华中地区军队人员卫生服务需要和利用调查

目的　研究我国军队人员卫生服务需要和利用的基本情况和特点。方法　采用多阶段分层整群随机抽样方法抽取华中地区 2 35 0名军队人员 ,进行面对面询问调查。结果　干部慢性病患病率 139 3‰ ,显著高于战士85 2‰ (χ2 =16 6 5 ,P <0 0 1)。门诊的服务利用主要集中在 (旅 )团卫生队、营卫生所 ,分别占 4 9 10 % ,17 2 4 % ;住院服务利用主要集中在中心医院 ,占住院总人数的 6 4 2 1%。结论　军队人员卫生服务需要及门诊、住院服务利用较高 ;应加强对军队人员的健康教育 ,同时加大对部队基层医疗机构的卫生投入。     

空巢老人卫生服务需求与利用及其影响因素的研究

目的:了解空巢老年人卫生服务需求与利用情况及其影响因素,为制定空巢老年人医疗保障措施、完善卫生服务管理和决策提供科学的依据。方法:采用多阶段随机抽样方法抽取288例60岁以上空巢老年人作为研究对象,应用自行设计的调查表进行面对面的访谈。结果:空巢老人的两周患病率为38.54%;慢性病患病率为80.21%;两周就诊率为21.2%;近一年的住院率为22.2%;两周患病率影响因素有:受教育程度(χ2=10.027,P=0.018)、婚姻状况(χ2=9.436,P=0.009)、是否饮酒(χ2=4.800,P=0.028)、每天睡眠情况(χ2=17.122,P<0.001),差别均具有统计学意义;两周就诊率影响因素有:受教育程度(χ2=8.779,P=0.032)、每天睡眠情况(χ2=7.104,P=0.029),差别具有统计学意义。结论:应加大对空巢老人的卫生服务需求和利用的保障力度,同时加大对其各种影响因素的控制,在提高卫生服务整体水平的同时逐渐满足空巢老人合理的健康需求。     

新疆农村居民健康状况及卫生服务利用分析

目的探讨新疆2003-2008年农村居民健康状况、卫生服务需求与利用的变化趋势及不同收入居民卫生服务利用公平性的变化。方法利用2003、2008年国家卫生服务调查数据,采用SPSS 13.0软件进行统计分析,利用5分组法测算卫生服务利用集中指数(CI)分析公平性变化。结果 2次农村卫生服务调查的性别及年龄构成无统计学差异(P>0.05);2008年新疆农村居民2周患病率由9.1%上升为15.0%,慢性病患病率由9.8%上升到17.2%,差异有统计学意义(P<0.001);2周就诊率由8.5%提高为11.0%(P<0.001),未就诊率分别为45.0%、45.1%;住院率由5.6%提高为11.6%,未住院率由42.4%下降为15.4%,差异有统计学意义(P<0.001);2周就诊率CI由0.09变为0.11,未就诊率CI由-0.01降为-0.06,住院率、未住院率CI分别降为0.03、0.01,趋向0。结论 2008年新疆农村居民2周患病率及慢病患病率升高,卫生服务利用量增加,低收入居民的门诊服务利用受到限制,不同收入居民的住院服务利用趋向公平。     

抚州市不同收入水平城镇居民卫生服务公平性分析

目的分析抚州市不同收入水平城镇居民卫生服务公平性。方法选择抚州市不同收入水平人群,共3486户13048名,对不同收入水平人群卫生服务需求情况、门诊服务利用情况、住院服务利用情况、住院费用支付情况进行分析。结果不同收入水平人群2周患病率差异具有统计学意义(χ2=21.615,P0.05),各组慢性病患病率未见显著性差异(χ~2=9.615,P0.05),2周患病就诊率差异具有统计学意义(χ~2=19.357,P0.05),各组2周患病治疗比例有显著性差异(χ~2=20.871,P0.05)。随收入水平升高,年人均住院天数、年住院率差异具有统计学意义(χ~2=18.173,23.982,P0.05),各组因经济困难未住院比例显著性下降(χ~2=25.139,P0.05)。各组住院费用并未呈现出显著性差异(χ~2=12.094,P0.05),自付住院费用占人均收入比例、自付住院费用占家庭收入比例显著下降,差异具有统计学意义(χ~2=31.572,29.148,P0.05)。结论抚州市不同城镇居民卫生服务存在一定程度的差异性,应加强对低收入人群的政策倾斜,保证医疗卫生服务的公平性。     

