McDonnell S M, Witte D L, Cogswell M E, McIntyre R
Centers for Disease Control and Prevention, Atlanta, Georgia 30303, USA.
Ann Intern Med. 1998 Dec 1;129(11):987-92. doi: 10.7326/0003-4819-129-11_part_2-199812011-00010.
As part of the Iron Overload, Public Health and Genetics conference, sponsored by the Centers for Disease Control and Prevention in March 1997, a working group was convened to consider strategies to increase early case detection of hemochromatosis. This group emphasized that the primary public health goal should be to diagnose hemochromatosis before symptoms appear. To reach this goal, education and action need to be targeted to physicians and other health care workers, laboratorians, administrators, payers, and the public. Strategies to disseminate updated information and increase early case detection were prioritized according to expected effectiveness. Strategies targeting physicians are 1) to identify national and local physician-leaders and 2) to educate physicians about hemochromatosis in basic, graduate specialty, and continuing medical education. Strategies aimed at the health system are 1) to encourage laboratories to provide the transferrin saturation test as part of routine laboratory panels and 2) to work with policymakers and payers to allow reimbursement for case detection. Finally, public education is recommended to increase lay support for the early diagnosis of hemochromatosis. Attempts to educate the public should be aimed first at persons who receive diagnoses of hemochromatosis in order to ensure that they are properly treated and then at asymptomatic persons who could be screened as part of health appraisals. Although identifying physician-leaders and educating physicians are the highest priorities, physicians should not be targeted at the exclusion of payers and the public. Simultaneous efforts to reach all groups in appropriate ways should be initiated to provide the interest and infrastructure necessary to decrease morbidity and mortality from hemochromatosis.
作为1997年3月由疾病控制与预防中心主办的“铁过载、公共卫生与遗传学”会议的一部分，一个工作组被召集起来，以考虑增加血色素沉着症早期病例检测的策略。该小组强调，主要的公共卫生目标应该是在症状出现之前诊断出血色素沉着症。为实现这一目标，需要针对医生和其他医护人员、检验人员、管理人员、支付方以及公众开展教育并采取行动。根据预期效果，对传播最新信息和增加早期病例检测的策略进行了优先排序。针对医生的策略包括：1）确定国家和地方的医生领袖；2）在基础医学教育、研究生专业教育和继续医学教育中对医生进行血色素沉着症方面的教育。针对卫生系统的策略包括：1）鼓励实验室将转铁蛋白饱和度检测作为常规实验室检查项目的一部分提供；2）与政策制定者和支付方合作，使病例检测能够得到报销。最后，建议开展公众教育，以增加公众对血色素沉着症早期诊断的支持。对公众的教育应首先针对已被诊断出血色素沉着症的人群，以确保他们得到妥善治疗，然后针对可能作为健康评估一部分接受筛查的无症状人群。虽然确定医生领袖和对医生进行教育是最优先事项，但不应只针对医生而忽略支付方和公众。应以适当方式同时对所有群体展开努力，以提供降低血色素沉着症发病率和死亡率所需的关注度和基础设施。
