What is intermediate care?
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《英国医生杂志》
EDITOR—In asking what is intermediate care Melis et al point out one major conceptual error in the United Kingdom's version: it aims at relieving an administrative problem—namely, excessive bed occupancy.1 They did not deal with the patient's perspective. To achieve change four issues need to be addressed, in sequence. What is needed? How can that need be met? Who can meet it? Who pays?
Patients' needs relate partly to the underlying pathological process.2 Some are born with disabilities or acquire them early. Acquired illness in adult life may have expectations of improvement (for example, trauma), progression (for example, motor neurone disease), or relapse and remission (for example, rheumatoid arthritis).3 Recovering patients may require intensive or slow rehabilitation as inpatients to facilitate returning home. For patients with deteriorating conditions, community based teams, which work in the patient's own home and liaise closely with community agencies (educational, social, vocational), are more appropriate. Hospital and community teams can together ensure a patient's (re)integration into the community.
Not all people with disabilities are elderly. The UK government pays incapacity benefits to about 2.7m people of working age.4 Ultimately, the taxes paid by the working population facilitate the health services needed by all. We cannot neglect the rehabilitation of those of working age.5 Neither can we ignore the generic support services needed by disabled people of all ages—for example, wheelchair services.
The Department of Health, the British Geriatrics Society, and the British Society of Rehabilitation Medicine should jointly devise a strategy to meet the needs of Britain's disabled population.
Andrew O Frank, consultant physician in rehabilitation medicine and rheumatology
Northwick Park Hospital and Harrow Primary Care Trust, Harrow HA1 3UJ Andrew.frank1@btinternet.com
Competing interests: AOF is a past president of the British Society of Rehabilitation Medicine, and medical adviser for a vocational rehabilitation company.
References
Melis R, Olde Rikkert M, Parker SG, van Eijken M. What is intermediate care? BMJ 2004;329: 360-1. (14 August.)
Frank AO, Maguire G. Disabling diseases. Physical, environmental and psychosocial management. Oxford: Heinemann, 1989.
Turner-Stokes L, Frank AO. Emerging specialities—disability medicine. Br J Hosp Med 1990;44: 190-3.
Frank AO, Sawney P. Vocational rehabilitation. J R Soc Med 2003;96: 522-4.
British Society of Rehabilitation Medicine. Vocational rehabilitation—the way forward: report of a working party (Chair: Frank AO). 2 nd ed. London: British Society of Rehabilitation Medicine, 2003.
Patients' needs relate partly to the underlying pathological process.2 Some are born with disabilities or acquire them early. Acquired illness in adult life may have expectations of improvement (for example, trauma), progression (for example, motor neurone disease), or relapse and remission (for example, rheumatoid arthritis).3 Recovering patients may require intensive or slow rehabilitation as inpatients to facilitate returning home. For patients with deteriorating conditions, community based teams, which work in the patient's own home and liaise closely with community agencies (educational, social, vocational), are more appropriate. Hospital and community teams can together ensure a patient's (re)integration into the community.
Not all people with disabilities are elderly. The UK government pays incapacity benefits to about 2.7m people of working age.4 Ultimately, the taxes paid by the working population facilitate the health services needed by all. We cannot neglect the rehabilitation of those of working age.5 Neither can we ignore the generic support services needed by disabled people of all ages—for example, wheelchair services.
The Department of Health, the British Geriatrics Society, and the British Society of Rehabilitation Medicine should jointly devise a strategy to meet the needs of Britain's disabled population.
Andrew O Frank, consultant physician in rehabilitation medicine and rheumatology
Northwick Park Hospital and Harrow Primary Care Trust, Harrow HA1 3UJ Andrew.frank1@btinternet.com
Competing interests: AOF is a past president of the British Society of Rehabilitation Medicine, and medical adviser for a vocational rehabilitation company.
References
Melis R, Olde Rikkert M, Parker SG, van Eijken M. What is intermediate care? BMJ 2004;329: 360-1. (14 August.)
Frank AO, Maguire G. Disabling diseases. Physical, environmental and psychosocial management. Oxford: Heinemann, 1989.
Turner-Stokes L, Frank AO. Emerging specialities—disability medicine. Br J Hosp Med 1990;44: 190-3.
Frank AO, Sawney P. Vocational rehabilitation. J R Soc Med 2003;96: 522-4.
British Society of Rehabilitation Medicine. Vocational rehabilitation—the way forward: report of a working party (Chair: Frank AO). 2 nd ed. London: British Society of Rehabilitation Medicine, 2003.