某潜艇支队艇员卫生服务的需求及利用

目的了解海军某潜艇部队官兵医疗服务需求和利用情况,为决策部门合理分配部队卫生资源提出依据。方法采取整群抽样方法,抽取某潜艇支队艇员183人进行问卷调查,调查内容包括与卫生服务需求及利用相关的情况,借助SPSS 11.0统计软件进行数据分析。结果该部队官兵两周患病率为36.6%,两周患病未就诊率为73.1%。两周所患疾病主要是运动系统疾病、呼吸系统疾病和消化系统疾病,患病率分别为70.1%、28.4%和23.9%。门诊就诊主要集中在舰艇军医和支队医院,分别占42.3%和34.6%;住院服务主要集中在联勤部医院,占42.9%。近1个月,41.9%的官兵表示压力很大或较大。结论该部队官兵卫生服务需求量大,但利用有待提高;运动系统疾患是影响官兵健康水平的第一位疾病因素;官兵对门诊服务的利用主要集中在基层医疗机构;该部队官兵心理卫生服务需求大而利用少。     

新型农村合作医疗对农民医疗服务需要与利用影响研究

目的:通过基线调查与实施1年后跟踪调查的比较,评价新型农村合作医疗的实施对农民医疗服务需要和利用的影响,为正确认识和科学调整新型农村合作医疗的实施方案提供依据。方法:采用分层整群随机抽样法抽取婺源县3个乡镇9个行政村,每村70户农户,采取入户调查的方式,对农村居民家庭健康状况,医疗服务需要和利用及其影响因素进行了基线调查和1年后的跟踪调查。结果:两次调查农民的性别和年龄分布均无显著差异( P>0 .0 5 ) ,本次调查两周患病率、年住院率和半年慢性病患病率分别为135 .86‰、4 7.70‰、10 6 .0 4‰,与基线调查相比,均无显著差异( P>0 .0 5 )。而就诊率、应就诊未就诊率和应住院未住院率分别为112 .2 9‰、16 .93%、2 4 .0 6 % ,两周卧床率及休工(学)率分别为4 .6 9‰和8.0 9‰,与基线调查相比两周就诊率显著提高,应就诊未就诊率、应住院未住院率、两周卧床率及休工(学)率显著下降( P<0 .0 5 )。因病致贫比例由4 7.6 2 %下降到2 7.78%。因经济困难未就诊的比例由4 7.9%下降到35 .2 % ,因经济困难未住院的比例由78.0 %下降到6 8.8%。结论:新型农村合作医疗实施1年后,卫生服务需要无显著变化,农民的就诊意识有所提高,门诊及住院服务利用有所增加,健康状况有所好转,因病致贫比例下降,但造成农民     

西藏农牧区贫困居民卫生服务现状研究*

目的了解西藏农牧区贫困居民卫生服务可及性、需要、利用情况及其影响因素,为改善西藏农牧区贫困居民医疗卫生服务现状提供依据。方法采用分阶段整群随机抽样的方法,抽取237户共775人进行入户式问卷调查。结果西藏农牧区贫困居民两周患病率为20.26%,两周就诊率为11.87%,住院率为7.23%。女性卫生服务需要高于男性(χ~2=8.773,P=0.003);丧偶居民卫生服务需要最高(χ~2=20.749,P0.001);随着年龄组增高(χ~2=43.164,P0.001)和文化程度降低(χ~2=16.221,P0.001),居民卫生服务需要升高;女性(OR=1.72,P=0.003)、高年龄组(OR=1.54,P0.001)、丧偶(OR=4.27,P0.001)和低学历(OR=1.70,P=0.001)贫困居民卫生服务需要较多。结论西藏农牧区贫困居民卫生服务可及性较差,卫生服务需要水平较高,卫生服务利用率较低。建议:加大卫生资源投入力度;改善农牧区交通和贫困状况;加强宣传教育,提高疾病防治意识,倡导健康的生活行为方式,提高居民健康水平;进一步提高西藏农牧区贫困居民卫生服务水平。     

