تبيين محورهاي اصلي خود مراقبتي به تفكيك سطوح پيشگيري و تعيين ابعاد مديريتي آن

Self-care in health system: Prevention and management dimensions

مقدمه: خودمراقبتي جايگزين مراقبت تخصصي و سازماني نيست بلكه مكمل آن و يكي از عوامل تعيين كننده ميزان و چگونگي استفاده از آن است. در يك رويكرد چهار نوع از فعاليتها شامل خودمراقبتي تنظيمي، خودمراقبتي پيشگيرانه، خودمراقبتي واكنشي و خودمراقبتي بازتواني بعنوان انواع اصلي خودمراقبتي ذكر شده اند. مقاله حاضر بر آن است تا محورهاي اصلي خودمراقبتي را در سطوح پيشگيري بررسي كرده و ابعاد مديريتي برنامه‌هاي خودمراقبتي در نظام ارايه خدمات سلامت را تبيين نمايد. مواد و روش كار: اين مطالعه به روش كيفي انجام شد. پس از جستجو و مطالعه متون موجود، گروه تحقيق محورهاي اصلي خودمراقبتي در سطوح مختلف پيشگيري و ابعاد مديريتي برنامه هاي خودمراقبتي را تدوين نموده و سپس در طي نشست تخصصي با صاحبنظران حوزه‌هاي بهداشتي و باليني به تبيين آن پرداخته است. يافته ها: محورهاي اصلي خودمراقبتي در سطح اول پيشگيري (پيشگيري ابتدايي و اوليه) شامل موارد حفظ و ارتقاي سلامت ، اصلاح شيوه زندگي و پيشگيري از بيماريها؛ در سطح دوم پيشگيري شامل موارد تشخيص زودرس، درمان و كنترل بيماري پنهان ، سازگاري بيمار با تشخيص احتمالي بيماري، تبعيت از شروع به موقع درمان مناسب و در سطح سوم پيشگيري شامل تشخيص بيماري، درمان و كنترل بيماري، سازگاري بيمار با بيماري يا ناتواني، ارزيابي علايم و مصرف داروي مناسب، مراقبت تسكيني و توان بخشي است. هم چنين ابعاد مديريتي برنامه هاي خودمراقبتي در نظام ارايه خدمت شامل سه جنبه آمـاده سـازي س?ستم سلامت، آماده سازي افراد جامعه و بيماران و ساز و كارهاي پرداخت هستند. بحث و نتيجه گيري: بر اساس نتايج مطالعه حاضر، خودمراقبتي جزيي از حيطه هاي مراقبت است؛ اجراي ساختارمند و مبتني بر شواهد نظام جامع حمايت از خودمراقبتي در ابتداي راه بوده و ايجاد يك نظام ارايه دهنده خدمت كه تسهيل‌گر اجراي رفتار خودمراقبتي باشد بايستي محور مطالعات اجرايي و مديريتي آتي قرار گيرند.

Objective (s): Self-care is the conscious, acquired, and purposeful activities that people take to preserve their lives and provide, maintain and enhance their own health and their families. In self-care, people use their knowledge, skills, and power as a source to take care of their health responsibly. Every human being inherently has the power and ability to take care of himself, and this is the gem that God has given to him. Self-care is not a substitute for professional and organizational care, but a complement to it and one of the determinants of using it. From this perspective, self-care is more about interacting with a health care system, and as a result of self-care, we will have a more efficient health care system. Regarding the main dimensions of self-care, various sources have addressed this issue with different approaches.Some researchers have classified self-care into health SC and medical SC. In another approach, four types of activities include regulatory self-care, preventive self-care; reactive self-care and restorative self-care are the main types of self-care. This study includes the main aspects of self-care in prevention levels and outlines the dimensions of self-care management in the health service delivery system. Methods: In this qualitative study, after a literature review, the research group developed the draft of the main dimensions of self-care, based on levels of prevention, and self-care management. Then findings shared with an expert panel. The expert panel included experts on epidemiology and public health, health education, health management, family health and clinical experts. The panel finalized the different levels of prevention and management dimensions of self-care in health delivery system. Results: The main dimensions of self-care were determined as follows: for first level of prevention, the main dimensions of self-care were: health maintenance and promotion, Lifestyle modification, Disease prevention; for the second level of prevention (secondary prevention), the main areas of self-care included the following three areas: early diagnosis, treatment and control of latent diseases; patient compatibility with the diagnosis of a disease (coping); compliance with the onset of timely treatment; for the third level of prevention (tertiary prevention), the following five dimensions were identified: diagnosis of diseases, treatment and control, patient compatibility with illness or disability, evaluation of symptoms and proper drug use, Palliative and rehabilitation care. Regarding implementation of self-care in health delivery system, at least three aspects should be considered: preparation of the system, preparation of patients, and payment mechanisms. Conclusion: According to the findings of this study, self-care is an integral part of all areas of care, and therefore health plans should be designed with a self-care reinforcement approach. Structured and evidence-based implementation of a comprehensive self-care support system is the first priority. The establishment of a health care provider that promotes and facilitates self-care behaviors should be the focus of future executive and management studies.