医生自卫性医疗行为调查分析

目的：比较军队、地方医院医生自卫性医疗行为现状,为卫生管理政策部门及医院管理者提供有价值的参数及理论依据。方法：应用自制的调查问卷,在北京9家三级甲等医院的部分医生中进行调查．部队医院5家,地方医院4家．用SPSS软件进行统计分析。结果：下发问卷600份,回收有效问卷512份．其中部队医院医生337名,地方医院医生175名。军队、地方医院医生的自卫性医疗行为相比较有显著差异。结论：自卫性医疗行为在我国医生群体中普遍存在,军队医院医生其自卫性医疗行为更具倾向性。     

呼吁：规范乡村医生医疗行为

乡村医生是特定历史时期的产物，曾为广大人民群众的医疗服务、预防保健、健康教育等发挥了重要作用。随着时代的进步、医学知识的更新和健康需求的变化，由于监管机制的相对滞后和乡村医生队伍自身的懈怠，使村级卫生机构的功能得不到充分发挥或部分缺失，乡村医生的行医行为存在较大的随意性和违规现象，这种状况严重制约了农村卫生工作的开展，危害着人民群众的健康安全。本文结合部分案例和乡村医生行医现状，呼吁规范乡村医生的行医行为。     

乡村医生医疗服务行为研究--次均服务费用分析

目的：了解乡村医生次均服务费用情况，为控制农村医疗费用上涨提供决策依据。对象：安徽省4县市5个乡镇随机调查的63名乡村医生．方法：乡村医生按设计的调查项目连续记录50例左右病例。结论：调查地区农村居民疾病经济负担水平较高；乡村医生的年龄、学历、工作年限是次均服务费用的影响因素等。     

512名医生自卫性医疗行为现状调查及分析

目的：调查医生自卫性医疗行为现状，为卫生管理部门及医院管理者提供有价值的参数及理论依据。方法：应用自制的调查问卷，在北京9家三级甲等医院的部分医生中进行调查，用SPSS软件进行统计分析。结果：下发问卷600份，回收有效问卷512份。512名医生均有不同程度的自卫性医疗行为，其中407(79．49％)例自卫性医疗行为的程度偏高，且自卫性医疗行为与医生的年龄、对医患关系和谐与否和医疗环境宽容与否的认知情况相关。结论：自卫性医疗行为在我国医生群体中普通存在，是一个值得政府、卫生管理部门、医疗机构及医生本人高度重视的社会现象。     

医生防御性医疗行为的社会成因分析

防御性医疗行为(亦称自卫性医疗行为,defen-sive medicine)是1978年由美国Tancredi等提出的。医生的防御性医疗行为是医疗失误法律诉讼的副产品,其目的非常明确,即医生要避免吃官司。伴随着法律、人权的发展,防御性医疗行为已不仅发生在个别情况中,而是普遍存在于医疗行为中。     

公费医疗改革中医生的行为及其看法

公费医疗改革中医生的行为及其看法程晓明，王旭辉，杨胜文，尚瑞华，丁佩军，姜正芝南京市的公费医疗改革至今已有７年了，为了全面了解和总结公费医疗改革的情况，我们于１９９２年６月在南京市向部分医生、病人和享受公费医疗者作了问卷调查，对医生问卷的调查结果进行...     

关于规范乡村医生医疗服务行为的建议

针对农村普遍存在的医疗服务行为不规范问题，文章认为：采取单一的、片面的措施难以根本解决这一问题，需要采用综合治理，实行标本兼治.并就此提出四项基本策略：①通过教育培训，提高乡村医生素质;②树立“以人为本”的服务理念，强化“规范服务”意识;③净化农村医疗服务市场，创造一个良好的农村医疗服务市场环境;④借助可利用的资源，加强对乡村医生服务行为的监督.     

