Primary care epidemiology: its scope and purpose.

摘要

Clinical epidemiology is a basic science of medical practice; informing, among other things, diagnostic, prognostic and therapeutic decisions relating to individuals. In the 1980s, Mullan coined the term 'primary care epidemiology' to describe the application of clinical epidemiology to primary care practice. Calls for a new discipline derived from the desire of Mullan, and others, to see an increased use of epidemiological principles to shape the development of community orientated primary care. To a large extent, these ambitions echoed those of Tudor Hart, who, a decade earlier, had called for a marriage between primary care and epidemiology so that programmes of organised, whole-population anticipatory care could be developed. They also built upon the work of other GP researchers who used epidemiological principles to describe clinical events in their practices. The emphasis on affecting the dynamics of health care within defined (usually single practice) communities required short intervals betweenthe seeking and using of information, with an acknowledged consequence that primary care epidemiology might only be able to answer relatively basic questions. We believe, however, that this focus is too narrow for the sector that provides 'integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practising in the context of family and community'. Primary care epidemiology can contribute to wider improvements in health and health care services, through better understanding of disease aetiology, use of health care services and the role of different health care interventions. Primary care is delivered by a wide range of health professionals, including nurses, doctors, care assistants,social workers, mental health specialists, dieticians, pharmacists, dentists, optometrists and other health care professionals, administrators and clerical staff. The practice of each of these professional groups can contribute to, and needs to be informed by, primary care epidemiology.