Abstract
Efforts to contain healthcare costs have led a renewed clinician interest in addressing population-level outcomes, with some proposing that the integration of population health into clinical practice represents a novel concept entitled “clinical population medicine” (CPM). This commentary offers an examination of the function and utility of CPM. In reviewing relevant literature, we note several inconsistencies in CPM’s purported mandate, which ranges from simply incorporating the social determinants of health into clinical practice to broad involvement in community health planning. The latter of these seems to overlap, and potentially conflict, with the work of public health practitioners, and cited examples of activities used to define “CPM” seem to apply a label to established clinician activities around the determinants of health that would be captured more simply as research, evaluation, or advocacy undertaken by clinicians in other areas of practice. Our analysis suggests that CPM may have value in encouraging clinicians to incorporate community determinants and contextual considerations into their practices, but must take care to remain complementary and distinct from public health practice.
Résumé
Les démarches de contrôle des coûts des soins de santé suscitent chez les cliniciens un regain d’intérêt pour les résultats populationnels, certains cliniciens allant jusqu’à proposer que la pratique clinique intégrant la santé des populations devienne un nouveau concept : la « médecine clinique des populations » (MCP). Dans notre commentaire, nous examinons la fonction et l’utilité du concept de MCP. Dans la littérature pertinente, nous avons remarqué plusieurs disparités dans le mandat présumé de la MCP, lequel peut aller de la simple intégration des déterminants sociaux de la santé dans la pratique clinique à la participation générale à la planification en santé communautaire. Ce dernier aspect semble faire double emploi (et pourrait être incompatible) avec le travail des praticiens de la santé publique, et les exemples d’activités citées dans la définition de la « MCP » semblent apposer cette étiquette sur des activités cliniques articulées autour des déterminants de la santé qui, si elles étaient menées par des cliniciens dans d’autres domaines de pratique, seraient désignées plus simplement comme étant de la recherche, de l’évaluation ou de la défense des droits. Notre analyse indique que la MCP peut être utile pour encourager les cliniciens à intégrer les déterminants de la population locale et les considérations contextuelles dans leur pratique, mais qu’il faut prendre soin de préserver le caractère complémentaire de la MCP et sa distinction par rapport à la pratique en santé publique.
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Rouble, A.N., Zayed, R., Harvey, B.J. et al. Integrating clinical medicine and population health: where to from here?. Can J Public Health 110, 801–804 (2019). https://doi.org/10.17269/s41997-019-00194-4
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DOI: https://doi.org/10.17269/s41997-019-00194-4