Building on Julian Tudor Hart's example of anticipatory care

Watt, G.C.M., O'Donnell, C.A. and Sridharan, S. (2011) Building on Julian Tudor Hart's example of anticipatory care. Primary Health Care Research and Development, (doi: 10.1017/S1463423610000216)

Abstract

The prevention and delay of chronic disease is an increasing priority in all advanced health-care systems, but sustainable, effective and equitable approaches remain elusive. In a famous pioneering example in the UK, Julian Tudor Hart combined reactive and anticipatory care within routine consultations in primary medical care, while applying a population approach to delivery and audit. This approach combined the structural advantages of UK general practice, including universal coverage and the absence of user fees, with his long-term commitment to individual patients, and was associated with a 28% reduction in premature mortality over a 25-year period. The more recent, and comprehensively evaluated Scottish National Health Service demonstration project, ‘Have a Heart Paisley’, took a different approach to cardiovascular prevention and health improvement, using population screening for ascertainment, health coaches and referral to specific health improvement programmes for diet, smoking and exercise. We draw from both examples to construct a conceptual framework for anticipatory care, based on active ingredients, programme pathways and whole system approaches. While the strengths of a family practice approach are coverage, continuity, co-ordination and longterm relationships, the larger health improvement programme offered additional resources and expertise. As theory and evidence accrue, the challenge is to combine the strengths of primary medical care and health improvement, in integrated, sustainable systems of anticipatory care, addressing the heterogeneity of individual needs and solutions, while achieving high levels of coverage, continuity, co-ordination and outcome.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: O'Donnell, Professor Kate and Watt, Professor Graham
• Authors: Watt, G.C.M., O'Donnell, C.A., and Sridharan, S.
• Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
• Journal Name: Primary Health Care Research and Development
• Publisher: Cambridge University Press
• ISSN: 1463-4236
• ISSN (Online): 1477-1128
• Copyright Holders: Copyright © 2010 Cambridge University Press
• First Published: First published in Primary Health Care Research and Development
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher