预防保健与就医诊疗.ppt

預防保健與就醫診療 台灣家庭醫學醫學會 秘書長李汝禮 前言：醫師是做什麼的？ 醫生，古代稱大夫或郎中，指學習醫學或行醫的人，醫生也叫杏林，專指醫術精良，醫德高尚的醫家。 華 陀 Hippocrates 民眾的健康醫療照護 就醫診療(disease treatment) 預防保健： 疾病預防(disease prevention) 健康促進(health promotion) 個人健康照護VS群體健康照護 就醫診療 S (Subjective Data）：自覺症狀徵候，包括主訴、現在病史、過去病史及個人史…。 O (Objective Data)：檢查發現，包括診療發現及各種檢查報告…。 A (Assessment)：診斷評估，即診斷(Diagnosis)或臆斷(Impression) 。 P (Plan)：治療計劃，包括各種處置、醫令或處方。 預防保健 篩檢screening 群眾篩檢vs個人病例發現(case-finding) 諮詢介入(counseling intervention) 疫苗接種(immunization) 化學預防(chemoprophylaxis) 預防性健康照護的實證依據 美國預防服務工作小組 (U.S.Preventive services Task force,USPSTF) 加拿大預防性健康照謢工作小組 (Canadian Task Force on Preventive Health Care, CTFPHC) 社區工作小組 (Community Task Force, CTF) Overview of Process of Recommendation Development AHRQ:the Agency for Healthcare Research and Quality USPSTF:U.S. Preventive Services Task Force EPCs:Evidence-based Practice Centers Procedures for Developing a Recommendation Statement Analytic Framework with Key Questions-1 Analytic Framework with Key Questions-2 1.Does screening for X reduce Morbidity and/or Mortality? 2.Can a group at high risk for X be identified on clinical grounds? 3.Are there accurate (i.e., sensitive and specific) screening tests available? 4.Are treatments available that make a difference in intermediate outcomes when the disease is caught early, or detected by screening? Analytic Framework with Key Questions-3 5.Are treatments available that make a difference in morbidity or mortality when the disease is caught early, or detected by screening? 6.How strong is the association between the intermediate outcomes and patient outcomes? 7.What are the harms of the screening test? 8.What are the harms of the treatment? Recommendation Grade Definitions Grade Definitions After May 2007 Grade Definitions Prior to May 2007 Grade Definitions After May 2007-1 Grade A The USPSTF USPSTF recommends the service. There is high certainty that the net benefit is substantial. Offer or provide this service Grade Definitions A