Pediatric Self-management: A Framework for Research, Practice, and Policy
Pediatric Self-management: A Framework for Research, Practice, and Policy
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DOI：
10.1542/peds.2011-1635
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发表时间：
2012-02-01
期刊：
影响因子：
8
通讯作者：
Drotar, Dennis
中科院分区：
文献类型：
--
作者：
Modi, Avani C.;Pai, Ahna L.;Drotar, Dennis
慢性儿科疾病的自我管理对患者、家庭和临床医生来说是一个巨大的挑战，研究表明，在儿科疾病中，自我管理不良和不依从的患病率很高。然而，有效的自我管理是必要的，以最大限度地提高治疗效果和临床结果，并减少不必要的医疗保健利用和成本。然而，这种复杂的行为是不充分的定义，依赖于条件特定和/或成人模型的自我管理，未能考虑众多因素影响患者的自我管理行为，缺乏综合的研究，临床实践和政策的影响，结果知之甚少。为了满足这一需求，我们提出了一个全面的概念模型儿科自我管理，阐明了个人，家庭，社区和医疗保健系统的水平影响，通过认知，情感和社会过程的影响自我管理行为。该模型进一步描述了患者和系统层面的自我管理、依从性和结局之间的关系。研究，临床实践和卫生保健政策有关儿科慢性病护理的影响，强调特别关注可修改的影响，循证干预目标，以及临床医生在提供自我管理支持的作用。我们预计，这种统一的概念方法将使儿科医疗保健的利益相关者能够（1）制定基于证据的干预措施以改善自我管理，（2）设计旨在预防不良自我管理行为发展的计划，以及（3）为最终改善慢性病儿童健康和心理社会结果的医疗保健政策提供信息。儿科2012; 129：e473-e485
Self-management of chronic pediatric conditions is a formidable challenge for patients, families, and clinicians, with research demonstrating a high prevalence of poor self-management and nonadherence across pediatric conditions. Nevertheless, effective self-management is necessary to maximize treatment efficacy and clinical outcomes and to reduce unnecessary health care utilization and costs. However, this complex behavior is poorly understood as a result of insufficient definitions, reliance on condition-specific and/or adult models of self-management, failure to consider the multitude of factors that influence patient self-management behavior, and lack of synthesis of research, clinical practice, and policy implications. To address this need, we present a comprehensive conceptual model of pediatric self-management that articulates the individual, family, community, and health care system level influences that impact self-management behavior through cognitive, emotional, and social processes. This model further describes the relationship among self-management, adherence, and outcomes at both the patient and system level. Implications for research, clinical practice, and health care policy concerning pediatric chronic care are emphasized with a particular focus on modifiable influences, evidence-based targets for intervention, and the role of clinicians in the provision of self-management support. We anticipate that this unified conceptual approach will equip stakeholders in pediatric health care to (1) develop evidence-based interventions to improve self-management, (2) design programs aimed at preventing the development of poor self-management behaviors, and (3) inform health care policy that will ultimately improve the health and psychosocial outcomes of children with chronic conditions. Pediatrics 2012; 129:e473-e485