以人为本的预防保健:收集利益相关者对证据和实施的投入

AJPM focus Pub Date : 2025-04-01 Epub Date: 2025-01-31 DOI:10.1016/j.focus.2025.100319
Leila C. Kahwati MD, MPH , Hanan J. Aboumatar MD, MPH , Alison K. Banger MPH , Sarah I. Bean MPH , Laurie W. Hinnant PhD , Daniel E. Jonas MD, MPH , Julia M. Kim MD, MPH , Jennifer S. Lin MD, MCR , Carrie D. Patnode PhD , Meagan R. Pilar PhD , Samantha I. Pitts MD, MPH , Shivani M. Reddy MD, MSc , Ritu Sharma BSc , Christiane E. Voisin MSLS , Elizabeth M. Webber MS , Jodi Blake MBA , Nora M. Mueller PhD, MAA
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引用次数: 0

摘要

临床预防服务,如筛检、疫苗接种、行为咨询或预防性药物,是根据年龄、性别、健康行为或临床风险因素向大多数人提供的,目的是发现早期疾病,预防未来疾病,或减轻不健康行为对未来健康的影响。然而,许多人并没有得到他们有资格获得的所有推荐服务。方法卫生保健研究和质量局确定了4个主题,以收集利益相关者对公平提供临床预防服务的证据和实施的意见。其中包括技术、创新交付模式、公共卫生联系和差异。对于每个主题,作者进行了环境扫描,以确定现有的计划或干预措施,以促进临床预防服务的提供,技术专家小组会议和关键信息提供者访谈。作者从每个主题的技术专家小组和关键信息访谈中综合输入,并使用归纳推理来确定主题。在每个总体主题中,作者确定了由具体陈述、示例和说明性引用支持的子主题。结果共有90人参加了利益相关者小组、技术专家小组或关键线人访谈;一些人参与了多个角色。在这些主题中,作者从技术专家小组和关键信息提供者访谈意见的综合中确定了3个总体主题:(1)向整体医疗保健服务和融资模式的过渡;(2)在医疗保健系统设计中包括社区和患者的声音;(3)利用技术改善临床预防服务的提供。促进临床预防服务的公平提供需要改善获得初级保健的机会,但也需要将努力扩大到临床环境之外,包括公共卫生和社区基础设施和参与。专家建议,以人为本的预防保健应使患者能够根据自己的价值、风险和偏好,对临床预防服务做出知情决定。这种根据需要和情况量身定制的更加个性化的方法可能会减少接受临床预防服务的障碍。
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Person-Centered Preventive Health Care: Gathering Stakeholder Input on Evidence and Implementation

Introduction

Clinical preventive services, such as screening tests, vaccinations, behavioral counseling, or preventive medication, are offered to most people on the basis of age, sex, health behaviors, or clinical risk factors, with goals of detecting early disease, preventing future disease, or mitigating the impact of unhealthy behaviors on future health. However, many people do not receive all the recommended services for which they are eligible.

Methods

The Agency for Healthcare Research and Quality identified 4 topics for gathering stakeholder input on evidence and implementation for the equitable delivery of clinical preventive services. These included technology, innovative delivery models, public health linkages, and disparities. For each topic, the authors conducted an environmental scan to identify existing programs or interventions to promote the delivery of clinical preventive services, a technical expert panel meeting, and key informant interviews. The authors synthesized input from each topic's technical expert panel and key informant interviews and used inductive reasoning to identify themes. Within each overarching theme, the authors identified subthemes supported by specific statements, examples, and illustrative quotes.

Results

A total of 90 individuals participated on stakeholder panels, technical expert panels, or key informant interviews; some individuals participated in multiple roles. Across the topics, the authors identified 3 overarching themes from synthesis of the technical expert panel and key informant interview comments across topics: (1) transitioning to holistic healthcare delivery and financing models, (2) including community and patient voice in healthcare system design, and (3) leveraging technology to improve clinical preventive services delivery.

Conclusions

Promoting the equitable delivery of clinical preventive services requires improving access to primary care but also expanding efforts beyond clinical settings to encompass public health and community infrastructure and engagement. Experts recommended that person-centered preventive care should empower patients to make informed decisions about clinical preventive services on the basis of their values, risks, and preferences. This more individualized approach tailored to needs and context may reduce barriers to receipt of clinical preventive services.
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AJPM focus
AJPM focus Health, Public Health and Health Policy
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