北京将允许在职医生办私人诊所

据报道,近日,北京市卫生计生委工作会上透露了这样一条消息,北京市将探索建立医生自主创业制度,允许在职医生开办私人诊所。鼓励在职医生开私人诊所,有助于打破公立医院对优质医疗资源的垄断,将大医院的专家门诊分化补充到社区医疗服务中去,让老百姓就近方便地享受到专家的诊疗服务。     

贵阳市乡村医生诊疗行为状况调查

目的:了解贵阳市乡村医生在诊疗活动中存在的问题,规范乡村医生的诊疗行为.提高农村的医疗卫生服务质量和农民的健康水平.方法:组织经过培训具有5年以上临床经验的县级临床医师,对村医诊疗的210名病人进行现场观察和记录评价.结果:村医的诊疗活动中,抗感染药物的使用占43.07%,联合应用2～3种抗菌素者占49.65%,输液费用在20元以上的达50%,输液是目前村医对病人的第二种给药方式;在治疗手段上村医以西医为主,传统中草医极少应用.同时,在村卫生室就诊病人所患疾病中调查者认为村医有能力处理的疾病为97.62%,需要转诊的仅占2.38%;在对病人的诊断上,调查者与村医在普通感冒、慢性支气管炎和其他消化系统疾病上对病人的诊断出入较大,而对症状和体征较为明显或有检查手段的疾病上,对病人的诊断出入不是很大.结论:应进一步强化村医诊疗基本功培训,建立健全乡村医生诊疗制度,特别应对感冒类疾病的诊疗行为进行重点规范;同时,要鼓励和倡导中西医结合,重视中草药在村医诊疗活动中的应用.     

Physician Office vs Retail Clinic: Patient Preferences in Care Seeking for Minor Illnesses

PURPOSE Retail clinics are a relatively new phenomenon in the United States, offering cheaper and convenient alternatives to physician offices for minor illness and wellness care. The objective of this study was to investigate the effects of cost of care and appointment wait time on care-seeking decisions at retail clinics or physician offices.METHODS As part of a statewide random-digit-dial survey of households, adult residents of Georgia were interviewed to conduct a discrete choice experiment with 2 levels each of 4 attributes: price ($59; $75), appointment wait time (same day; 1 day or longer), care setting–clinician combination (nurse practitioner in retail clinic; physician in private office), and acute illness (urinary tract infection [UTI]; influenza). The respondents indicated whether they would seek care under each of the 16 resulting choice scenarios. A cooperation rate of 33.1% yielded 493 completed telephone interviews.RESULTS The respondents preferred to seek care for both conditions; were less likely to seek care for UTI (β =−0.149; P = .008); preferred to seek care from a physician (β =1.067; P <.001) and receive same day care (β =−2.789; P<.001). All else equal, cost savings of $31.42 would be required for them to seek care at a retail clinic and $82.12 to wait 1 day or more.CONCLUSIONS Time and cost savings offered by retail clinics are attractive to patients, and they are likely to seek care there given sufficient cost savings. Appointment wait time is the most important factor in care-seeking decisions and should be considered carefully in setting appointment policies in primary care practices.     

Delayed Care and Unmet Needs among Health Care System Users: When Does Fiduciary Trust in a Physician Matter?

Objectives. To examine whether fiduciary trust in a physician is related to unmet health care needs and delayed care among patients who have a regular physician, and to investigate whether the relationships between trust and unmet health care needs and delays in care are attenuated for disadvantaged patients who face structural obstacles to obtaining health care.
Data Sources/Study Setting. The 1998–1999 Community Tracking Study (CTS) Household Survey, a cross-sectional sample representative of the U.S. noninstitutionalized population. This study analyzes adults who usually see the same physician for their health care ( n =29,994).
Study Design. We estimated logistic regression models of the association of trust with unmet health care needs and delayed care. We tested interactions between trust and barriers to obtaining care, including minority race/ethnicity, poverty, and the absence of health insurance. Control variables included patients' sociodemographic characteristics, health status, satisfaction with the available choice of primary physicians, and the number of physician visits during the last year.
Principal Findings. Patients' fiduciary trust in a physician is negatively associated with the likelihood of reporting delayed care and unmet health care needs among most patients. Among African Americans, Hispanics, the poor, and the uninsured, however, fiduciary trust is not significantly associated with the likelihood of delayed care. For unmet needs, only the uninsured have no significant association with trust.
Conclusions. Results show that trust is associated with improved chances of getting needed care across most subgroups of the population, although this relationship varies by subpopulation.     

