Reducing health inequalities through general practice.

Autor:	Gkiouleka A; Department of Public Health and Primary Care, Cambridge, UK., Wong G; University of Cambridge, Cambridge, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK., Sowden S; Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK., Bambra C; Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK., Siersbaek R; Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, Ireland., Manji S; Department of Educational Research, Lancaster University, Lancaster, UK., Moseley A; Norwich, UK., Harmston R; Norwich, UK., Kuhn I; University of Cambridge Medical Library, School of Clinical Medicine, Cambridge, UK., Ford J; Wolfson Institute of Population Health, Queen Mary University of London, London, UK. Electronic address: j.a.ford@qmul.ac.uk.
Jazyk:	angličtina
Zdroj:	The Lancet. Public health [Lancet Public Health] 2023 Jun; Vol. 8 (6), pp. e463-e472.
DOI:	10.1016/S2468-2667(23)00093-2
Abstrakt:	Although general practice can contribute to reducing health inequalities, existing evidence provides little guidance on how this reduction can be achieved. We reviewed interventions influencing health and care inequalities in general practice and developed an action framework for health professionals and decision makers. We conducted a realist review by searching MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library for systematic reviews of interventions into health inequality in general practice. We then screened the studies in the included systematic reviews for those that reported their outcomes by socioeconomic status or other PROGRESS-Plus (Cochrane Equity Methods Group) categories. 159 studies were included in the evidence synthesis. Robust evidence on the effect of general practice on health inequalities is scarce. Focusing on common qualities of interventions, we found that to reduce health inequalities, general practice needs to be informed by five key principles: involving coordinated services across the system (ie, connected), accounting for differences within patient groups (ie, intersectional), making allowances for different patient needs and preferences (ie, flexible), integrating patient worldviews and cultural references (ie, inclusive), and engaging communities with service design and delivery (ie, community-centred). Future work should explore how these principles can inform the organisational development of general practice. Competing Interests: Declaration of interests GW was Deputy Chair of the UK's National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Prioritisation Committee: Integrated Community Health and Social Care (A), HTA Remit and Competitiveness Group, HTA Prioritisation Committee A methods group, and HTA Post-Funding Committee. SS was a member of Public Health Research's Research Funding Board. RH was a member of HTA Prioritisation Committee C (mental health, women, and children's health) and HTA Commissioning Committee. All other authors declare no competing interests. (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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