Calnan M, Cant S, Williams S, Killoran A
Centre for Health Services Studies, University of Kent at Canterbury.
Br J Gen Pract. 1994 May;44(382):224-8.
Recent years have seen a vast increase in the amount of health promotion activity undertaken in general practice.
This study set out to identify the level of general practitioner and nurse involvement in activities aimed at coronary heart disease prevention and to examine variations in involvement.
A questionnaire survey was undertaken of a sample of general practitioners across England and the nurses who worked in their practices.
Of 1696 randomly selected general practitioners 64% completed a questionnaire, of 928 practice nurses 71% responded and of 682 health visitors and 679 district nurses 52% and 40% responded, respectively. Of the general practitioners 94% reported that they were involved in assessing lifestyle risk factors in the routine consultation and regular assessments most commonly involved blood pressure testing and inquiry about smoking status. Eighty six per cent of practices were reported by the practice nurse as having well person clinics; these clinics were usually run by the practice nurse. Clinics for the management of specific lifestyle risk factors were also usually run by practice nurses, although many doctors were involved in hypertension clinics and cholesterol clinics. Health visitors and district nurses had a low level of involvement in this practice based clinic activity. Involvement of general practitioners and practice nurses in coronary heart disease prevention was associated with training in health promotion and positive attitudes towards prevention and health promotion. The level of involvement of practice nurses in health promotion was associated with the support received from primary health care facilitators, family health services authorities and district health authorities.
Members of the primary health care team appeared to have their own distinct area of preventive activity. However, this division did not appear to be a result of organized teamwork and deployment of skills and expertise according to a clearly defined management protocol. Instead it seemed to be a product of general practitioner contract and management arrangements which tended to encourage an approach to general practice health promotion which revolved around the practice nurse and which hindered the development of a broader team based approach to planning and delivery of health promotion in relation to the needs of the practice population.
近年来，全科医疗中开展的健康促进活动数量大幅增加。
本研究旨在确定全科医生和护士参与冠心病预防活动的程度，并考察参与程度的差异。
对英格兰各地的全科医生样本及其诊所工作的护士进行了问卷调查。
在随机抽取的1696名全科医生中，64%完成了问卷；在928名执业护士中，71%做出了回应；在682名健康访视员和679名社区护士中，回应率分别为52%和40%。94%的全科医生报告称，他们在常规会诊中参与评估生活方式风险因素，常规评估最常涉及血压检测和吸烟状况询问。执业护士报告称，86%的诊所设有健康体检门诊；这些门诊通常由执业护士负责。针对特定生活方式风险因素的管理门诊通常也由执业护士负责，不过许多医生参与了高血压门诊和胆固醇门诊。健康访视员和社区护士参与此类基于诊所的活动的程度较低。全科医生和执业护士参与冠心病预防与健康促进培训以及对预防和健康促进的积极态度有关。执业护士参与健康促进的程度与从初级卫生保健促进者、家庭健康服务当局和地区卫生当局获得的支持有关。
初级卫生保健团队成员似乎各自有其独特的预防活动领域。然而，这种分工似乎并非有组织的团队合作以及根据明确界定的管理方案部署技能和专业知识的结果。相反，这似乎是全科医生合同和管理安排的产物，这些安排往往鼓励围绕执业护士开展全科医疗健康促进的方式，这阻碍了基于更广泛团队的方法的发展，这种方法旨在根据诊所人群的需求规划和提供健康促进服务。
