Addressing social determinants of noncommunicable diseases in primary care: a systematic review.
Addressing social determinants of noncommunicable diseases in primary care: a systematic review.
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DOI：
10.2471/blt.19.248278
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发表时间：
2020-11-01
影响因子：
11.1
通讯作者：
Currie J
中科院分区：
文献类型：
--
作者：
Allen LN;Smith RW;Simmons-Jones F;Roberts N;Honney R;Currie J
探讨初级保健组织如何评估当地人口非传染性疾病的社会决定因素并随后采取行动。在本次系统综述中，我们检索了 PubMed®、MEDLINE®、Embase® 和健康管理信息联盟的在线数据库（从成立到 2019 年 6 月 28 日），并手动检索了参考文献。包括对初级保健组织评估非传染性疾病社会决定因素的任何设计的研究。对于质量评估，我们使用 Cochrane 工具来评估干预措施非随机研究中的偏倚风险。我们使用叙述性数据合成来评估评估收集世界卫生组织健康问题社会决定因素框架领域数据的程度。我们确定了 666 项研究，其中 17 项纳入了评价。所有研究均采用描述性研究设计。与人口层面的数据相比，基于临床和家庭的调查和访谈更常用于评估当地社会决定因素。我们没有发现任何组织评估非传染性疾病的社会政治驱动因素的例子；所有这些都侧重于社会人口因素或日常生活环境。尽管如此，为解决社会决定因素而采取的行动包括个人层面的干预措施、全民措施以及在系统层面的政策和规划委员会中引入初级保健组织的代表权。我们的研究结果可能有助于政策制定者考虑在其国内背景下评估和解决健康问题社会决定因素的适当方法。需要更严格的观察和实验证据来确定衡量社会决定因素是否会导致采取干预措施来缓解未满足的社会需求并缩小健康差距。
To explore how primary care organizations assess and subsequently act upon the social determinants of noncommunicable diseases in their local populations. For this systematic review we searched the online databases of PubMed®, MEDLINE®, Embase® and the Health Management Information Consortium from inception to 28 June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of noncommunicable diseases were included. For quality assessment we used Cochrane’s tool for assessing risk of bias in non-randomized studies of interventions. We used narrative data synthesis to appraise the extent to which the assessments gathered data on the domains of the World Health Organization social determinants of health framework. We identified 666 studies of which 17 were included in the review. All studies used descriptive study designs. Clinic-based and household surveys and interviews were more commonly used to assess local social determinants than population-level data. We found no examples of organizations that assessed sociopolitical drivers of noncommunicable diseases; all focused on sociodemographic factors or circumstances of daily living. Nevertheless, the resulting actions to address social determinants ranged from individual-level interventions to population-wide measures and introducing representation of primary care organizations on system-level policy and planning committees. Our findings may help policy-makers to consider suitable approaches for assessing and addressing social determinants of health in their domestic context. More rigorous observational and experimental evidence is needed to ascertain whether measuring social determinants leads to interventions which mitigate unmet social needs and reduce health disparities.