When health technologies do not reach their effectiveness potential: A health service research perspective
When health technologies do not reach their effectiveness potential: A health service research perspective
复制标题
DOI：
10.1016/j.healthpol.2011.09.010
复制
发表时间：
2012-01-01
期刊：
影响因子：
3.3
通讯作者：
Campillo-Artero, Carlos
中科院分区：
文献类型：
--
作者：
Campillo-Artero, Carlos
本文试图解开以下问题：为什么我们有时会获得比预期更差的结果，尽管使用的技术是profective-effective或有效的，并消除了主要群体的原因导致性能不佳？归纳分析和综合的基础上的九个领域的卫生服务研究表明，有效地采用一些卫生技术，它是不够的，简单地选择一个有效的或有效的变革战略。有时需要改变使用它的卫生工作者的行为，并改变某些环境因素。技术的有效性还取决于在各级同时进行干预。采用一系列基于证据的变革（多方面）战略往往是强制性的。改善保健服务需要长期而不是零星的努力;需要确保普遍获得信息，并需要通过条例，防止提供不良或可能有害的服务。在服务方面取得的一部分改进，不是由于采用了孤立的改革措施，而是由于采用了最有效的措施的组合，作为单一综合干预措施的一部分。为了进一步缩小观察到的效果和预期效果之间的差距，我们应该在采用某些卫生技术之前试行行为改变战略，并在我们的卫生系统中永久安装我们仍然缺乏的多因素综合技术采用机制。做不到这一点将意味着效率低下，追求短期成果，而牺牲可行和合理的中期目标。(C)2011爱思唯尔爱尔兰有限公司保留所有权利。
This paper tries to unravel the following question: why do we sometimes obtain results that are worse than expected despite having used technologies that are provenly efficacious or effective and having eliminated major groups of causes leading to poor performance? Inductive analysis and synthesis based on nine areas of health service research show that to effectively adopt some health technologies, it is not enough to simply choose an efficacious or effective change strategy. It sometimes becomes necessary to change the behavior of the health workers that will use it, and to modify certain environmental elements. Technology's effectiveness also depends on intervening simultaneously at various levels. Using a mix of evidence-based change (multifaceted) strategies is often mandatory. Improving health service calls for permanent, not sporadic, efforts; for ensuring universal access to information, and for adopting regulations to prevent poor or potentially harmful service delivery. A portion of the service improvements that have been attained have resulted from the use not of isolated change measures, but of combinations of the most effective measures as part of a single integrated intervention. To further reduce the gap between observed and expected effectiveness we should pilot behavior change strategies before adopting some health technologies, and to permanently install in our health system the multifactorial, integrated technology adoption mechanisms that we still lack. Failure to do this will mean being inefficient and pursuing short-term results at the expense of feasible and legitimate medium-term objectives. (C) 2011 Elsevier Ireland Ltd. All rights reserved.