Abstract：
UNASSIGNED: Socio-economic inequalities in health have been in the public agenda for decades. General practice has an influential role to play in mitigating the impact of inequalities especially regarding chronic conditions. At the moment, general practice is dealing with serious challenges in relation to workforce shortages, increasing workload and the impact of the COVID-19 pandemic. It is important to identify effective ways so that general practice can play its role in reducing health inequalities.
UNASSIGNED: We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice.
UNASSIGNED: Realist review.
UNASSIGNED: Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria.
UNASSIGNED: Realist review based on Pawson\'s five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence.
UNASSIGNED: Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: • connected so that interventions are linked and coordinated across the sector; • intersectional to account for the fact that people\'s experience is affected by many of their characteristics; • flexible to meet patients\' different needs and preferences; • inclusive so that it does not exclude people because of who they are; • community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships.
UNASSIGNED: The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care.
UNASSIGNED: Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred.
UNASSIGNED: Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice.
UNASSIGNED: This trial is registered as PROSPERO CRD42020217871.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.
Health inequalities are unfair differences in health across different groups of the population. In the United Kingdom, the health inequality gap in life expectancy between the richest and poorest is increasing and is caused mostly by differences in long-term conditions like cancer and cardiovascular disease and respiratory conditions, such as chronic obstructive pulmonary disease. Partly National Health Service inequalities arise in delays in seeing a doctor and care provided through doctors’ surgery, such as delays in getting tests. This study explored how general practice services can increase or decrease inequalities in cancer, cardiovascular disease, diabetes and chronic obstructive pulmonary disease, under what circumstances and for whom. It also produced guidance for general practice, both local general practices and the wider general practice system, to reduce inequalities. We reviewed existing studies using a realist methodology. This methodology helps us understand the different contexts in which interventions work or not. We found that inequalities in general practice result from complex processes across different areas. These include funding and workforce, perceptions about health and disease among patients and healthcare staff, everyday procedures involved in care delivery, and relationships among individuals and communities. To reduce inequalities in general practice, action should be taken in all these areas and services need to be connected (i.e. linked and coordinated across the sector), intersectional (i.e. accounting for the fact that people’s experience is affected by many of their characteristics like their gender and socio-economic position), flexible (i.e. meeting patients’ different needs and preferences), inclusive (i.e. not excluding people because of who they are) and community-centred (i.e. working with the people who will receive care when designing and providing it). There is no one single intervention that will make general practice more equitable, rather it requires long-term organisational change based on these principles.
UNASSIGNED: We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice.
UNASSIGNED: Realist review.
UNASSIGNED: Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria.
UNASSIGNED: Realist review based on Pawson\'s five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence.
UNASSIGNED: Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: • connected so that interventions are linked and coordinated across the sector; • intersectional to account for the fact that people\'s experience is affected by many of their characteristics; • flexible to meet patients\' different needs and preferences; • inclusive so that it does not exclude people because of who they are; • community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships.
UNASSIGNED: The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care.
UNASSIGNED: Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred.
UNASSIGNED: Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice.
UNASSIGNED: This trial is registered as PROSPERO CRD42020217871.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.
Health inequalities are unfair differences in health across different groups of the population. In the United Kingdom, the health inequality gap in life expectancy between the richest and poorest is increasing and is caused mostly by differences in long-term conditions like cancer and cardiovascular disease and respiratory conditions, such as chronic obstructive pulmonary disease. Partly National Health Service inequalities arise in delays in seeing a doctor and care provided through doctors’ surgery, such as delays in getting tests. This study explored how general practice services can increase or decrease inequalities in cancer, cardiovascular disease, diabetes and chronic obstructive pulmonary disease, under what circumstances and for whom. It also produced guidance for general practice, both local general practices and the wider general practice system, to reduce inequalities. We reviewed existing studies using a realist methodology. This methodology helps us understand the different contexts in which interventions work or not. We found that inequalities in general practice result from complex processes across different areas. These include funding and workforce, perceptions about health and disease among patients and healthcare staff, everyday procedures involved in care delivery, and relationships among individuals and communities. To reduce inequalities in general practice, action should be taken in all these areas and services need to be connected (i.e. linked and coordinated across the sector), intersectional (i.e. accounting for the fact that people’s experience is affected by many of their characteristics like their gender and socio-economic position), flexible (i.e. meeting patients’ different needs and preferences), inclusive (i.e. not excluding people because of who they are) and community-centred (i.e. working with the people who will receive care when designing and providing it). There is no one single intervention that will make general practice more equitable, rather it requires long-term organisational change based on these principles.
