合肥市安庆路街道常住老年居民健康状况及卫生服务需求调查

目的　了解合肥市安庆路街道老年人慢性病的患病状况 ,探讨社区卫生服务内容 ,为社区综合防治提供依据。方法　对 11个居委会 6 0岁以上老年居民采用调查表进行面对面的调查。结果　调查 1831位社区老年居民 ,患有慢性病前 10位病种依次为高血压、冠心病、高血脂、白内障、慢支、糖尿病、胆道疾病、前列腺疾病、骨质增生、胃肠疾病 ,老年居民最需要的社区卫生服务依次为健康咨询、家庭病床、上门护理康复服务。结论　针对社区老年居民的健康状况和卫生需求 ,应立足社区开展全方位老年社区卫生服务 ,广泛开展健康教育和健康促进 ,努力提高社区居民的健康水平和生活质量     

城市居民社区卫生服务需求意愿及影响因素分析

通过大连市居民社区卫生服务需求意愿及影响因素分析表明：居民的健康需求是全方位的,就近就医受到患者的普遍欢迎,其中需求较大的前五位依次是医生到家庭出诊,家庭病床,。医院与患者签定合同,定期上门体检和指导就医,年龄,文化程度,职业,医疗费用支付方式均不同程度地影响居民卫生服务需求。因此,社区卫生服务应以需求为导向,并针对其需求特点,扩大服务范围,提供适宜的卫生服务。     

家庭医生制下家庭病床中医药服务包的政策研究和评价

目的:了解家庭医生制下居民对家庭病床中医药服务包的需求以及医生能提供的中医药内容。方法:通过问卷调查,了解居民及家属需求,了解家庭医生能够提供的服务,统计结果,并找出存在差距的原因。结果:通过调查居民及家属家庭病床中医药服务内容需求、调查家庭医生可提供上门服务内容,可见供方与需方之间在大部分内容上都存在差异性。结论:在目前家庭医生制下,居民对家庭病床中医药服务包的需求度很高,同时和医生能提供的服务内容存在很大差异,需通过加强队伍建设、针对性完善服务内容,满足居民的服务需求。     

成都市贫困居民卫生服务利用研究

目的 :了解成都市贫困居民卫生服务需求与利用现况 ,及其对开设家庭病床服务的态度 ,为政府决策提供科学依据。方法 :采用分层定额抽样方法 ,抽取 4个不同类型的社区 ,以入户调查和面对面访谈的方式共调查居民 4 17名 ,比较贫困居民和普通居民在卫生服务需求和利用方面的差异 ,并了解他们对家庭病床的认识。结果 :贫困人群卫生服务利用低于一般人群并且疾病经济负担较重。年龄、文化、经济状况和日常活动能力是影响家庭病床使用的因素。结论 :家庭病床被居民认作一种行之有效的减轻疾病经济负担的治疗方式 ,应尽快纳入医疗保险范畴     

加强社区卫生 促进三医联动改革

随着城市人口老龄化程度的快速提升，居民对保健理念的改变和健康需求的不断增长，作为发展中国家的基本医疗保险的承受能力越来越难于应对日益增长的居民健康和医疗需求，三医改革处在多重矛盾聚焦的关键时期，发展社区卫生服务、培养全科医生队伍已成为满足居民需求、发展社会医疗保障与政府决策的当务之急。     

杭州市居民医疗保健需求状况的分析

目的：了解杭州市居民对健康知识了解情况，自我保健现况，对医疗保健需求状况，为今后开展卫生服务工作提供科学的依据。方法：采取多阶段抽样方法，从杭州市区抽取3个社区2341居民作为目标人群进行调查。结果：（1）居民自我保健意识已经增强，对预防保健知识需求增加。（2）居居对社区卫生服务中心（站）的了解和利用不够，分析与对策（1）分层次，有针对性地开展健康教育和健康促进；（2）大力开展社区卫生服务工作。     

社区居民健康状况调查

为了解社区居民健康状况及对社区卫生服务的需求情况,实施社区卫生服务,对泉州市丰泽新村２ ２４８ 例居民进行健康调查。结果显示：社区人群中６０岁以上老年人行为能力需要别人帮助的占１３．５％,主要疾病顺位为心 血管病、骨关节病、糖尿病和慢支,需要各种不同程度服务的占７９．４９％。提示：开展社区健康服务及教育的必要性。     

社区卫生服务的持续发展探讨

人口老龄化和疾病谱的改变,导致慢性非传染性疾病成为危害社区居民人群健康的主要疾病,社区居民的医疗服务需求也急剧增加,传统的医疗卫生服务模式已不能满足他们的健康需求。社区卫生服务集医疗、预防、保健、康复、健康教育于一体,深入居民家庭,极大地方便居民群众,满足了他们的卫生保健需求,合理有效地利     

