居民就医行为与社区卫生服务中心利用情况调查

目的了解济南市长清区居民就医行为及其对社区卫生服务中心的利用情况。方法采用问卷调查的方法对271名社区居民进行问卷调查。结果65．3％的居民患小病后未就医,7．4％的居民选择到大医院,13．2％的居民选择社区卫生服务中心,14．0％的居民选择到私人诊所。性别、年龄、文化程度、健康状况及医疗费用支付形式与居民就医行为有相关性。结论只有提高社区医护人员医疗水平,改善就诊环境,才能引导居民合理就医。     

患者就医意向与社区卫生服务

文章对门诊患者就医意向进行了调查,结果发现：４５．２％的患者一般大医院就医,２１．７％的患者选择中小医院就医,４６．６％的患者选择副教授以上的医生,在选择医院或医生时,首要考虑因素均是医疗技术水平,调查结果提示,开展社区卫生服务必须要有高素质的社会医务人员,才能更好地引导群众建立的就医行为,使社卫生服务真正7被区居民所接受。     

患者社区就医意向与社区卫生服务的调查研究

目的调查分析患者就医意向和对社区卫生服务的认知与评价，为医改及合理利用各层次卫生资源提供依据。方法对515名到广州三甲医院门诊就医的患者进行随机调查，使用SPSS13．0对数据进行统计分析。结果只有17．2％的受调查者患轻瘸时就医取向为社区卫生机构。不愿到社区就医的主要原因是担心社区医疗能力不足耽误最佳治疗时间。结论加强社区卫生机构建设，使社区卫生服务与群众的基本医疗卫生需求相适应。     

广州市荔区华林街308户居民卫生需求调查分析

目的 通过对社区居民的卫生需求进行调查,掌握居民就医取向,更有利于探讨社区卫生服务的发展方向,寻求更合理的社区卫生服务方式,解决“看病难、看病贵”的社会问题。方法选取2005年居住荔湾区华林街辖内常住住户,以户为单位,每居委抽14户,共308户,采取入户调查方式进行。结果308户居民的医疗费用支付方式自费占53.25%。在就医取向中社区卫生服务中心占39.96%,区级医院占31.17%,省市级医院占29.87%。选择社区卫生服务中心就诊的主要原因是离家或单位;对上门服务需求需要以上占68.51%。结论发展社区卫生服务,必须减低医疗收费,提高医务人员的医疗技术水平,开展特色便民服务,增加信任度。     

成都市武侯区社区居民卫生服务需求及双向转诊现状

目的：了解成都市武侯区居民的卫生服务需求及双向转诊的运行现状，为建立合理的双向转诊制度以及促进双向转诊的开展提供科学依据。方法：采用分层随机抽样的方法抽取成都市武侯区450名社区居民作为调查对象，采用统一设计的问卷进行现况调查。结果：调查显示：76．3％社区居民患病后首先都会选择去大中型医院就诊，主要原因是他们信任大中型医院的医疗技术水平；78．7％调查对象不了解社区卫生服务的内容；仅39．6％的居民听说过双向转诊，而实施情况也不容乐观。结论：为保证双向转诊合理运行建议加强大中型医院和社区卫生服务中心的功能定位；基本医疗保险应向社区卫生服务倾斜；全面提高社区卫生服务中心的服务质量；加大对双向转诊的宣传教育，提高双向转诊知晓度。     

云南省城市居民健康状况及卫生服务需求与利用调查

目的：了解云南省城市社区居民健康状况和卫生服务需求现况，为城市社区卫生服务发展指明方向。方法：采用两阶段抽样的方法选取调查对象，用自行设计的问卷进入入户调查。结果：被调查的居民以老年人居多占49.8％；初中以下文化程度占60．9％；51．2％的居民是企业在职或退休职工；36．6％的居民家庭每月人均收入低于500元；81．5％的居民参加城市职工基本医疗保险；居民慢性病自报患病率81．9％，两周患病率44．8％，两周就诊率31．7％；居民未就诊的主要原因是自我医疗和自觉病轻；居民对社区卫生服务的态度和服务时间较满意。对服务的技术和项目不满意较多；总体对社区应提供的六种基本服务需求较高。结论进行社区诊断，探索适合居民需求的社区卫生服务模式，完善社区卫生服务机构功能，促使居民合理利用社区卫生资源。     

