开展全科医学教育 推进社区卫生服务

多年来,天津市把发展社区卫生服务作为深化城市卫生服务体系改革的切入点,积极开展工作,在市内各区、各街道建立初级卫生保健站1064个,占居委会总数的51．5％;建立全科医疗站153个,投入卫生人力1413人;为135个居民区建立了健康档案,服务总数达73．7万户,244．9万人;每张处方值比开展社区卫生服务前平均降低11元;全市妇幼保健保供制全面开展,市区人保率达80％以上,1994年孕产妇死亡率已降到13．98／10万;婴儿死亡率为11．34‰;5岁以下儿童死亡率为11．63‰,提前完成天津市儿童发展规划2000年指标。全市范围内开展的以社区为…     

广东省全科医学教育社区实践基地卫生人力资源现状研究

目的:了解广东省全科医学教育社区实践基地卫生人力资源现状,为促进实践基地建设提供参考依据.方法:拟定统一的调查表,由各实践基地统一填报,并分为经济发达及欠发达地区进行统计分析.结果:广东省全科医学教育社区实践基地共87所,职工7233人,其中卫技人员占84%,硕士研究生占1.1 %,本科占26.5%;师级及以上占56.3%;临床医学和护理专业占58.6%,预防医学专业占3.1%;全科医学培训率28.2%.经济发达地区高学历高职称所占比例、接受全科医学培训率均高于欠发达地区.结论:广东省全科医学教育社区实践培训网络逐步形成,但部分实践基地规模小,学历偏低、职称不高,专业结构尚需改善.     

全科医学本科社区实践基地研究与实践

本科教育阶段建设全科医学社区实践基地有利于转变学生医疗理念、树立全科医学思维,也有利于培养学生社区卫生服务能力。温州医科大学以为各地政府培养定向社区医学人才的天然联系为纽带,通过校地共建方式,进行全面标准化建设,并实施特色发展,以远程协作方式开展全科教学,在省内26所社区实践基地开展试点研究与实践,正逐步建设完成交互式多媒体诊断实验室,实现体检与诊断的远程教学共享。     

开展全科医学教育及社区实习培养新型卫技人才

由于我国全科医学教育滞后，全科医学人才严重匮乏已经成为制约我国社区卫生服务可持续发展的一大“瓶颈”。对此，绍兴文理学院医学院作为一所综合性大学中新办的二级学院。在进一步明确学院办学与人才培养目标要面向社区基层定位中，确立了培养“专业口径宽，具有应用型知识技能，尤其是开展社区卫生服务用得上、下得去和留得住”的高级卫技人才模式。利用学校多学科优势，充分发挥学院良好师资等教学资源作用，首先对临床医学专业实施了课程与实践教学改革，开展全科医学教育与社区卫生服务实习，经过4年实践探索，已取得良好成效。根据国家人事部等《关于加强城市社区卫生人才队伍建设的指导意见》，学院已扩大对护理学等专业的教学改革。努力培养更多实用的新型农村卫技人才，为推进社会主义新农村建设作贡献。     

构建全科医学教育体系 发展社区卫生服务

为保障社区卫生服务持续健康发展，必须建立和完善我国全科学医学教育体系。本文就如何适应社会发展，大力发展全科医学教育的必要性作了剖析，就构建全科医学教育体系及可持续发展等问题提出了探讨性意见。     

发展全科医学教育 为推进社区卫生服务提供人才保障

全科医学（亦称通科医学或家庭医学）于20世纪60年代在欧美国家兴起,社区卫生服务的主要执行者全科医生以全科医学技术为患者和家庭提供第一线的医疗、预防、保健及康复等卫生服务,这是当今许多发达国家和地区实施基层医疗卫生保健的主要模式。国外全科医学实践表明,城镇居民70％～80％的医疗保健需求在社区得到解决。全科医学的主要作用是：合理利用卫生资源,使广大社区居民得到有效、经济、便捷的医疗保健服务,满足居民对卫生保健的需求,改善和促进全民的健康状况。     

吴江市松陵镇社区卫生服务中心人员全科培训分析

目的调查并分析吴江市松陵镇社区卫生服务中心人员全科培训结果,为全科转岗培训设置统一规范的要求提供依据。方法对吴江市松陵镇社区卫生服务中心随机抽取全科医师和社区护士进行考试。结果全科医师中最高分66．7分,最低分27。5分,平均分52．8分;社区护士中最高分75分,最低分58．3分,平均分68．3分。结论现有医护人员的知识结构不能很好地满足“六位一体”的功能需求,有必要建立全省统一的规范化培训要求。     