摘要：
几十年来，卫生方面的社会经济不平等一直被列入公共议程。一般做法在减轻不平等的影响方面可以发挥重要作用，特别是在慢性病方面。此刻,一般做法正在应对与劳动力短缺有关的严峻挑战，增加的工作量和COVID-19大流行的影响。重要的是要确定有效的方法，以便一般做法能够在减少健康不平等方面发挥作用。
■我们探讨了一般实践中哪些类型的干预措施和常规护理方面减少或增加了健康和护理相关结果的不平等。我们专注于心血管疾病，癌症,糖尿病和/或慢性阻塞性肺疾病。我们探讨了这些干预措施和护理方面最适合谁，为什么,在什么情况下。我们的主要目标是将这些证据综合为医疗保健专业人员和决策者提供有关如何最好地实现公平的一般实践的具体指导。
■现实主义评论。
■按社会经济群体划分的临床或护理相关结果，或其他PROGRESS-Plus标准。
■基于Pawson的五个步骤的现实主义评论：（1）定位现有理论，(2)寻找证据，（3）选择文章，（4）提取和组织数据；（5）合成证据。
■三百二十五项研究符合纳入标准，其中159项被选择用于证据综合。关于一般实践干预措施对健康不平等影响的证据有限。为了减少健康不平等，一般实践需要：•相互联系，以使干预措施在整个部门之间相互联系和协调；•相互联系，以解决人们的经历受到许多特征影响的事实；•灵活地满足患者的不同需求和偏好；•包容性，因此不会因为他们是谁而将人们排除在外；•以社区为中心，以便接受护理的人们参与其设计和交付。这些品质应该为四个领域的行动提供信息：资金和劳动力分配等结构，组织文化,涉及护理交付的日常监管程序，人际关系和社区关系。
■所审查的证据提供了关于特定干预措施增加或减少一般实践中不平等的方式和程度的有限细节。因此,我们专注于在干预措施中常见的基础原则，以产生更高层次的，关于实现公平护理的方法的可转移结论。
■一般实践中的不等式来自四个不同领域的复杂过程，包括结构，想法,规范的日常程序，以及个人和社区之间的关系。为了实现公平，一般实践需要联系起来，相交，灵活,包容和以社区为中心。
■未来的工作应该集中在如何更好地利用这五个基本素质来塑造未来一般实践的组织发展。
■本试验注册为PROSPEROCRD42020217871。
■该奖项由美国国立卫生与护理研究所（NIHR）健康与社会护理提供研究计划（NIHR奖参考：NIHR130694）资助，并在《健康与社会护理提供研究》中全文发表。12号7.有关更多奖项信息，请参阅NIHR资助和奖励网站。
健康不平等是不同人群在健康方面的不公平差异。在英国,最富有和最贫穷人群预期寿命的健康不平等差距正在扩大，主要是由癌症、心血管疾病和呼吸系统疾病等长期疾病的差异造成的，如慢性阻塞性肺疾病。部分国家卫生服务不平等是由于延误看病和通过医生手术提供的护理，例如延迟获得测试。这项研究探讨了全科医疗服务如何增加或减少癌症的不平等，心血管疾病,糖尿病和慢性阻塞性肺疾病，在什么情况下，为谁。它还为一般实践提供了指导，地方一般做法和更广泛的一般做法体系，减少不平等。我们使用现实主义方法回顾了现有的研究。这种方法有助于我们了解干预措施起作用或不起作用的不同背景。我们发现，一般实践中的不平等来自不同领域的复杂过程。这些包括资金和劳动力，患者和医护人员对健康和疾病的看法，涉及护理交付的日常程序，以及个人和社区之间的关系。为了减少一般实践中的不平等，应在所有这些领域采取行动，服务需要相互联系(即跨部门联系和协调)，交叉（即考虑到人们的经历受到其性别和社会经济地位等许多特征的影响），灵活(即满足患者不同的需求和偏好)，包容性（即不因为人们是谁而将其排除在外）和以社区为中心（即与在设计和提供护理时将获得护理的人合作）。没有一种单一的干预措施可以使一般做法更加公平，相反，它需要基于这些原则的长期组织变革。
