EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings.
EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings.
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DOI：
10.1186/s12939-015-0271-y
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发表时间：
2015-12-14
影响因子：
4.8
通讯作者：
EQUIP Research Team
中科院分区：
文献类型：
--
作者：
Browne AJ;Varcoe C;Ford-Gilboe M;Wathen CN;EQUIP Research Team
初级卫生保健部门作为人口健康干预的场所越来越重要，特别是与边缘化群体有关，因为在这些群体中，健康状况可以获得最大程度的改善。本文件的目的是概述一种创新的多组成部分、组织一级的干预措施，旨在加强PHC诊所提供注重公平的护理的能力，特别是为边缘人群提供护理。这项名为Equipp的干预措施正在加拿大的四家不同的PHC诊所实施，为受结构性不平等影响的人群提供服务。这些初级卫生保健诊所是实施和评估装备干预的个案研究。我们讨论了为干预提供依据的证据和理论，描述了干预的组成部分，并讨论了在不同背景下评估干预实施和影响的方法。工作人员教育：使用标准化的教育模式和整合战略，加强工作人员与一般面向公平的护理、特别是与文化安全、创伤和暴力相关的护理有关的知识、态度和做法；以及；组织整合和定制：使用参与式方法、做法便利化和催化剂赠款促进组织结构、做法和政策的转变，以提高提供面向公平的护理的能力，改进护理流程，并转变关键的客户成果。与以公平为导向的护理相关的研究和理论以及复杂性理论是装备干预设计的核心。这项干预措施旨在提高工作人员和组织一级(即政策和业务)注重公平的护理的能力，其新颖之处在于它的双重重点：使用混合方法、多案例研究设计，我们正在审查干预措施在以下方面的影响：增进工作人员的知识、态度和做法；改进护理流程；改变组织政策和结构；以及改进选定的客户成果。多案例研究设计提供了一个理想的机会，来研究在不同的PHC环境中，影响我们量身定做的干预措施的实施、吸收和影响的背景因素。装备干预说明了提高PHC部门在现实世界临床环境中提供以公平为导向的护理的能力所涉及的复杂性。
The primary health care (PHC) sector is increasingly relevant as a site for population health interventions, particularly in relation to marginalized groups, where the greatest gains in health status can be achieved. The purpose of this paper is to provide an overview of an innovative multi-component, organizational-level intervention designed to enhance the capacity of PHC clinics to provide equity-oriented care, particularly for marginalized populations. The intervention, known as EQUIP, is being implemented in Canada in four diverse PHC clinics serving populations who are impacted by structural inequities. These PHC clinics serve as case studies for the implementation and evaluation of the EQUIP intervention. We discuss the evidence and theory that provide the basis for the intervention, describe the intervention components, and discuss the methods used to evaluate the implementation and impact of the intervention in diverse contexts. Staff education: using standardized educational models and integration strategies to enhance staff knowledge, attitudes and practices related to equity-oriented care in general, and cultural safety, and trauma- and violence-informed care in particular, and; Organizational integration and tailoring: using a participatory approach, practice facilitation, and catalyst grants to foster shifts in organizational structures, practices and policies to enhance the capacity to deliver equity-oriented care, improve processes of care, and shift key client outcomes. Research and theory related to equity-oriented care, and complexity theory, are central to the design of the EQUIP intervention. The intervention aims to enhance capacity for equity-oriented care at the staff level, and at the organizational level (i.e., policy and operations) and is novel in its dual focus on: Using a mixed methods, multiple case-study design, we are examining the impact of the intervention in enhancing staff knowledge, attitudes and practices; improving processes of care; shifting organizational policies and structures; and improving selected client outcomes. The multiple case study design provides an ideal opportunity to study the contextual factors shaping the implementation, uptake and impact of our tailored intervention within diverse PHC settings. The EQUIP intervention illustrates the complexities involved in enhancing the PHC sector's capacity to provide equity-oriented care in real world clinical contexts.