The Role of Physician Assistants in Rural Health Care: A Systematic Review of the Literature

Purpose: A literature review was performed to assess the role of physician assistants (PAs) in rural health care. Four categories were examined: scope of practice, physician perceptions, community perceptions, and retention/recruitment. Methods: A search of the literature from 1974 to 2008 was undertaken by probing the electronic bibliographic databases of English language literature. Criterion for inclusion was original data published on rural PAs. Each paper was assessed and assigned to the four categories. Findings: A total of 51 papers were identified; 28 papers had a primary focus on research and specified PAs in a rural setting. Generally, the literature suggests that PAs provide cost‐efficient and supplemental medical services to underserved rural populations and that these services are valued. It also appears that rural PAs possess a larger scope of practice than urban PAs. This broad range of skills and procedures may be necessary to match the extensive health care needs of underserved rural populations. Over a 35‐year period of examination, the literature improved in numbers of PAs studied and the quality of research. However, the lack of longitudinal studies was considered a shortcoming of rural health PA observational research. Conclusions: Through this review, some insights about the role of PAs emerged. Overall, they seem well adapted to rural health. Important issues regarding the recruitment and retention of PAs to rural populations also emerged. Improvement in enabling legislation contributes to the utilization of PAs in America.     

西藏高原学子就读内地大学的预防保健研究

目的 了解西藏高原学子就读内地大学时,由于环境反差大而遇到的不良反应、多发疾病及预防保健措施.方法 采用分层随机整群抽样方法,抽取西藏民族学院2 000名藏族大学生为研究对象,用自行设计的问卷进行自填式问卷调查.结果 影响西藏高原来内地就读大学生健康的几个主要方面是:(1)低山晕氧反应,93.6％的同学存在明显的晕氧反应,持续时间在3d至半年不等.(2)63.5％的同学患过感冒.(3)呼吸道疾病,41.3％的同学得过呼吸道疾病.(4)42.6％的同学胃肠功能出问题.结论 西藏高原学子来内地就读大学时,由于环境反差大存在明显的不良反应和健康隐患,应采取积极的预防保健措施降低其疾病风险.     

浦东新区社区卫生服务中心医疗卫生服务状况分析

目的分析2008—2010年上海市浦东新区社区卫生服务中心的医疗卫生资源配置和服务状况。方法收集浦东新区医疗机构管理中心有关社区卫生服务中心运行的数据。结果近年来社区卫生服务功能进一步完善,社区卫生服务效率不断提高,但社区卫生服务面临着发展瓶颈。结论如何通过恰当的社区卫生服务中心的资源配置,以满足社区医疗卫生服务的需求,保障医疗卫生服务的安全和质量,使上海市医改重点落到实处,值得关注。     

社区产妇产后保健的市场开发策略分析

从市场分析的角度探讨了开展社区产妇产后保健的潜在市场并作了市场细分,探讨了产妇产后保健市场形成的障碍,并提出了相应的市场开发策略,为社区卫生服务脆弱人群保健功能的切实落实探索一条在技术和经济上可行的途径。     

农村乡镇防保服务体系现状与评价

农村乡镇防保服务体系是农村公共卫生服务体系的重要组成部分。随着农村社会经济的发展,相应的乡镇防保组织机构形式发展呈现多元化的特点,概括介绍目前我国乡镇防保机构的几种重要模式,并对乡镇防保服务体系评价的指标和方法进行分析和探讨,为进一步进行乡镇防保服务体系改革和从事深入研究提供切入点和思路。     

现阶段城市社区预防保健服务评价指标研究

目的建立社区预防保健等公共卫生服务评价指标体系,提高社区卫生服务管理的科学化水平,确保社区公共卫生服务目标的实现。方法采用文献研究法和专家深入访谈法相结合的研究方法。结果建立的评价体系由一级指标、二级指标和权重、分值等构成。结论本评价体系较适用于现阶段城市社区公共卫生卫生服务的评价,评价指标体系应随着社区卫生服务的发展不断调整和完善。     

山东省儿童保健服务利用及影响因素分析

目的 调查儿童保健服务利用情况,并对其影响因素进行分析.方法 采取分层随机抽样的方法进行调查,运用x2检验、多元Logistic回归等统计方法进行影响因素分析.结果 儿童健康体检和“五苗”接种率利用率较高,新生儿疾病筛查、新生儿访视和儿童保健指导利用率较低;居住地、家庭收入、母亲文化程度和儿童出生方式等是影响儿童保健服务利用的重要因素.结论 提高对儿童保健服务的关注程度,通过健康教育等措施不断提升儿童保健服务利用率.