江苏省居民社区首诊意愿及其影响因素分析

目的 研究居民对社区卫生服务的利用及影响居民去社区卫生服务机构首诊的因素。方法 采用选择加随机．多阶段分层抽样方法，对江苏省1141名城市居民进行问卷调查。结果 85．6％的居民在自感病重时会选择市级及以上医院．54．1％的居民在自感病轻时选择去社区卫生服务机构就诊。居民愿意到社区首诊的原因前3位依次为就近方便、医疗费用低和服务态度好。卫生机构的类型是居民去社区首诊的主要因素。结论 居民择医观念是理性的，影响居民去社区就诊的关键因素是医疗质量。     

上海市中医药社区卫生服务现状调查

目的为了确保上海市社区中医药示范点的示范作用，于2005年对上海市19个区（县）21个社区中医药示范点作中医药资源、中医药服务和从业人员巾医药知识、行为与态度调查。方法收集近3年社区卫生服务中心中医药服务状况及中医药社区资料；采用分层配额随机抽样方法抽取样本。由经过培训合格的调查员人户对住户成员逐一进行询问调查；采用889名社区卫生服务机构从业人员的意向调查数据，运用单因素和多因素Binary Logistic回归方法进行统计。结果本次调查的神区中医药服务示范点占全市社区卫生服务中心总数的14．54％，中医药服务量占总服务量的25．98％；中医处方数占处方总数的28．11％；中药收入占药品总收入的22．73％；中医家庭病床占家床总数的27．14％；院均中医师7．81人；中心城区居民步行15分钟即可得到中医药服务的占78．70％；所有的示范点提供中医药服务；16．47％的社区居民首选中医药治疗。社区医生认为中医医疗功能在社区卫生服务巾心所占比例为48．90％，中医预防占24．69％。结论居民在社区能得到中医药服务，缓解了“看病难，看病贵”。影响中医药计区卫生服务的重要原凶是投入不足和中医药服务队伍结构不合理。中医药适宜技术开展率低，中医药特色优势术觅分发挥，还远远不能满足计区居民需求。     

广州市白云街社区人群健康状况及医疗需求调查

目的 了解社区人群健康状况及医疗需求，为制订社区人群的保健措施提供依据。方法 采用整群抽样的方法，对社区7695户家庭15岁以上居民19564人进行问卷调查。结果 社区居民总患病率为14．02％，老年人患病率为40．70％，高血压患病率为5．78％。明显高于其他疾病，慢性病患病率为11.33％，占总患病人数的80．79％。2周患病率为7．56％；社区居民中较多存在不良的健康行为，43．49％的居民不进行体育锻炼，18．10％的居民吸烟，11．00％的居民经常饮酒；58．52％的居民首选市级以上医院就医，首选社区卫生服务站或街道医院就医的分别为2．61％和6．53％。结论 白云街社区疾病防治应以老年人及高血压病人为主，但社区医疗服务未得到充分利用，需要得到社会及政策的支持。     

社区居民药品需求和利用分析

目的：了解社区居民对药品的需求和利用情况，分析存在的问题，为社区卫生服务机构更好地开展服务提出相应的建议一方法：对深圳市宝安区公明镇17个社康站进行现场调查，数据输入计算机，用Spss for Windows 11、5．0进行统计分析．结果：社区居民对药品的需求增加，到药店购买药品较多，对卫生服务机构提供的药品利用不足。结论：社区卫生服务机构应承担居民在自我药物治疗中的责任，加强管理，降低医疗费用，特别是药品费用；转变服务模式，积极开展“六位一体”的综合性卫生服务。     

