北京市朝阳区居家养老医疗服务供需现状研究

目的了解北京市朝阳区居家养老医疗服务供需现状。方法采用自行设计问卷,于2017年6—10月调查了朝阳区784名60岁及以上的老年人与45家社区卫生服务中心。结果 37. 5%的老年人需要至少一项居家养老医疗服务,11. 6%的老年人过去一年内曾利用居家养老医疗服务。提供医生上门诊疗、家中药物注射、健康及医疗咨询服务、慢性病随访服务的社区卫生服务中心的比例排在前四位,分别为77. 3%、77. 3%、93. 2%及90. 9%。当前社区卫生服务中心开展居家养老医疗服务面临困难的前三位为:医疗风险较大、医务人员数量不足和缺乏完善的法律法规,分别占95. 2%、92. 9%和83. 3%。结论北京市朝阳区老年人对于居家养老医疗服务的利用率远低于需求率。社区卫生服务机构发展居家养老医疗服务面临社区机构人力资源不足、缺乏完善的法律法规和医疗风险较大等问题。     

社区居家养老健康服务模式研究

目的探索桃源社区居家养老健康服务模式,为社区养老的发展提供科学依据。方法建立社区动员体系,成立社区自我健康管理协会,利用社区资源为社区老人提供居家养老健康服务。观察开展居家养老健康服务前后社区老人慢性病的管理及控制情况,自拟调查问卷对接受居家养老健康服务的144名社区老年人进行满意度调查。结果桃源社区居家养老健康服务模式深受社区老人喜爱,满意度达93.1%;居家养老健康服务后,社区老年人对高血压、糖尿病的管理率和控制率得到了明显提高（P〈0.01）。结论社区居家养老健康服务模式充分整合了社区可利用资源,为社区居民提供综合、全面的居家养老健康服务,社区居民乐于接受,进一步促进了社区基本公共卫生服务工作的提升。     

上海市闵行区居家老年人身体功能状况调查及养老服务需求分析*

目的调查上海市闵行区居家老年人的身体功能状况和生存质量,分析居家老年人养老服务需求,为满足居家老年人的照护和健康需求提出建议。方法采用ADL量表、SF-12量表和自行设计的问卷,对闵行区902名60岁以上居家老年人的身体功能、生存质量和养老需求进行面对面调查。结果 902名居家老年人中,86.6%的老年人日常生活活动能力良好,11.7%的老年人有轻度功能障碍,1.6%的老年人有中度以上功能障碍。年龄、婚姻状况、是否患高血压和是否患糖尿病是居家老年人生理健康和心理健康的共同影响因素;居家养老的老年人目前获取社区养老服务的比例相对较低,环境打扫在居家老年人最希望获取服务中选择的比例最高。结论闵行区居家老年人面临社区养老资源发掘不足、缺乏专业化的养老服务供给等问题,应通过完善市场机制,激活社区资本的参与,发展嵌入式养老模式,改善居家养老服务的社会环境,提升居家老年人的健康服务水平,推动健康老龄化。     

主动式居家养老智慧终端服务模式探讨

在我国"9073"的养老格局下,90%的老年人选择了居家养老。如何能让居家养老的老年人既能享受亲情,又能保障居家安全成为了当前难题。我们在查阅大量文献的基础上,结合城市社区107户老年人居家养老智慧终端服务需求调查结果以及社区"嵌入式医养结合病房"工作情况,提出"主动式居家养老"(Activehome-based eldercare)的概念,通过智慧信息软件(电脑端:PC端;移动端:手机App)+硬件(居家硬件设备、健康驿站的硬件设备)+三甲医疗资源下沉的专业服务,构建了社区-居家医康养护一体化居家养老云平台。云平台设计了13个版块,涵盖医养结合6个方面15项监测与管理指标内容,充分把网络远程技术、智能居家智慧终端系统、实时健康监测管理系统与医康养护资源整合到一起。实践证明,主动式居家养老是一种"有亲情有保障"的升级优化版居家养老模式。     

美国老年人全面照护服务模式及其启示

随着我国人口老龄化的加剧,养老服务成为社会关注的焦点之一。与入住养老院和养老护理院等机构养老相比,依托社区,为居家的老年人提供医疗、护理及其他服务的居家养老模式有许多优势。我国政府倡导将居家养老作为主要养老方式,但是,目前我国居家养老尚处于起步阶段,存在许多不完善之处。美国的老年人全面照护服务(PACE)模式是一个针对老年人的医疗护理救助项目,它的对象是那些需要护理院级别的照顾但能够在社区生活的老年人。PACE通过多学科小组为参加人在社区提供包括医疗性服务、康复性服务和社会支持性服务在内的医疗照护服务。它成功地将老年人的短期医疗与长期照护结合起来,使高龄患病老人能够更长时间地在社区中生活。经过多年实践,PACE已经成为一种成功和有效的老年照护服务模式,其成功经验中有许多值得借鉴之处。     