基层就诊居民家庭医生签约及首诊行为的影响因素

目的：分析基层医疗机构就诊居民签约家庭医生以及签约后首诊行为的影响因素，为进一步推动基层首诊制度提供依据。方法：采用目的抽样，2019年7-10月在东、中、西部三个样本市6家基层医疗机构对就诊居民进行出口调查；采用描述性统计和二元logistic回归分析方法进行数据分析。结果：共调查484名基层就诊居民。logistic回归分析显示，对家庭医生内涵认识正确，对家庭病床服务需求更高，由社区医务人员推荐、居民区宣传栏等方式了解家庭医生的就诊居民更愿意签约；清楚家庭医生提供健康管理服务，医保优惠和长处方政策，签约时间更长的签约居民更倾向于基层首诊。结论：应进一步通过社区医务人员推荐、居民区宣传栏等方式加强居民对家庭医生"健康管理者"内涵的理解，以需求家庭病床的居民为重点对象，促进有效签约；强化签约居民对健康管理服务内容和医保优惠政策的认知，巩固续签意愿。     

松江区居民健康档案资料管理的做法

居民健康档案记载着居民的健康状况和对卫生服务需求等内容,是重要的信息资源,它在社区卫生服务、科研和信息利用等方面都有着重要的作用。如果居民健康档案资料杂乱无章,极易丢失或造成查阅上的不便。为了规范社区居民健康档案资料的管理,使居民健康档案真正能为广大居民提供正确、及时、有效的服务,我区对社区居民健康档案资料进行了科学管理。     

天津市社区卫生服务中心开展家庭病床服务的SWOT分析

目的 了解天津市18家社区卫生服务中心目前家庭病床开展情况、开展家庭病床的优势和开展过程中所遇到的困难,为天津市今后是否以及如何开展家庭病床提供依据.方法 从医疗卫生服务提供方的角度,采用定性研究的方法,对天津市18家社区卫生服务中心院长进行一对一访谈,采用SWOT分析法进行研究.结果 此次调查的天津市18家社区卫生服务中心院长对目前开展家庭病床的情况满意度均不高.主要表现为居民对家庭病床知晓程度低、人员工作积极性有限、政策制度不完善、人力财力支持不到位和医务人员工作风险大等问题.结论 天津市目前开设家庭病床的情况并不理想,需要从政府政策、医院硬件设施和软件条件以及居民的认知度等方面进行进一步改进和加强.     

军队医疗保障制度改革前后伤病员用药情况分析

目的：了解医改实施后军队伤病员门诊和住院用药情况，探索存在问题及解决方法。方法：借助“军卫一号”数据库，调取医改前后军队各类保障对象用药信息，采用Microsoft Excel2003和SPSS11．0软件对统计结果进行汇总、分析和比较。结果：门诊人次均药品费用增幅为319．9％；住院人次均药品费用增幅为143．1％；床日均药品费用增幅为130．9％，各类人员门诊及住院药品费用均有不同程度的提升。结论：军队人员医疗保障制度改革后门诊及住院用药受益明显；各类人员用药水平显著提高；药品费用增长速度快的原因需进一步探讨；合理的药品消费机制急需建立。     

Patient expectations at a multicultural out-patient clinic in Switzerland

BACKGROUND: Recognizing patient expectation is considered as an important objective for primary care physicians. A number of studies suggest that failure to identify patient expectations can lead to patient dissatisfaction with care, lack of compliance and inappropriate use of medical resources. It has been suggested that identifying patient expectations in multicultural contexts can be especially challenging. OBJECTIVES: The aim of the study was to compare health care expectations of Swiss and immigrant patients attending the out-patient clinic of a Swiss university hospital and to assess physicians' ability to identify their patients' expectations. METHODS: Over a 3-month period, all patients attending the out-patient clinic at a Swiss university hospital were requested to complete pre-consultation surveys. Their physicians were requested to complete post-consultation surveys. Outcome measures were patients' self-rated health, resort to prior home treatment, patients' expectations of the consultation, physicians' perception of their patients' expectations and agreement between patients and physicians. RESULTS: We analysed 343 questionnaires completed by patients prior to their consultation (> 50% immigrants) and 333 questionnaires completed by their physicians after the consultation. Most expectations were shared by all patients. Physicians had inaccurate perceptions of their patients' expectations, regardless of patients' origin. CONCLUSIONS: Our study found no evidence that immigrant patients' expectations differed from those of Swiss patients, nor that physicians had more difficulty identifying expectations of immigrant patients. However, physicians in our study were generally poor at identifying patients' expectations, and therefore inter-group differences may be difficult to detect. Our results point to the need to strengthen physicians' general communication skills which should then serve as a foundation for more specific, cross-cultural communication training.     

Hospital bed availability: developing accurate estimates

Bed population ratios have long been used by health planners as a method of estimating resource availability to community residents. In Canada's tertiary care urban centres, it is recognized that these bed population ratios are misleading because so many beds in both tertiary care and community hospitals are occupied by patients referred from other areas. This paper illustrates a method for calculating bed population ratios based on actual number of hospital beds used by area residents, regardless of where this usage takes place, and regardless of whether this usage is based on in-patient or out-patient admissions. Since the information required for making these calculations is available to provincial insurance systems across Canada, this technique should have wide applicability.     