南京市老年人卫生服务需要和利用情况分析

目的了解南京市老年人卫生服务需要和利用现状,并探讨卫生服务利用影响因素,为卫生系统合理配置资源、有关部门制定相应卫生管理政策提供参考。方法采用随机整群抽样方法,以自行设计的"老年人健康信息调查表",对南京市某社区老年人一般健康状况、卫生服务利用情况进行现场问卷调查。共调查500份,有效问卷493份,有效率为98.6%。结果南京市某社区老年人两周患病率为21.1%,慢性病患病率为77.3%,两周就诊率为23.3%,住院率为3.9%。影响两周就诊率因素为:居住状况、医疗保险和自我健康评分,影响住院率因素为:年龄、医疗保险和自我健康评分。结论南京市老年人卫生服务需求量较大,卫生服务利用率较低,应加强基层卫生机构建设,积极开展老年人健康教育,完善医疗保险制度。     

重庆市某社区居民卫生服务需要、需求与利用现状的研究

目的了解重庆市主城区社区居民家庭情况及社区卫生服需求与利用情况,并与第五次国家卫生服务调查结果比较,为合理配置卫生资源、提高居民健康水平及生活质量提供客观依据。方法 2014年5—8月对重庆市巴南区某街道960户家庭采用自行设计的问卷进行入户面对面调查,对社区居民卫生服务需求与利用的相关指标进行统计分析。结果共调查960户家庭、居民2 742人,社区居民两周患病率为9.1%,慢性非传染性疾病(慢性病)患病率为35.6%,两周就诊率为5.9%,两周患者中未就诊比例为35.0%住院率为14.1%,应住院而未住院比例为21.2%;两周患病率、两周就诊率低于第五次国家卫生服务调查结果,慢性病患病率、两周患者未就诊比例、住院率、应住院而未住院比例高于第五次国家卫生服务调查结果;60岁及以上年龄组所占比例大(52.4%),且其两周患病率、慢性病患病率、住院率较高。结论社区居民卫生服务需要总体较大,而对卫生服务的利用率有待提高,社区老龄化程度高,老年人对卫生服务需求和利用相对较高。应加强老年人群医疗资源的供给,优化资源配置,提高社区卫生服务的利用程度与服务质量。     

天津市城乡基本医疗卫生服务需求分析

目的:分析天津市城乡基本医疗卫生服务需求与利用的情况.方法:利用excel2007建立数据库,并用SPSS16.0的描述性统计分析方法对数据进行分析.结果:天津市居民2008年两周患病率为299.15‰,住院率为43.17‰,分别比1998年增加了231.51‰、19.54‰;基层医疗机构中平均执业医师拥有量仅为11.5人,占全部卫生人员的32%.结论:要加强适宜技术推广应用长效机制建设,加大基层卫生人才的培养力度.     

Self-reported patterns of health services utilisation: an urban-rural comparison in South Australia