中国老龄化社会下主动式居家养老医疗保障探究

我国的特殊国情决定了居家养老将为90%以上老年群体养老的主要方式。主动式居家养老不同于传统家庭养老,主动式居家养老是一种有保障的养老模式。主动式居家养老将传统的"有亲情无保障"被动式家庭养老,转变为"有亲情有保障"的主动式养老。主动式居家养老是一种在增强老年人自理能力,促进老年人主动健康的同时,辅以社区养老服务、医疗保障服务的养老模式。主动式居家养老模式是符合我国国情、切实可行的养老模式,是我国养老事业发展的必由之路,其可有效地化解我国当前的养老困境。但如何为主动式居家养老的老年群体提供优质高效、值得信赖的医疗保障,需要居家老年人、医疗机构及社会各界共同努力。加强健康教育,提升整个社会的健康素养,鼓励老年人全面开展主动健康行动;社会层面借鉴多方经验智慧,寻求先进的养老理念和建立积极的养老支持体系;坚持主动健康理念,积极运用大数据、人工智能等先进技术,促使优质医疗资源精准辐射;对老年人居住环境、生活环境进行适老化、数字化改造等,均为主动式居家养老提供了基础性支持。主动式居家养老任重道远,但未来可期。     

居家养老医疗关爱服务模式浅析

居家养老服务是指政府和社会力量依托社区,为居家的老年人提供生活照料、家政服务、康复护理和精神慰藉等方面服务的一种服务形式。它是对传统家庭养老模式的补充与更新,是我国发展社区服务,建立养老服务体系的一项重要内容[1]。文章阐述了目前我国居家养老医疗关爱服务的现状,详细分析了建立居家养老医疗关爱服务体系的必要性和可行性,并针对现阶段居家养老医疗关爱服务中存在的问题,提出了提升我国居家养老医疗关爱服务水平的设想,阐明居家养老医疗关爱服务是我国现阶段养老模式医疗服务的最佳选择。     

德阳市老年人养老方式意愿及服务需求

目的调查德阳市老年人养老方式意愿的现状及养老服务需求,并分析影响养老意愿的因素,为相关部门制定有效措施,缓解养老压力提供参考。方法 2019年2—9月采取方便抽样,选取德阳市下辖区县517名老年人作为调查对象,进行问卷调查。结果 517名调查对象中,74.9%的养老方式意愿是家庭养老,13.7%是机构养老,11.4%是社区居家养老;养老服务需求中,选择最多的是紧急救助、医疗保健、生活照料;单因素分析显示,不同文化程度、居住地、子女个数、医疗保险类型、月收入、慢性疾病个数、面临养老困难个数对老年人养老方式意愿均有影响(均P0.05);Logistic回归分析显示,文化程度越高、子女个数越少的老年人越容易选择机构养老和社区居家养老;月收入越高的老年人越容易选择社区居家养老;面临养老困难越多的老年人越容易选择机构养老。结论传统家庭养老目前依旧是老年人的主要养老意愿,机构养老和社区居家养老的比例相对而言有一定的提升;老年人最希望得到的养老服务依次是紧急救助、医疗保健、生活照料;努力建设以家庭养老为基础,医养结合,机构养老和社区居家养老等多元化协调发展的养老方式,对实现健康老龄化、构建健康中国有积极作用。     

我国老年人社区居家养老服务利用情况的影响因素研究

目的 分析我国老年人社区居家养老服务利用情况的影响因素。方法 选取2018年中国健康与养老追踪调查数据(CHARLS)中重要变量完整的17 075名老年人,收集人口社会学特征、生活方式、养老服务利用等信息。根据社区居家养老服务利用情况分为利用组（1 946人）和未利用组（15 129人）。按1∶1对人口学特征行倾向性评分匹配,并采用logistic回归分析社区居家养老服务利用的影响因素。结果 成功匹配1 945对,匹配前两组数据在年龄、教育水平、婚姻状态的组间差异有统计学意义(t=42.560,χ¹=126.614,191.320,P<0.001),匹配后在人口学特征上的组间差异均无统计学意义(P>0.05)。多因素logistic回归分析模型结果显示,戒烟(OR=1.168,95%CI:1.008~1.396)、患慢性病(1~2类,OR=1.433,95%CI:1.107~1.687;≥3类,OR=1.566,95%CI:1.269~1.931)、无社会活动量(OR=0.617,95%CI:0.515~0.741)、无长期照顾者(OR=0.573,95%CI:0.496~0.661)、有养老金或退休金(OR=1.221,95%CI:1.034~1.443)及医疗服务满意度(一般,OR=1.375,95%CI:1.127~1.678;满意,OR=1.531,95%CI:1.257~1.865)是老年人社区居家养老服务利用的独立影响因素(P均<0.05)。结论 倡导健康的生活方式、加强健康管理、鼓励社会活动、加强长期照护和提高社区医疗服务水平可有效促进我国老年人对社区居家养老服务的利用。     

