在基层保健研究中进行卫生政策分析:将临床理念转化成行动

Conducting Health Policy Analysis in Primary Care Research:Turning Clinical Ideas into Action

医疗卫生指南在基层保健工作者的日常诊疗中发挥着重要作用,而卫生政策研究对这些指南的制定有帮助。卫生政策分析是解释卫生机构、特殊利益和理论建构之间相互作用的多学科公共政策研究方法。本文中,会展示基层保健工作者如何在基层保健环境中使用Bardach政策分析八步法来进行高影响的卫生政策研究。在一个医学病例中,家庭医学住院医师给1位有全子宫切除病史的妇女进行了全面检查,其中包括巴氏涂片筛查性检查,与全子宫切除术后对巴氏涂片检查的建议相互矛盾,从而引发了一项采用美国预防服务工作组标准进行卫生政策分析的调查。其充分说明了如何通过使用广泛适用的Bardach卫生政策框架来检验临床照护困境,以便做出有意义的政策变化调整。Bardach框架包括:(1)界定问题;(2)收集证据;(3)构建备选方案;(4)选择标准;(5)预测结果;(6)权衡利弊;(7)决策;(8)分享过程所产生的结果。政策分析显示,没有足够的证据建议子宫切除术后进行巴氏涂片检查,这些发现有助于形成国家层面的建议。通过遵循Bardach步骤,基层保健研究人员可以用这个可行而强大的工具来进行有意义、影响临床诊疗的卫生政策研究和分析。

Healthcare guidelines play a prominent role in the day-to-day practice of primary care providers,and health policy research leads to the formation of these guidelines.Health policy research is the multidisciplinary approach to public policy explaining the interaction between health institutions,special interests and theoretical constructs.In this article,we demonstrate how primary care providers can conduct high-impact health policy research using Eugene Bardach’s eightfold policy analysis framework in a primary care context.In a medical case,a woman with a history of total hysterectomy had scheduled a visit for a Papanicolaou(Pap)smear screening test as part of a wellwoman health check-up with a family medicine resident.Conflicting recommendations on Pap smear screening after total hysterectomy sparked an investigation using the US Preventive Services Task Force criteria for conducting a health policy analysis.We illustrate broadly how clinical care dilemmas can be examined by usingBardach’s broadly applicable health policy framework in order to inform meaningful policy change.Bardach’s framework includes(1)defining the problem,(2)assembling evidence,(3)constructing alternatives,(4)selecting criteria,(5)projecting outcomes,(6)confronting trade-offs,(7)decision-making and(8)sharing the results of the process.The policy analysis demonstrated insufficient evidence to recommend Pap test screening after hysterectomy and the findings contributed to national recommendations.By following Bardach’s steps,primary care researchers have a feasible and powerful tool for conducting meaningful health policy research and analysis that can influence clinical practice.