门诊电子病历的应用

门诊电子病历是按病历书写规范设计，采用基于XML技术，结构化描述各类病历，实现病历内容的格式化和数据化，规范日常诊疗数据，实现完整、统一和标准的数据管理，并集成了数据、文本、图形、图片、影像等。同时由于其具有永久性、适时性、连续性，医生可随时调用病人的历史病历及检查结果，对病情的发展、观察、诊治都具有重要的意义。我院从2006年开始实行门诊电子病历，取得了较好的效果，有效地促进了病历质量的提高及保管，提高了门诊的诊疗水平。主要做法：以门诊电子病历为核心整合HIS、LIS、内窥镜等系统信息；以规范为准则设计门诊电子病历内容和格式；以制度为保障确保门诊电子病历系统的健康发展。主要体会：做好计算机基础培训作为项目实施的前题；做好应用培训作为项目实施的根本；做好病历模板作为项目实施的保障。     

门诊预约服务的实践体会

本文阐述了预约门诊服务的背景条件、实施方法及绩效。通过开展预约门诊,医院取得了良好的社会信誉及经济效益,在创建"和谐医院"的进程中又迈进了一大步。     

上海市社区居民家庭医生签约服务的认知及影响因素研究

目的:家庭医生签约服务助力分级诊疗制度,认知是签约利用的基础,了解社区居民对签约服务的认知及其影响因素,为提高居民认知度提供切实可行的建议。方法:于2019年5—7月,采用随机抽样方法,选择上海市16个区50家社区的2 500名居民,采用自行设计的调查问卷进行调查。结果:85.96%的社区居民认知签约服务相关政策,84.18%的社区居民认知签约服务内容。影响居民家庭医生签约服务认知情况的因素有户籍、居住地、文化程度、月收入和患慢性病情况。结论:上海市社区居民家庭医生签约服务的认知水平较高,但宣传方式单一,应丰富宣传方式和途径,针对不同人群制定不同宣传方案,实现真实有效的宣传,提高居民对签约服务的认知。     

Inappropriate reattendances in out-patient departments.

In an attempt to identify the number and characteristics of inappropriate reattendances at out-patient clinics, clinic doctors and patients in two specialties throughout a health district were given a questionnaire to complete on every patient attendance over one week. Four hundred and fifty-two patients were seen, and 293 were asked to reattend: in some 80 of the latter cases the clinic doctor felt that the GP could nevertheless manage the problem. These 'inappropriate' invitations to reattend were more likely to be given by junior hospital staff to long-standing patients of the clinic attending for monitoring purposes. The patients involved in these 'inappropriate' requests to reattend also tended to think that their GP could manage the problem. It is concluded that discharge policy needs to be made more explicit and training for juniors organized if out-patient resources are to be used most efficiently.     

General practitioners use of hospital and community based paediatric out-patient services in Nottingham

The paper compares and contrasts the referral patterns of general practitioners in Nottingham for paediatric specialist opinion in a hospital and community setting. Data were collected from case notes review and medical activity data returns on 100 consecutive referrals made by GPs to a hospital paediatric consultant out-patient clinical and 100 consecutive referrals to a community based consultant clinic.Multiple diagnoses are more commonly made and recorded by community based paediatricians with a bias towards behavioural, nutrition, growth and neurodevelopmental problems. Hospital clinic staff made more system and disease based diagnoses with more investigations arranged than the community staff[53 cf. 15 (OR 6.39, 95% CI; 3.25–12.55, P = <0.0001)]. More children under five were seen in the community clinic sample compared to the hospital sample [75 cf. 57 under fives (OR 2.26, 95% CI; 1.24–4.13, P = 0.01)].Patients are more likely to be discharged from the hospital clinic than the community clinic after the initial visit. [59 cf. 33 (OR 2.92, 95% CI; 1.64–5.20, P = 0.0004)]. Costs per new case consultation were substantially less in the community clinic than the hospital setting. A broadly similar range of clinic problems are referred to both hospital and community based paediatricians in Nottingham. The educational and liaison value of local community paediatric clinics together with relatively easier access by parents and lower per case costs is an advantage. Commissioners of paediatric and child health services need to take into consideration these factors when purchasing out-patient specialist paediatric opinion. Further research is required into the quality and desirability of these developments.     

农村社区开展家庭医生签约服务及建立固定诊疗关系的探索

家庭医生责任制是建立在全科医生与居民签约并建立固定诊疗关系的基础之上.上海市浦东新区农村社区开展广泛宣传发动、组建包括乡村医生在内的全科团队、上门开展签约和采集电子健康档案,并建立社区首诊、在联合体内梯度就诊的新型家庭医生服务模式,根据社区居民与社区卫生服务中心联系的紧密程度,将服务对象分为健康管理、健康服务和健康关怀三大类,针对不同服务需求提供不同的签约服务内容,服务质量好坏与家庭医生的报酬相关.经过第三方测评,群众和社会各界知晓率达到75.0％,户籍人口签约率达到了84.6％,群众满意度达到91.4％,做法和经验对其他地区开展工作有参者意义.