Integrating a nationally scaled workforce of community health workers in primary care: a modelling study
Integrating a nationally scaled workforce of community health workers in primary care: a modelling study
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DOI：
10.1177/0141076818803443
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发表时间：
2018-12-01
影响因子：
17.3
通讯作者：
Harris, Matthew
中科院分区：
文献类型：
--
作者：
Hayhoe, Benedict;Cowling, Thomas E.;Harris, Matthew
目的对全国社区卫生工作者队伍的成本和效益进行建模。设计建模练习基于所有的一般做法在英国。英国国家卫生服务初级保健。参加者不适用。数据来源关于全科人口统计、人口密度、家庭规模、工资水平以及筛查和免疫接种的公开数据。我们估计了所需社区卫生工作者的数量、预期工作量和可能给患者带来的好处。结果保守的模型显示，英格兰需要110,585名社区卫生工作者来覆盖普通医疗注册人口，每年花费22.2亿英镑。假设社区卫生工作者能够与20%的合格未筛查或未接种疫苗的个人接触并成功转诊，那么在各自的审查期内，预计将增加753,592次宫颈癌筛查、365,166次乳腺癌筛查和482,924次肠癌筛查。每年总共有16,398名额外的儿童可以在12个月时接受MMR1, 24,716名儿童可以在5岁时接受MMR2。社区卫生工作者还将为慢性病患者提供以家庭为基础的健康促进和生活方式支持。结论将规模较大的社区卫生工作者队伍纳入初级保健可能是一项有价值的政策选择。需要进行试点研究，以确定国民保健制度初级保健的可行性和影响。
Objective To model cost and benefit of a national community health worker workforce. Design Modelling exercise based on all general practices in England. Setting United Kingdom National Health Service Primary Care. Participants Not applicable. Data sources Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake. Main outcome measures We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients. Results Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing 2.22bn pound annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease. Conclusion A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.