苗族村寨留守老年患者门诊服务利用及影响因素分析

目的了解苗族村寨农村留守老年人患病时门诊服务利用状况,分析其影响因素。方法 2011年7月选取贵州省黔东南苗族侗族自治州施秉县梨山坪、屯上、板屯3个苗族村寨112例≥60岁留守老年患者进行面访问卷调查,采用多元logistic逐步回归方法分析影响因素。结果留守老年人2周患者就诊率为47.3%(53/112),2周患者未就诊率为52.7%(59/112);53例农村留守老年人就诊地点为村卫生室占66.0%(35/53),乡镇卫生院及以上医疗机构占34.0%(18/53);候诊时间≥1 h占73.6%(39/53),<1 h占26.4%(14/53);医生在患者就诊时未告诉患者相关卫生保健知识占79.2%(42/53),告诉占20.8%(11/53);未向患者清晰解释病情占64.2%(34/53),清晰解释病情占35.8%(19/53);医生未很好地介绍治疗方案占52.8%(28/53),很好地介绍治疗方案者占47.2%(25/53);就诊满意占52.8%(28/53),不满意占47.2%(25/53);留守老年人患者不同说汉语能力、医疗单位距离、卫生保健知识、自感患病严重2周患者就诊情况比较,差异均有统计学意义(χ2=6.02、5.11、8.21、7.08,P<0.05或P<0.01);卫生保健知识(OR=4.13)、自感患病严重(OR=2.27)对门诊服务利用具有正向预测作用,医疗单位距离(OR=0.43)具有负向预测作用。结论留守老年人门诊服务利用程度较低,卫生保健知识、自感患病严重、医疗单位距离对门诊服务利用有影响。     

Factors affecting the utilization of prenatal health care services in Jerusalem

Health service utilization patterns during pregnancy were studied among 780 women from selected neighborhoods of Jerusalem who delivered between December 1, 1985 and June 30, 1986. Factors affecting the choice of care-provider, the timing of the first contact with the prenatal care service and the frequency of visits to prenatal care centers were studied with respect to several demographic, socio-economic and needs variables. About one half of the women visited the Family Health Centers, the traditional site for delivery of prenatal care. Forty percent visited their regular doctor during pregnancy while about 30% sought private care. In all, fifty two percent of women consulted more than one source of medical care service during pregnancy. Logistic regression analysis showed that the choice of care was determined by the type of insurance, need factors and education. The timing of the first visit depended on origin, level of education and parity. The frequency of visits was related to the type of insurance and to perceived health.Avi Y. Ellencweig is Senior Lecturer of Health Administration (deceased 1992), Hava Palti, Professor of Public Health, Yehuda Neumark, instructor of Public Health and Milka Donchin, Lecturer of Public Health, all at the Hebrew University-Hadassah, Braun School of Public Health and Community Medicine, Jerusalem, Israel.The research was supported by Hadassah Medical Organization, The Labour Union Sick Fund, Jerusalem Municipality, and the Ministry of Health Israel.     

Attitudes of professionals in providing maternity care in a primary health care system in Saudi Arabia

This study was done on a sample of the primary care centers in the Al-Baha region, Saudi Arabia to assess the opinions of the medical and paramedical staff regarding the capability and acceptability of providing antenatal and intrapartum care in the primary health care setting. The study showed that 96% of all the respondents supported the provision of antenatal care services in primary health care with 60% of them giving the reason that it is more convenient for pregnant women.90% of the respondents wanted the antenatal care to be delivered through special clinics and the majority of them wanted to give a greater role to the midwives in antenatal care. Questioned about the intranatal care provision in the centers, 98% of all the respondents agreed to the utilization of primary health care in such service. A similar percentage of them claimed to have the ability to do deliveries in the centers with existing facilities.To avoid duplication of care and to best use of available resources, low risk pregnancies should be seen antenatally and delivered in the primary health care centres provided the quality of such care is kept under control.Abdulaziz N. Al-Nasser is Assistant Professor of Primary Health Care; Mohammed A. Al-Sekait is Assistant Professor of Community Medicine; Elijah A. Bamgboye is Assistant Professor of Medical Statistics; all in the Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia.Wahid A. Khan is coordinator in the Primary Health Care Program, Al-Baha, Saudi Arabia.     