社区居家养老服务对老年人慢性病管理的影响分析

目的以成都市郫都区居家养老服务机构为例,分析城市社区居家养老服务对老年人慢性病管理的影响,为社区居家养老的发展提供科学依据。方法采用自行设计的问卷,对比分析接受居家养老服务前后,以及接受社区卫生服务中心的社区老年慢性病的管理、控制以及服务满意度情况。结果在慢性病健康管理服务实施后,社区居家养老服务中心老年人对慢性病健康管理服务的满意度明显提高。其中健康咨询提高31.7%,健康教育与促进提高31.2%,健康体检与检测提高32.3%,健康信息管理提高28.7%,差异均有统计学意义(P0.05)。相对于社区卫生服务中心的慢病管理,居家养老服务中心的健康咨询高出11.7%,健康教育与促进高出16.2%,年检与监测提高21.2%,健康档案动态管理提高29.7%,满意度提高28.1%,差异均有统计学意义(P0.05)。结论社区居家养老服务在老年慢性病患者中需求日益增高,因此社区居家养老服务有其开展的必然性和必要性。     

EDITORIAL

No abstract available for this article.     

Progress of Ontario's Family Health Team model: a patient-centered medical home

Ontario's Family Health Team (FHT) model, implemented in 2005, may be North America's largest example of a patient-centered medical home. The model, based on multidisciplinary teams and an innovative incentive-based funding system, has been developed primarily from fee-for-service primary care practices. Nearly 2 million Ontarians are served by 170 FHTs. Preliminary observations suggest high satisfaction among patients, higher income and more gratification for family physicians, and trends for more medical students to select careers in family medicine. Popular demand is resulting in expansion to 200 FHTs. We describe the development, implementation, reimbursement plan, and current status of this multidisciplinary model, relating it to the principles of the patient-centered medical home. We also identify its potential to provide an understanding of many aspects of primary care.     

Improvements in Health Status after Massachusetts Health Care Reform

Context

Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states.

Methods

We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity.

Findings

The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.

Conclusions

Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low-income households. These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform.     

Ranking of priorities in employees' reward and recognition schemes: from the perspective of UAE health care employees

A reward and recognition (RR) system is a tool widely applied by organizations to motivate their employees. Outstanding employees expect their effort to be acknowledged by the organization. However, the variety of rewards and recognitions systems used by organizations may be perceived differently by different employees. The diverse workforce structure in the United Arab Emirates (UAE) poses various challenges for organization managers. Managers need to implement the shrewd RR system which best fits their diverse workforce. This research studied how medical sector employees in the private and public health sector view the RR systems in the UAE. Two lists, comprising 26 major approaches to RR, were prepared and its items prioritized by taking inputs from 250 employees working in more than 30 varied public and private health care organizations in the UAE. The findings of the research are expected to provide guidelines for developing appropriate RR systems for organizations in general, and UAE health care organizations in particular.     

The demand for private health care in the UK

Policy change has eroded the entitlement of UK residents to free state-provided health care, with a resulting rise in the use of the private sector. This paper examines the choice between public and private health care. It models the use of private health care as a function of its costs and benefits relative to state care and no care. The results indicate a difference between users of private care and other care, and the importance of past use as a predictor of current use. But they also show considerable movement between the public and private sectors, indicating a complex relationship in public and private sector use.     

挪威卫生服务体系概况及对我国的启示

本文通过对挪威卫生服务体系的发展脉络进行追溯,了解到挪威政府对初级卫生保健体系和专科卫生服务体系一直采取不同的管理模式,并随着人口结构、卫生服务需求的变化将初级卫生保健逐步交由自治市政府管理,而专科卫生服务则采取了市场化较强的半政府、半市场的组织管理模式,并由中央政府进行统筹。这样的管理结构从目前来看较好的解决了初级卫生服务供给不足和专科卫生服务效率低下的问题。     

The labour market costs of community care

This paper reports an empirical investigation into the influence of informal care responsibilities on the labour supply of women. The objective is to examine the argument that the UK policy of caring for the chronic sick 'in the community' involves a nontrivial opportunity cost in the form of the forgone labour supply of the informal carers upon which it relies. We find that informal carers who care for less than 20 h per week are, in fact, more likely to participate in the labour market, but tend to work for fewer hours per week than otherwise similar noncarers. Informal carers who care for 20 h or more a week are less likely to participate, but only slightly. However, when they do undertake formal employment, they tend to earn less per hour and work for fewer hours per week.     

Occupational health services for farmers

There are many unmet health needs in the farming community, needs that are peculiar to the agriculture industry. Health research and regulations to protect the safety of the farmer have lagged far behind those for other sectors of our economy. At a time when health needs are increasing, there is a decreasing availability of hospitals, physicians, nurses, and other health care personnel. The ability of the rural section to pay for these services is also declining. The evidence calls for a multifaceted solution, with improved cooperation and understanding on the part of the consumer as well as the provider. The regional health network is one system that may help solve some of these dilemmas.     

Organizational Leadership For Building Effective Health Care Teams

The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.