BACKGROUND This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. METHODS We evaluated an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners (GPs) in co-designing integrated clinical services. RESULTS The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. CONCLUSIONS From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making.

中文翻译：

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初级和二级护理一体化的伦理挑战：定性和规范分析。


背景本文探讨了医疗保健一体化中出现的伦理问题。我们认为，整合对于应对当代和未来的医疗保健挑战是必要的，需要更强有力的证据基础来证明其有效性的条件。特别是，鉴于政策层面越来越强调整个医疗基础设施更好地一体化，我们对一体化逻辑本身所带来的伦理挑战的分析是及时且重要的，但迄今为止尚未受到足够的重视。方法 我们评估了一项教育干预措施，旨在通过更有效地提高初级保健到二级保健之间的过渡来改善儿童健康结果，确保儿童和家长在整个过程中得到更好的支持。该计划为见习儿科医生和全科医生 (GP) 提供共同设计综合临床服务的技能。结果 从临床角度来看，综合护理的主要伦理挑战是： 综合工作环境中的专业身份和自主权；在这种环境下相应的职业责任范围；以及迫切需要提供更多证据作为大规模整合战略的基础。结论 根据我们的分析，我们从广泛位于道义论和护理伦理学交叉点的规范立场来看，提出了一种试探性的前进方向。 我们采取这一立场是因为综合护理关注背景下的主要临床伦理问题：如何确保在临床责任可能不明确的新定位工作环境中履行对个体患者的所有护理职责；以及需要通过突出患者的自主偏好并确保在临床决策中与患者临床医生建立良好的关系来围绕患者进行护理。