将基于证据的预防性健康整合到英格兰NHS的复杂性:从PrEP案例中吸取的教训
Tehseen Khan1,2, Clare Coultas3,4, Katharina Kieslich5
1King's College London, London, United Kingdom.
Health research policy and systems
|June 14, 2023
概括
在英格兰,整合预防性卫生服务面临着耻辱和分散系统等障碍. 政策能力问题阻碍了合作,阻止了基于证据的健康干预措施的有效实施.
科学领域:
- 公共卫生政策 公共卫生政策
- 医疗保健服务研究 医疗服务研究
- 社会政策分析 社会政策分析
背景情况:
- 英格兰的卫生政策优先考虑将预防性服务纳入国家卫生服务 (NHS).
- 旨在消除NHS组织,地方政府和社区团体之间合作的立法障碍.
- 关于PREP司法审查的案例研究说明了当前融合策略的不足.
研究的目的:
- 分析整合基于证据的预防性卫生服务的障碍.
- 检查政策能力在阻碍合作努力中的作用.
- 了解机构因素如何阻碍预防性卫生干预措施的实施,以PrEP资金争端作为案例研究.
主要方法:
- 质量研究涉及采访15名艾滋病毒专家.
- 在"政策能力"概念框架下的分析 (Wu等人, 2016).
- 探索英格兰NHS拒绝为暴露前预防 (PrEP) 承担资金责任,从而阻碍了艾滋病毒预防议程.
主要成果:
- 他们发现了三个关键的合作障碍:与"生活方式条件" (个人分析能力) 相关的潜在耻辱感.
- 在分散的卫生和社会护理系统中,预防的隐形性影响了证据的生成和共享 (组织运营能力).
- 机构政治和机构之间的不信任造成了系统政治能力问题.
结论:
- 这些发现对其他需要多机构资助的"生活方式"条件有影响.
- 该研究扩展了"政策能力"框架,以纳入更广泛的政策科学见解.
- 提出了建议,以限制委员会成员在以证据为基础的预防性健康方面"超越责任".
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