who overuse healthcare services calls for integrated care among providers across all settings and sectors. In either case, intersectoral action between healthcare and social professionals and resources remains central to bringing care closer to the people and the community, enhancing equitable access, and improving health status. However, efforts to implement integrated care are unevenly weighted toward clinical and professional strategies (micro level), which could jeopardize our ability to implement and sustain integrated care. The development of appropriate policies and governance mechanisms (macro level) is essential to break down silos, promote a coherent intersectoral action, and improve health equity.
许多人面临着健康的生理、心理和社会层面的问题,可能有复杂的需求。他们经常经历需求与医疗保健系统满足这些需求的能力之间的不匹配,导致医疗保健系统的利用不足或过度利用。一方面,改善难以接触到的人群获得基于社区的初级医疗保健的机会,应将所有医疗保健和社会服务带到社区附近的一个联络点。另一方面,更好地满足过度使用医疗保健服务的人的未满足需求,需要在所有环境和部门的提供者之间开展综合护理。在这两种情况下,医疗保健和社会专业人员和资源之间的部门间行动仍然是将护理更贴近人民和社区、增强公平获取机会和改善健康状况的核心。然而,实施综合护理的努力在临床和专业策略(微观层面)上存在不平衡,这可能危及我们实施和维持综合护理的能力。制定适当的政策和治理机制(宏观层面)对于打破隔阂、促进连贯的部门间行动和改善健康公平至关重要。