■我们探讨了一般实践中哪些类型的干预措施和常规护理方面减少或增加了健康和护理相关结果的不平等。我们专注于心血管疾病，癌症,糖尿病和/或慢性阻塞性肺疾病。我们探讨了这些干预措施和护理方面最适合谁，为什么,在什么情况下。我们的主要目标是将这些证据综合为医疗保健专业人员和决策者提供有关如何最好地实现公平的一般实践的具体指导。
■现实主义评论。
■按社会经济群体划分的临床或护理相关结果，或其他PROGRESS-Plus标准。
■基于Pawson的五个步骤的现实主义评论：（1）定位现有理论，(2)寻找证据，（3）选择文章，（4）提取和组织数据；（5）合成证据。
■三百二十五项研究符合纳入标准，其中159项被选择用于证据综合。关于一般实践干预措施对健康不平等影响的证据有限。为了减少健康不平等，一般实践需要：•相互联系，以使干预措施在整个部门之间相互联系和协调；•相互联系，以解决人们的经历受到许多特征影响的事实；•灵活地满足患者的不同需求和偏好；•包容性，因此不会因为他们是谁而将人们排除在外；•以社区为中心，以便接受护理的人们参与其设计和交付。这些品质应该为四个领域的行动提供信息：资金和劳动力分配等结构，组织文化,涉及护理交付的日常监管程序，人际关系和社区关系。
■所审查的证据提供了关于特定干预措施增加或减少一般实践中不平等的方式和程度的有限细节。因此,我们专注于在干预措施中常见的基础原则，以产生更高层次的，关于实现公平护理的方法的可转移结论。
■一般实践中的不等式来自四个不同领域的复杂过程，包括结构，想法,规范的日常程序，以及个人和社区之间的关系。为了实现公平，一般实践需要联系起来，相交，灵活,包容和以社区为中心。
■未来的工作应该集中在如何更好地利用这五个基本素质来塑造未来一般实践的组织发展。
■本试验注册为PROSPEROCRD42020217871。
■该奖项由美国国立卫生与护理研究所（NIHR）健康与社会护理提供研究计划（NIHR奖参考：NIHR130694）资助，并在《健康与社会护理提供研究》中全文发表。12号7.有关更多奖项信息，请参阅NIHR资助和奖励网站。
健康不平等是不同人群在健康方面的不公平差异。在英国,最富有和最贫穷人群预期寿命的健康不平等差距正在扩大，主要是由癌症、心血管疾病和呼吸系统疾病等长期疾病的差异造成的，如慢性阻塞性肺疾病。部分国家卫生服务不平等是由于延误看病和通过医生手术提供的护理，例如延迟获得测试。这项研究探讨了全科医疗服务如何增加或减少癌症的不平等，心血管疾病,糖尿病和慢性阻塞性肺疾病，在什么情况下，为谁。它还为一般实践提供了指导，地方一般做法和更广泛的一般做法体系，减少不平等。我们使用现实主义方法回顾了现有的研究。这种方法有助于我们了解干预措施起作用或不起作用的不同背景。我们发现，一般实践中的不平等来自不同领域的复杂过程。这些包括资金和劳动力，患者和医护人员对健康和疾病的看法，涉及护理交付的日常程序，以及个人和社区之间的关系。为了减少一般实践中的不平等，应在所有这些领域采取行动，服务需要相互联系(即跨部门联系和协调)，交叉（即考虑到人们的经历受到其性别和社会经济地位等许多特征的影响），灵活(即满足患者不同的需求和偏好)，包容性（即不因为人们是谁而将其排除在外）和以社区为中心（即与在设计和提供护理时将获得护理的人合作）。没有一种单一的干预措施可以使一般做法更加公平，相反，它需要基于这些原则的长期组织变革。
