McDonald P, St Leger S
West Pennine Health Authority, Oldham.
J Public Health Med. 1996 Dec;18(4):443-8. doi: 10.1093/oxfordjournals.pubmed.a024543.
Environmental control systems (ECS) enhance the independence of housebound severely physically disabled people and offer them the prospect of a greater quality of life. A Department of Health scheme has provided ECS to severely disabled people. Provision and quality of provision in the North West were examined.
Audit of five years' prescriptions within the North West of England was carried out. Postal questionnaires were sent to 41 voluntary and self-help groups. Additional qualitative data were collected by contacting manufacturers and voluntary group advisors.
Eighty per cent of people referred for assessment received an ECS. However, there was geographical variation in referral rates and a bias toward younger people. There were unexplained variations among the assessors. The commonest diagnoses resulting in referral were multiple sclerosis, motor neurone disease and muscular dystrophy. Many other conditions, such as stroke and arthritis, for which an ECS might produce benefit were under-represented. There were some problems with the quality of the service, especially with the timescale of provision.
It is concluded that doctors and other professionals need a heightened awareness of the categories of person who can benefit from an ECS. Clarification of criteria and training are required if assessors are to be more consistent. Moreover, the mechanism of provision needs review. Public health physicians should re-evaluate their roles in provision, and should concentrate on commissioning an appropriate and good quality service rather than on co-ordination of the scheme.
环境控制系统（ECS）提高了居家严重身体残疾者的独立性，并为他们提供了更高生活质量的前景。卫生部的一项计划已为严重残疾者提供了环境控制系统。对西北地区的提供情况和提供质量进行了检查。
对英格兰西北部五年内的处方进行了审计。向41个志愿和自助团体发送了邮政调查问卷。通过联系制造商和志愿团体顾问收集了更多定性数据。
被转介进行评估的人中，80%获得了环境控制系统。然而，转介率存在地域差异，且偏向年轻人。评估人员之间存在无法解释的差异。导致转介的最常见诊断是多发性硬化症、运动神经元病和肌肉萎缩症。许多其他疾病，如中风和关节炎，环境控制系统可能对其有益，但代表性不足。服务质量存在一些问题，尤其是提供的时间安排。
得出的结论是，医生和其他专业人员需要提高对可从环境控制系统中受益的人群类别的认识。如果评估人员要更加一致，就需要明确标准并进行培训。此外，提供机制需要审查。公共卫生医生应重新评估他们在提供方面的作用，并应专注于委托提供适当且高质量的服务，而不是协调该计划。