Objective: To compare self‐reported patterns of health service utilisation among residents of urban and rural South Australia. Design, setting and main outcome measures: Secondary analysis of data generated by computer‐assisted telephone interviews of 7377 adults done in 1995–6. Respondents were asked if they had used each of 18 different health services during the previous 12 months. Residence was classified in three ways: (1) capital city versus rest of the state, (2) by the Rural, Remote and Metropolitan Areas classification (RRMA) and (3) by the Accessibility and Remoteness Index for Australia classification (ARIA). Results: General practitioner services were most frequently used, by approximately 89% of respondents. Only 4% reported not using any service. Comparing capital city with rest of the state, modest but statistically significant differences in utilisation (P < 0.01) were measured for nine services. In eight of these nine, utilisation was higher among rural residents. Analysing by RRMA, eight services were reportedly used differently and seven of these were the same as those identified from the capital city versus rest of state comparison. Across the five ARIA categories, six previously identified services were reported as being used differentially. Overall, rural residents had a higher than expected rate of moderate and high level of health service use. Conclusions: Self‐reported use of a range of health services was broadly similar across urban and rural South Australia, with most cases of higher use were reported from rural areas rather than urban areas. Similar results were obtained when residence was classified in the three different ways. What is already known on this subject: It is widely reported that the health status of and access to health services for rural Australians is worse than their urban counterparts. However, while this is clearly the case for some conditions and some groups, further data is needed to understand rural–urban health differentials better. Few explicit comparisons of different methods of classifying rurality (RRMA, ARIA and capital city vs. the rest) have been published. What does this study add: This study demonstrates that the self‐reported utilisation of a wide range of health services in South Australia is no worse, and is often greater, among rural residents compared to those in Adelaide. The same conclusions are reached irrespective of the method of classifying rurality.     

近些年来中国居民卫生服务利用及费用的变化

依据80年代中期以来国家卫生部组织的卫生服务调查和卫生部门综合医院门诊及住院费用连续调查结果,结合我国国民经济与卫生事业费增长情况,分析了近年来中国居民卫生服务利用及费用变化的趋势,在此基础上提出了有关政策建议。     

Variation in Networks and Forms of Support for Care‐Seeking Across the HIV Care Continuum in the Rural Southeastern United States

Purpose

In spite of progress in understanding the importance of social support for health outcomes in Persons Living with HIV (PLWH), more remains to be known about mechanisms of support most beneficial at each stage of HIV treatment. In this study, we use a qualitative analytic approach to investigate the forms and sources of social support deemed most integral to the diagnosis, care engagement, and medication adherence behaviors of a diverse sample of PLWH in a mostly rural health district in the Southeastern United States.

Methods

In‐depth interviews (N = 18) were collected during the qualitative phase of a larger mixed methods needs assessment for the Northeast Georgia Health District. A deductive‐inductive analysis of participant narratives revealed variation in the perceived importance of particular forms and sources of social support during the initial versus advanced stages of HIV care.

Findings

PLWH identified the emotional, informational, and appraisal support provided by family as especially critical for emotional stability, coping, and care linkage during the initial stages of diagnosis and treatment. However, once in care, PLWH emphasized informational and instrumental forms of support from care providers and appraisal support from peers as key influences in care engagement and retention behaviors.

Conclusion

Increased understanding of the social support mechanisms that contribute to the HIV treatment behaviors of PLWH can fill knowledge gaps in research and inform the efforts of health care providers seeking to leverage various aspects of the social support toward improving the care retention, health, and wellness outcomes of PLWH.     

Complementary and alternative medicine in rural communities: current research and future directions

Contexts: The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally. Purpose: This article presents the first review and synthesis of research findings on CAM use and practice in rural communities. Methods: A comprehensive search of literature from 1998 to 2010 in CINAHL, MEDLINE, AMED, and CSA Illumina (social sciences) was conducted. The search was confined to peer‐reviewed articles published in English reporting empirical research findings on the use or practice of CAM in rural settings. Findings: Research findings are grouped and examined according to 3 key themes: “prevalence of CAM use and practice,”“user profile and trends of CAM consumption,” and “potential drivers and barriers to CAM use and practice.” Conclusions: Evidence from recent research illustrates the substantial prevalence and complexity of CAM use in rural regions. A number of potential gaps in our understanding of CAM use and practice in rural settings are also identified.     

试点区社区卫生服务机构服务提供现状分析

通过抽样调查 ,对UHPP项目区的社区卫生服务中心及服务站的服务提供现状进行了分析 ,结果表明 :随着社区卫生服务的发展 ,中心及服务站提供的服务内容不断扩展 ,预防保健工作有所加强 ;但康复、精神病病人管理等服务是薄弱环节 ;基本医疗设备差 ,人员素质较低等是制约中心及服务站供给能力提高的关键因素