南京市社区居民卫生服务需要和利用研究

目的:为了了解社区居民卫生服务需要和利用状况,开展社区诊断。方法:采用整群随机抽样法,对南京市12 878名居民进行入户调查。结果:社区居民慢性病患病率为26．6％,60岁以上居民患2种及2种以上疾病的患病率为64．0％,隐性高血压患病率为14．8％,高血压病人药物控制率为35．4％,社区居民的两周患病率、就诊率和年住院率分别为30．8％、13．0％和6．9％。结论:提示应尽快发展社区卫生服务,开展慢性病的社区预防工作,提高卫生服务的利用率。     

长沙市望月湖社区控烟效果的研究

目的了解社区居民在开展控烟干预前后对吸烟和戒烟的知识、态度、行为变化情况。方法对干预社区的20—60岁居民采用单纯随机抽样，两次共调查2068人。结果吸烟及被动吸烟危害健康的知晓率分别提高17．97％和21．01％，社区居民主动向医护人员寻求戒烟服务、看到朋友或家人吸烟时经常进行劝阻的比例明显提高。但项目实施前后，吸烟率分别为39．62％、38．96％，戒烟率分别为8．60％和8．30％，均无显变化。结论成人控烟难度大，控烟工作的重点应该是创造无吸烟环境，防止被动吸烟。因此，控烟工作应从小抓起，从拒吸第一支烟抓起。     

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。     

南京市社区居民健康和卫生服务利用状况调查

目的了解社区居民健康状况和卫生服务需求。方法采用整群随机抽样法，对南京市12878名居民进行入户调查。结果社区居民慢性病患病率为26．6％，隐性高血压患病率为14．8％，高血压患者药物控制率为35．4％。社区居民的两周患病率、就诊率、年住院率分别为30．8％，13．0％和6．9％。结论应尽快发展社区卫生服务。开展社区慢性病预防。     

社区心理卫生服务需求调查

目的研究城市居民对社区开展心理卫生服务的需求情况和特点,以提出适合我国国情的社区心理卫生服务模式。方法采用问卷调查方法,对深圳市宝安区420户居民及31个社区卫生服务站进行访谈式调查。调查内容包括社区居民对开展心理卫生服务的需求状况及目前实际情况等。结果25岁以下和26～40岁的人群对心理卫生服务的需求量,分别占到35%和36%;认为需要心理卫生服务的居民占被调查居民数的86%。而社区医护人员数量基本上能满足增设心理卫生服务的需要,但缺乏必要的设施及相应的培训。结论社区开展心理卫生服务有较大发展前景,应引起广泛重视和关注。     

北京市东城区社区医护人员健康生活方式相关知信行调查

目的了解社区医护人员健康生活方式相关知信行情况,为全民健康生活方式活动提供建议。方法随机抽取北京市东城区社区医护人员132名,采用面对面询问方法进行调查。结果北京市东城区社区医护人员健康生活方式知晓率除全民健康生活日时间（22．5％）和千步活动量定义（10．8％）认知较低外,其余均高于65．0％;对不健康生活方式与高血压、冠心病、糖尿病、肿瘤、高血脂、脑卒中有关的态度认同率均高于65．0％;除锻炼（25．8％）和参与社区居民健康生活行动（57．5％）较低外,其余健康生活方式行为发生率均高于70．0％。40岁以下的社区医护人员对体质指数（BMI）计算方法、“全民健康生活日时间”的知晓率高于40岁及以上人员,而锻炼的行为发生率低于40岁及以上人员。结论北京市东城区社区医护人员健康生活方式相关知信行水平较高,但对40岁及以上者应加强理论指导和培训,对40岁以下者应加强锻炼教育的宣传力度,促使社区医护人员在全民健康生活方式活动中更好地发挥指导和示范作用。     

上海市社区医护人员对精神卫生服务的培训需求分析

目的了解上海市社区卫生服务中心不同岗位医护人员对精神卫生服务知识与技能的需求,为社区开展培训和提高社区医护人员精神卫生服务能力提供参考。方法依托上海市心理卫生服务体系建设三年行动计划项目,以问卷形式对上海市三家试点社区的171名社区医护人员开展调查,采用频数统计、单因素R×C表χ2检验分析方法。结果不同岗位医护人员对精神卫生服务知识与技能培训的需求存在差异(P0.05)。约53.4%的医护人员倾向于短期培训,63.6%选择集中现场授课,46.0%选择理论知识讲授和38.0%选择模拟案例分析。岗位工作需要是医护人员参加培训的首要原因,其次是个人发展需要。医护人员不参加培训的原因均以时间安排与工作冲突为主。结论社区应根据岗位需求优化培训内容,合理设计培训方案,并给予多种支持,鼓励医护人员积极参加培训。     

宝山区社区健康教育人力资源现状分析

目的 了解宝山区社区健康教育人力资源现状,为制订对策提供依据。方法 采用问卷调查,对宝山区社区公共卫生服务人员基本情况及平时所开展健康教育的情况进行调查。结果 显示目前宝山区社区公共卫生服务人员的学历层次偏低,大部分为中专毕业,占77．2％,所开展的健康教育活动大多仍停留在卫生宣传的阶段,只有8．7％的社区公共卫生服务人员进行过健康教育与健康促进计划、实施及评价的尝试。 接受过一周健康教育相关专业培训的为36．5％。结论 应通过各种渠道进行人才的培养,同时提高工作要求,制定工作规范,并在政策上给予支持。     

