初级保健研究与发展:欧洲初级保健论坛官方杂志

P. Groenewegen, J. De Maeseneer, S. Kendall
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引用次数: 1

摘要

《初级卫生保健研究与发展》(PHCRD)于2015年8月宣布,现已成为欧洲初级保健论坛(EFPC)的官方期刊。PHCRD和EFPC都对这次合作感到高兴。EFPC旨在加强初级保健在欧洲国家的地位。随着欧洲人口的卫生需求不断变化,为所有人提供强有力的初级保健变得越来越重要。由于人口老龄化和多种疾病的增加,医疗保健必须从强调(单一)疾病转向以人为本的护理(De Maeseneer和Boeckxstaens, 2012年)。人们的健康问题并不遵循狭义的保健专业人员分类。人们需要——而且越来越期望——初级保健内部以及初级保健、二级保健部门和社会保健之间的协作。因此,初级保健能够提供更多的综合护理,将患者的观点置于任何有关卫生保健的讨论的核心。实现综合护理需要那些参与计划和提供服务的人“将患者的观点作为服务提供的组织原则”(Lloyd and Wait, 2005: 7)。这可以被视为强有力的初级保健的指导原则。然而,强大的初级保健不是自发产生的(Groenewegen et al., 2002)。它不是卫生保健系统的“自然状态”,而是需要监管,例如,使初级保健对特定人群负责,并成为有健康问题的人的第一接触点。因此,EFPC倡导强有力的初级保健。需要在不同层面进行宣传,从形成初级保健做法的地方和区域,到政府和民间社会组织(患者组织、专业团体)努力实现最佳监管的国家,以及在欧洲层面。欧洲层面是重要的,尽管卫生保健系统的组织不是欧盟的职权范围。归根结底,欧盟是建立在经济原则和消费者选择的基础上的。当我们意识到卫生部门是经济的重要组成部分时(平均占国民生产总值的10%,支付约10%的劳动力的工资),欧盟对成员国经济的建议(例如通过欧洲学期的国别建议)经常与卫生保健部门有关就不足为奇了。因此,同时迫切需要欧洲的倡导,但很难实现- -例如,这种倡导究竟应该指向哪里?然而,在欧盟内部,也需要信息和输入来获得合法性,并测试想法和主张。作为强有力的初级保健的倡导者,EFPC在回应欧盟组织的相关磋商方面有着良好的记录。通常很难评估这些行动的影响,但它们将想法放在欧盟公务员的脑海中,有时会导致文件和提案的措辞和框架的具体变化。EFPC制定了将其成员与倡导进程联系起来的工作方式。例如,对欧盟磋商的反应是基于成员的投入,通过讨论和辩论以及德尔菲调查来明确优先问题。在更结构性的基础上,EFPC通过制定立场文件与其成员合作。这些活动涉及重要问题,带来基于证据的信息和实践经验,并形成对该问题的立场。最近的立场文件涉及初级保健在罗姆人保健中的作用以及初级保健中的跨专业合作。未来,EFPC的立场文件将在PHCRD上发表。期刊名称中的“研究”和“发展”两个词与EFPC初级卫生保健研究与发展2016;17: 207-208编辑doi:10.1017/S1463423616000116
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Primary Health Care Research & Development: Official Journal of the European Forum for Primary Care
Announced in August 2015, Primary Health Care Research & Development (PHCRD) is now the Official Journal of the European Forum for Primary Care (EFPC). Both PHCRD and EFPC are delighted with this connection. The EFPC aims to strengthen the position of primary care in European countries. As the health needs of the population of Europe are changing, strong primary care for all is increasingly important. As a result of an ageing population and an increase in multi-morbidity, health care has to move from an emphasis on (single) diseases to person-centred care (De Maeseneer and Boeckxstaens, 2012). The health problems of people do not follow the narrowly defined classifications of health-care professionals. People need – and increasingly expect – collaboration both within primary care and between the boundaries of primary care, the secondary health-care sector and social care. As such, primary care is in a position to offer more integrated care described as putting the patient’s perspective at the heart of any discussion about health care. Achieving integrated care requires those involved with planning and providing services to ‘impose the patient perspective as the organising principle of service delivery’ (Lloyd and Wait, 2005: 7). This could be seen as a guiding principle of strong primary care. However, strong primary care is not something that comes about by itself (Groenewegen et al., 2002). It is not the ‘natural state’ of health-care systems but requires regulation, for example, in making primary care responsible for a defined population and the first point of contact for people with health problems. Therefore, the EFPC provides advocacy for strong primary care. Advocacy is needed at different levels, ranging from local and regional, where primary care practice is shaped, to national, where governments and civil society organizations (patient organizations, professional groups) work towards optimal regulation, and also at European level. The European level is important, even though the organization of health-care systems is not the remit of the EU. In the end, the EU is built on economic principles and consumer choice. When we realize how important a part of the economy the health sector is (on average 10% of gross national product, paying the salaries of again ~10%of the workforce), it will come as no surprise that EU advice on the member states’ economy (eg through the country-specific recommendations of the European Semester) often relates to the health-care sector. European advocacy is therefore at the same time strongly needed but difficult to achieve – for example, exactly where should such advocacy be directed? However, within the EU there is also a need for information and inputs to gain legitimacy and to test ideas and propositions. As an advocate for strong primary care, the EFPC has a track record in responding to relevant consultations, organized by the EU. It is often difficult to assess the impact of these actions, but they place ideas in the minds of the people working within the EU civil service and sometimes lead to concrete changes in the wording and framing of documents and proposals. The EFPC has developed ways of working that connects its members to the processes of advocacy. Reactions to EU consultations, for example, are built from the inputs of the members, drawn together through discussion and debate and Delphi surveys to articulate priority issues. On a more structural basis the EFPC works with and through its members by developing position papers. These address important issues, bring in both evidence-based information and practical experience and develop a position towards the issue. Recent position papers relate to the role of primary care in the care for Roma populations and inter-professional collaboration within primary care. In the future, position papers of the EFPC will be published in PHCRD. The two words ‘research’ and ‘development’ in the journal’s name link closely to what EFPC Primary Health Care Research & Development 2016; 17: 207–208 EDITORIAL doi:10.1017/S1463423616000116
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