PDF(Pubmed)
Abstract：
BACKGROUND: Addressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system\'s level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.
METHODS: In-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.
RESULTS: Interviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system\'s approach to reducing health inequalities was evident as was collective action and involving people, with links to a \"strong third sector\". Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.
CONCLUSIONS: We provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system\'s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.
METHODS: In-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.
RESULTS: Interviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system\'s approach to reducing health inequalities was evident as was collective action and involving people, with links to a \"strong third sector\". Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.
CONCLUSIONS: We provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system\'s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.
摘要：
背景：解决卫生和医疗保健领域的社会经济不平等，和减少可避免的住院需要整个卫生系统的综合战略和复杂的干预。然而,对如何创建有效系统以减少卫生和医疗保健方面的社会经济不平等的理解是有限的。目的是探索和发展一个系统的水平理解，即当地如何解决健康不平等，重点是可避免的紧急入院。
方法：在英国城市地方当局使用定性调查（文献分析和关键线人访谈）进行深入的案例研究。使用滚雪球抽样确定受访者。文件是通过关键线人和相关组织的网络搜索检索的。访谈和文件是根据专题分析方法独立分析的。
结果：访谈（n=14），来自地方当局的广泛代表（n=8），NHS（n=5）和自愿，社区和社会企业(VCSE)部门(n=1)，有75份文件(包括来自NHS，地方当局,包括VCSE）。相互参照的主题是了解当地情况，如何解决健康不平等的促进者：资产，以及新出现的风险和担忧。解决可避免入院中的健康不平等问题本身通常没有通过访谈或文件明确联系起来，也没有付诸实践。然而,一个强有力的连贯的战略性综合人口健康管理计划与一个系统的方法来减少健康不平等是显而易见的集体行动和涉及人，链接到“强大的第三部门”。报告的挑战包括结构性障碍和威胁，数据的分析和可获取性，以及对医疗保健系统的持续压力。
结论：我们深入探索了当地如何解决健康和护理不平等问题。该系统工作的关键要素包括促进战略一致性，跨机构工作，和基于社区资产的方法。需要采取行动的领域包括跨组织的数据共享挑战和分析能力，以协助减少健康和护理不平等的努力。其他领域围绕着系统的弹性，包括招聘和留住劳动力。需要采取更多行动，在当地明确地减少可避免的入院中的健康不平等，而不采取行动则有可能扩大健康差距。
方法：在英国城市地方当局使用定性调查（文献分析和关键线人访谈）进行深入的案例研究。使用滚雪球抽样确定受访者。文件是通过关键线人和相关组织的网络搜索检索的。访谈和文件是根据专题分析方法独立分析的。
结果：访谈（n=14），来自地方当局的广泛代表（n=8），NHS（n=5）和自愿，社区和社会企业(VCSE)部门(n=1)，有75份文件(包括来自NHS，地方当局,包括VCSE）。相互参照的主题是了解当地情况，如何解决健康不平等的促进者：资产，以及新出现的风险和担忧。解决可避免入院中的健康不平等问题本身通常没有通过访谈或文件明确联系起来，也没有付诸实践。然而,一个强有力的连贯的战略性综合人口健康管理计划与一个系统的方法来减少健康不平等是显而易见的集体行动和涉及人，链接到“强大的第三部门”。报告的挑战包括结构性障碍和威胁，数据的分析和可获取性，以及对医疗保健系统的持续压力。
结论：我们深入探索了当地如何解决健康和护理不平等问题。该系统工作的关键要素包括促进战略一致性，跨机构工作，和基于社区资产的方法。需要采取行动的领域包括跨组织的数据共享挑战和分析能力，以协助减少健康和护理不平等的努力。其他领域围绕着系统的弹性，包括招聘和留住劳动力。需要采取更多行动，在当地明确地减少可避免的入院中的健康不平等，而不采取行动则有可能扩大健康差距。