居家晚期患者临终关怀护理的探讨

目的探讨基层社区卫生服务中心在社区家庭病床对居家晚期患者开展临终关怀服务的可行性及方法。方法回顾性分析61例居家晚期患者的临终护理情况并进行讨论。结果居家晚期患者安详死去者占93%。患者家属满意率为98%。结论本着"以人为本"的原则,对居家晚期患者开展临终关怀护理服务,采用患者亲属参与、医护共同协商治疗护理方案,实施全方位的整体照护具有重大的社会意义。     

老龄化背景下社区老年人群对临终关怀的需求及对策研究

随着社会发展及人口老龄化,我国临终关怀服务的发展正在由传统的综合性医院内附设临终关怀病房向社区居家照料的临终关怀服务过渡,并呈多元化发展.文章分析社区临终关怀服务的发展现状,并提出我国临终关怀服务发展中存在的问题及相关对策研究,以推进我国临终关怀事业的发展.     

大型企业所办社区卫生服务机构存在的问题和对策

社区卫生服务是保证广大城镇居民享受基本卫生保健和缓解“看病难,看病贵”的根本保证和有效途径,大型企业所办社区卫生服务机构是城市社区卫生服务体系建设中的重要组成部分。通过对东风汽车公司在十堰所办的社区卫生服务机构进行调研,发现在管理体制、政府投入和管理及社区卫生服务机构自身业务发展上均存在一定的问题,提出了政府部门要提高认识、完善相应政策以及加强企业所办社区卫生服务机构业务发展等对策建议。     

Intermittent preventive treatment of malaria in pregnancy: the incremental cost-effectiveness of a new delivery system in Uganda

The main objective of this study was to assess whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilisers could administer intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP) to pregnant women. The study was implemented in 21 community clusters (intervention) and four clusters where health centres provided routine IPTp (control). The primary outcome measures were the proportion of women who completed two doses of SP; the effect on anaemia, parasitaemia and low birth weight; and the incremental cost-effectiveness of the intervention. The study enrolled 2785 pregnant women. The majority, 1404/2081 (67.5%) receiving community-based care, received SP early and adhered to the two recommended doses compared with 281/704 (39.9%) at health centres (P<0.001). In addition, women receiving community-based care had fewer episodes of anaemia or severe anaemia and fewer low birth weight babies. The cost per woman receiving the full course of IPTp was, however, higher when delivered via community care at US$2.60 compared with US$2.30 at health centres, due to the additional training costs. The incremental cost-effectiveness ratio of the community delivery system was Uganda shillings 1869 (US$1.10) per lost disability-adjusted life-year (DALY) averted. In conclusion, community-based delivery increased access and adherence to IPTp and was cost-effective.     

A community-wide volunteer-intensive hospice program.

Hospice of Frederick County has developed a volunteer-intensive community-model hospice program that is in many ways different from hospice programs that see themselves as a new specialty within the health care system. The intention of the program is to keep the patient and family in control of decisions and to work closely with existing health care providers selected by the family. Hospice of Frederick County believes hospice care is far more than professional health care. "The Board of Directors believes that hospice is a community concern. The compassion and caring which characterizes hospice belongs in the churches, neighborhoods, schools, workplace, service clubs...in all areas of community life. Hospice volunteers are people from the community who care so much that they are willing to receive special training and supervision to be friends to the dying, their families and their loved ones".     

太原社区不同医保老年人卫生服务利用研究

目的了解太原市社区享有不同医疗保障老年居民卫生服务利用现状，为政府制定卫生政策提供依据。方法采用二阶段整群抽样法，在太原市万柏林区共抽取65岁以上老年人854人，围绕一般人口学特征、前半年和前两周慢性病患病情况、门诊服务需求、住院服务需求、医疗保障覆盖率、对社区卫生保健需求和满意度等方面展开调查。结果社区老年人群慢性病患病率为43．68％，20．73％的老年人群未享有医疗保障，享有不同医疗保障老年人群2周患病率未见显著统计学意义差异（x^2=1．254，P=0．771），住院率存在显著统计学意义差异（x^2=29．388，P=0．000）。享有不同医疗保障的老年人愿意接受社区卫生服务的主要原因：方便快捷、医疗费用低；不愿意接受社区卫生服务主要原因：非医保定点单位、环境设备差。结论社区老年群体医疗费用支出持续上涨与社会可筹集医疗资源有限之间矛盾日益突出，政府应加强卫生经费投入力度和现有卫生资源合理配置，改善医疗保障体系，满足老年居民卫生服务需求。     

Involving communities in health service planning in primary care

Recent health service policy in the United Kingdom has emphasized the need to involve local people in health service planning. This paper will describe how local communities were involved in the development of Primary Care Resource Centres. These centres are designed to provide a base for the delivery of a range of health, social welfare and information services within a community setting. Four centres in the process of being developed in one region were selected for in-depth study. The main method of data collection consisted of semi-structured interviews with key “stakeholders”, namely purchasers and providers of primary health care, social care providers, hospital outreach staff and local community and voluntary group workers (Weiss 1983). This paper examines how the health service organizations developing the centres involved local communities in planning them and the obstacles and difficulties encountered. The paper suggests lessons that can be learned for future community involvement in the planning of local health services.     