Primary health care provision for people with learning difficulties

The health care needs of people with learning difficulties living in the community are in danger of being ignored. Discussion of such needs is inhibited by a fear of ‘remedicalization’, that is, returning to a domination of a medical model of health in the lives of people with learning difficulties. In a new synthesis of the literature, this paper reviews evidence that health care needs are not being met. It considers the potential for a more effective Primary Health Care (PHC) service through better interprofessional collaboration between Primary Health Care Teams (PHCTs) and Community Learning Difficulty Teams (CLDTs). The meaning of collaboration, in theory and practice, is explored, and the reasons it can be difficult to achieve are discussed. Finally, ways in which improvements in PHC for people with learning difficulties can be attained are suggested.     

以社区为基础的医养结合策略分析

目的:对社区卫生服务机构参与医养结合服务的方式、所需资源及保障条件等可行策略进行归纳分析。方法:选取东、中、西部地区已开展医养结合服务且具有代表性的上海、武汉和重庆三地6家社区卫生服务机构进行现场调查和焦点组访谈,定性资料采取主题框架分析法。结果:社区卫生服务机构参与医养结合应以家庭医生签约服务为依托,借助信息化手段,以服务协作等方式不同程度参与;所需资源以人力资源、资金投入、设备和信息化建设为主;需要政策支持、多部门协作、支付制度、第三方参与等多重保障条件。结论:社区卫生服务机构是医养结合服务的重要平台,应充分依托家庭医生签约服务的开展,在不同形式下与养老资源进行协作融合;国家层面需做好顶层设计和相应标准,提高统筹层次。     

Acute respiratory infections in children under five years. Control project in Bagamoyo District, Tanzania

Control of acute respiratory infections (ARI) in children under five years of age has been implemented as an integrated part of Primary Health Care in rural Bagamoyo District in Tanzania. Community supported Village Health Workers visited each family at their homes every six to eight weeks, giving health education on recognition and prevention of ARI, treating children with pneumonia on the spot with oral Cotrimoxazole or referring them to the next higher level of care. Within a two-year period the total under five mortality has been reduced by 27.2% from 40.1 to 29.2/1000 children aged under five per year. The disease-specific mortality rate for pneumonia has been reduced by 30.1% from 14.3 to 10.0/1000 under-five per year, contributing 40% to the overall mortality reduction. It is concluded that an active health service outreach programme, within Primary Health Care, can efficiently reduce high child mortality rates from ARI and other diseases. A similar approach will be used to tackle other problems such as diarrhoeal diseases, malnutrition, malaria and child spacing.     

门诊患者对区域医疗联合体的认知与期望研究

目的 :从服务利用方的角度出发,调查了解患者对医联体的知晓程度、参与意愿和期望以及他们对社区首诊的评价,以期为卫生行政部门提供决策依据。方法 :采用方便抽样的方法对某社区卫生服务中心门诊患者进行问卷调查和深入访谈。结果 :总共调查306人,以中老年人为主;患者对医联体的了解程度较低,但78.8%的人表示愿意参加医联体;多数受访者接受医联体"分层就医、有序医疗"的理念,迫切期望缓解"看病难、看病贵"的问题;86.9%的受访者表示"看病时会首选社区卫生服务中心",社区首诊已被患者,尤其是老年人群逐渐接受。结论:进一步推进医联体改革需要创新服务模式,以服务升级带动观念升级;加大宣传力度,营造良好舆论氛围;实施惠民政策,吸引老年人群签约医联体;加强基层建设,满足居民基本医疗需求。     

Child health in poor areas of North and Northeast Brazil: a comparison of areas covered by the Children's Mission and control areas

Community surveys are essential to estimate health indicators, evaluate health programs, and define health interventions. In 2002, a cross-sectional survey of children under five was conducted in 18 areas of the poorest counties in North and Northeast Brazil. Nine areas were visited by volunteer community health workers (CHW) under the Children's Mission, and the others were not visited. Using a standard questionnaire, trained interviewers collected information at the household level for 1,528 children, 782 of whom were visited monthly by CHWs and 772 were not. All the children and their families were living below the poverty line; 40.0% of the parents were illiterate, per capita daily income was about US$0.30, and household conditions were substandard. However, most were living less than 1km from a public health service and almost all children who were referred to these services received medical care. Prenatal care was also poor in terms of number of medical visits and laboratory tests. Children visited by CHWs from the Children's Mission received better care in terms of growth monitoring, number of medical check-ups, and prenatal iron supplementation.