Hopkins A, Solomon J, Abelson J
Research Unit, Royal College of Physicians of London, England.
J R Soc Med. 1996 Jul;89(7):364-71. doi: 10.1177/014107689608900704.
The nature of the work undertaken by different health professionals and inter-professional boundaries are constantly shifting. The greater knowledge of users of health care, and the increasing technical and organizational complexity of modern medicine, have partly eroded the control of health professionals over the substance of their work. The definition of a field of work as lying within the province of any one profession is culturally rather than scientifically determined. It is evident that care of good quality should be delivered at the lowest possible cost. This might include delivery of care by a less trained person than heretofore, or by someone with limited but focused training. Sharing of skills is a more sensible subject for discussion than transfer of tasks. We review a number of studies which show the effectiveness of inter-professional substitution in various care settings, and also the effectiveness of substitution by those other than health professionals. The views of users of health services on inter-professional substitution need to be considered. Health professionals and others need to work together to devise innovative ways of delivering effective health care. The legal issues need clarification.
不同卫生专业人员所从事工作的性质以及专业间的界限一直在变化。医疗保健使用者知识的增长以及现代医学技术和组织复杂性的增加，在一定程度上削弱了卫生专业人员对其工作实质内容的控制。将一个工作领域定义为属于任何一个专业范畴，是由文化而非科学决定的。显然，高质量的护理应以尽可能低的成本提供。这可能包括由比以往训练较少的人员提供护理，或者由受过有限但针对性强的培训的人员提供护理。技能共享比任务转移是更值得讨论的合理话题。我们回顾了一些研究，这些研究表明在各种护理环境中专业间替代的有效性，以及非卫生专业人员替代的有效性。需要考虑卫生服务使用者对专业间替代的看法。卫生专业人员和其他人员需要共同努力，设计出提供有效医疗保健的创新方法。法律问题需要澄清。