Independent hospice care in the community: two case studies

Following its remarkable success over the past 25 years the hospice movement is now at a watershed in its development. The growing legitimacy of palliative care as a health care specialty has coincided with the development of the internal market within public sector services, and the promotion of community care. The impact of these changes is now being felt by the hospice movement and may well result in radically new forms of service provision. The focus of this paper is on the future direction of the hospices. We argue, that in the present policy context the main priority must be palliative care in the community, using two case studies of innovative services to illustrate how this might be achieved. We also explore a variety of factors which may constrain the development of community care for dying people. These include the diminishing experience of families and primary health care workers in managing death and dying and the often strongly held belief that hospice care must be in-patient care. New community services may also face difficulties both in finding a market niche which complements rather than supersedes existing provision, and in securing service contracts where provision cuts across the health and social care divide. These issues are explored through an examination of the models of care developed by the two hospice groups, their integration within existing networks of provision, and their relationship with purchasing authorities.     

Monitoring and predicting community mental health centre utilization in Auckland, New Zealand

Deinstitutionalization of mental health care has been in progress in many countries for over a quarter of a century. A comprehensive and detailed literature has evolved focussing on this process and its implications for alternative forms of combatting the incidence of mental illness. Most notably, literature has concentrated on the need for community-based mental health services both to prevent hospitalization in the first place and to ease the return of the hospital patient into the outside environment. In this paper the evolution of such a community-based system in metropolitan Auckland, New Zealand is discussed. More specifically, the focus is on the utilization of four community-based centres, with a view to plan better growth or reduction of service provision. Two dimensions of centre use, spatial and sociodemographic, are analysed and incorporated into four predictive models that, with appropriate refinement, can be used to determine the likely level of centre use in unserviced parts of the metropolitan area. Distance of individuals from centre locations is shown to be a significant factor in affecting use for three suburban primary prevention and intervention centres, whilst distance is non-significant for an inner-city aftercare facility. Also, various combinations of socio-demographic variables, reflecting service-specific needs for specific groups in the population, are shown to contribute significantly to predicting centre use. The paper presents the results against a policy backdrop in New Zealand where community mental health services are very much experimental in nature. The results reaffirm the importance of community mental health care in fulfilling an important need in society that health care administrators should take seriously in future policy developments.     

‘Where do I go from here’? A cultural perspective on challenges to the use of hospice services

Do hospice services as shaped by a western perspective adequately fulfil the needs of persons from non‐Western cultures? Based on a Western view of palliative care, the vision outlined in the New Zealand Palliative Care Strategy (2001) is to deliver palliative care services, including hospice services, to all patients and their families requiring them in the context of an increasingly pluralistic and multicultural society. It is predicted that over the next two decades the proportion of people identifying as Māori, Pacific and Asian will dramatically increase within New Zealand. Ministry of Health information provided through a GAP analysis identified hospices as facing access‐to‐care pressures for Māori, Pacific and Asian patients. It is therefore critical to identify the challenges to hospice service access for Māori, Asian and Pacific patients. This project involved qualitative interviews with 37 cancer patients (Māori, Pacific and Asian self‐identified ethnicities), whānau/family and bereaved whanua/family, as well as 15 health professionals (e.g. referring GPs, oncologists, allied health professionals) within one District Health Board. Patients and their families included both those who utilised hospice services, as well as those non‐users of hospice services identified by a health professional as having palliative care needs. Challenges to hospice service utilisation reported in the findings include a lack of awareness in the communities of available services, as well as continuing misconceptions concerning the nature of hospice services. Language barriers were particularly reported for Asian patients and their families. Issues concerning the ethnic representativeness of the hospice services staff were raised. The findings highlight the importance of patient and family knowledge of hospice care for utilisation of services. This information can be used for future planning to enable hospices to both provide high quality evidence based palliative care services for patients and families and provide consultative services to primary healthcare providers in the community.     

全民医保模式下免费提供部分基本医疗服务可行性分析： 以珠海市为例

目的：对珠海市在无缝隙覆盖全民的医疗保障体系下,免费提供部分基本医疗服务的可行性进行分析。内容和方法：通过文献回顾和描述性统计方法,对社区卫生服务机构基本医疗服务收支和政府投入进行计算,分析全民医保模式下免费提供部分基本医疗服务的可行性和群众受益情况。结果：珠海市免费提供部分基本医疗服务需总费用为2.03亿元,占GDP的0.27%。如居民就诊交付8～10元的费用,政府投资于基本医疗服务仅需1.31亿元,占GDP的0.15%。结论：珠海市政府可以通过财政投入实现免费提供部分基本医疗服务项目,社区卫生服务机构和个人均可以获益。