Povar G J
Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
J Fam Pract. 1996 Feb;42(2):124-8.
In Defining Primary Care: An Interim Report, the Institute of Medicine offers a set of attributes for primary care that raise many unresolved empirical and philosophical questions. For instance, the "integrated nature" of primary care immediately challenges the validity of the content of research in primary care using data such as ICD-9 codes, which, by nature, reduce patients to disaggregated sets of problems rather than coherent wholes. Likewise, considering accessibility as a hallmark of primary care focuses attention on how health care is organized, and whether depending on primary care-trained professionals as the necessary or ideal first point of access might be a deterrent to the delivery of optimal care among some populations. Primary care clinicians should and will be held accountable for achieving the attributes of practice that make primary care unique. This paper provides a detailed examination of the Institute's definition, and identifies many aspects that require additional thought and research before these attributes can be applied as criteria for the evaluation of primary care practice.
在《定义初级保健：中期报告》中，医学研究所提出了一套初级保健的属性，这引发了许多尚未解决的实证和哲学问题。例如，初级保健的“综合性”立即对使用ICD - 9编码等数据进行的初级保健研究内容的有效性提出了挑战，从本质上讲，这些数据将患者简化为分散的问题集，而不是连贯的整体。同样，将可及性视为初级保健的一个标志，会将注意力集中在医疗保健的组织方式上，以及依赖经过初级保健培训的专业人员作为必要或理想的第一接触点，是否可能对某些人群提供最佳护理起到阻碍作用。初级保健临床医生应该并且将会为实现使初级保健独具特色的实践属性负责。本文对该研究所的定义进行了详细审视，并指出在这些属性能够用作评估初级保健实践的标准之前，有许多方面需要进一步思考和研究。
