Martin C, Nisa M
National Centre for Epidemiology and Population Health, Australian National University.
Aust Fam Physician. 1996 Aug;25(8):1273-5, 1277, 1279-81.
Care of children with chronic disease is an important part of general practice. While the emphasis of management has traditionally been on the biomedical aspects of ill health categorised by specific medical diagnoses, other dimensions may be important.
To define chronic disease and illness. To describe 'non categorical' dimensions or common features of different chronic diseases in childhood and their impact on the child and family involved. To explore needs for care and the role of the general practitioner in providing this care.
A literature review based on a search of the Medline electronic database. Both quantitative and qualitative articles on the topic of non-categorical or generic approaches to chronic childhood disease were selected on the basis of their quality and relevance to the Australian health care system.
Chronic illness disturbs the lives of children, limiting their roles in schools, recreation, and vocational pursuit. Parents and siblings often experience social, economic and personal disadvantage. Care that is orientated to the 'whole child' and facilitates 'family control' in the various stages of illness and disease promotes better coping. Non-categorical management is optimised by continuity of both the setting and provider, with a provider who co-ordinates care.
Chronic illness management offers a challenge to general practitioners to take on an expanded generalist role. This should complement specialised activities. When technical or specialised disease orientated care bypasses the general practitioner, important elements may be neglected. Proposed case management reforms are a stimulus to reappraise the role of general practitioners in chronic illness and disease care.
慢性病患儿的护理是全科医疗的重要组成部分。传统上，管理的重点一直是由特定医学诊断分类的健康问题的生物医学方面，而其他方面可能也很重要。
界定慢性病和疾病。描述儿童期不同慢性病的“非分类”维度或共同特征及其对患儿及其家庭的影响。探讨护理需求以及全科医生在提供此类护理中的作用。
基于对Medline电子数据库的检索进行文献综述。根据文章质量及其与澳大利亚医疗保健系统的相关性，选取了关于儿童慢性病非分类或通用方法主题的定量和定性文章。
慢性病扰乱患儿的生活，限制他们在学校、娱乐和职业追求中的角色。父母和兄弟姐妹经常面临社会、经济和个人方面的不利处境。以“全人”为导向并在疾病的各个阶段促进“家庭掌控”的护理有助于更好地应对。通过护理场所和提供者的连续性以及协调护理的提供者来优化非分类管理。
慢性病管理对全科医生提出了挑战，要求他们承担起扩展后的通科角色。这应补充专科活动。当以技术或专科疾病为导向的护理绕过全科医生时，重要的要素可能会被忽视。拟议的病例管理改革促使人们重新评估全科医生在慢性病护理中的作用。