某公立医院卫技人员离职情况的调查

该文调查江苏某公立医院卫生专业技术人员离职情况,探讨离职的原因及相关因素,提出稳定医院卫生专业技术人员队伍的几点对策。     

发展全科医学教育 促进社区卫生服务

全科医学是随着传统的医学模式向现代的生物一心理一社会医学模式转化的过程中出现的新兴医学学科。近年来，医学的高度专科化虽然极大地促进了医学本身的发展，但专科化的弊端也日益显现，如医疗照顾不完整、就医不便以及医疗费用上涨等现实问题。单纯的专科化的医疗保健服务已愈来愈不能满足人们日益增长的卫生保健需求，而能提供连续、完整、经济方便的全科／家庭医学则顺应时代潮流逐渐兴起。因此，“为21世纪设计新的医生”成为当今卫生事业发展对医学教育工作提出的迫切要求。     

广州市天河区卫生防疫站1986～1995年卫技人员状况分析

天河区卫生防疫站承担辖区内的疾病控制、卫生监督监测、卫生宣教和科研培训等重任，是全区卫生防病的指导中心。为了健全机构，合理配备人员，提高卫生防疫工作人员的索质和工作质量，以适应改革开放的需要，笔对天河区卫生防疫站1986～1995年卫生技术人员构成状况进行初步分析，试图为今后卫生技术人员调配、选拔、培养提供依据。     

全科医学教育与社区卫生服务现况分析与对策

通过介绍国内外全科医学的起源、发展,全科医生在社区卫生服务中的地位和作用以及目前我国社区卫生服务人力资源存在的问题,揭示发展全科医学教育、培养全科医生的重要性和迫切性;探讨适合中国国情的全科医学教育模式。     

加快发展全科医学教育 积极推进社区卫生服务

探讨发展全科医学的相关问题.通过联系我国卫生改革与发展的新形势要求,研究加快发展全科医学教育的重要 意义及举措.提出:积极开展多种形式的全科医学教育,促进社区卫生服务.     

推行家庭医生签约对社区卫生服务利用的影响

目的 :了解上海市长宁区家庭医生制的实施效果,为完善家庭医生服务内容提供依据和支撑。方法 :使用自行设计的"家庭医生服务利用及效果评价"调查表,采用入户调查的方式收集资料,所有的调查员均由复旦大学统一培训。结果 :共调查社区常住居民736人,其中签约居民412人(56.0%),60岁以上居民占60.1%,38.9%的调查对象有明确诊断的慢性病。既往半年有就诊记录的调查对象中,签约居民对社区卫生服务中心的利用率(77.9%)是非签约居民(31.5%)的2.47倍(P0.01)。家庭居住区域、是否签约家庭医生、家庭人均年收入影响社区居民的就诊行为。签约居民、低学历居民、41~80岁社区居民生病后到社区卫生服务中心的首诊意愿高于非签约居民(OR=1.80,95%CI:1.11~2.92)、高学历居民(其中初中及以下组OR=4.45,95%CI:1.86~10.61;大专组OR=2.29,95%CI:1.06~4.97)、40岁及以下居民(其中41~60岁组OR=2.78,95%CI:1.10~7.00;61~80岁组OR=3.46,95%CI:1.00~11.90;80岁以上组OR=4.55,95%CI:0.97~21.43)。签约居民对家庭医生满意度非常高,总体评分为93.44。结论 :上海市长宁区试行的家庭医生制成效明显,为探索"优化社区卫生资源配置、建立分级诊疗制度"提供了科学依据。     

Variations in practice nursing: implications for family health services authorities

Differences between Family Health Services Authorities (FHSAs) in practice nurse activities are described and interpreted, using the results of postal questionnaires to all practice nurses in England and Wales in late 1992. There were an estimated 15000 practice nurses of whom 12589 (85%) returned a completed questionnaire, which asked about 30 tasks, including domiciliary visits, carried out by practice nurses; employment conditions, professional qualifications, experience, and clinical grading; and practice characteristics. The proportion of nurses undertaking four out of five tasks varied by a factor of two or more across FHSAs. Just over a third (39%) of the variation in nurses' activities could be explained by professional and practice characteristics. The analysis distinguished between FHSAs where nurses were more likely to engage in tasks requiring diagnostic and clinical skills, including assisting with minor surgery, and FHSAs where nurses were more likely to conduct domiciliary visits, help with chronic disease management, and provide advice on welfare benefits, incontinence and health promotion. The former FHSAs were characterized by larger practices with four or more partners employing several nurses, training practices, and practices with a manager. The latter group was characterized by smaller inner city or urban practices, including single-handed partnerships, and practices often employing one nurse. The 1990 general practitioner (GP) contract boosted nurses' involvement in those activities attracting new payments but its impact on their roles and responsibilities was mediated by their professional skills and experience and the type of practice where they worked. The contribution of practice nursing to the delivery of primary and community health care varies considerably. Further research is required to find out whether role diversity reflects uncertainty about the appropriate use of their skills. FHSAs need to develop a variety of strategies to support and promote practice nursing.     

开展高校社区卫生服务的重要意义和形式内容及具体做法

根据国家医疗保障制度改革的总体目标和要求，高校医院的工作将逐步转向高校的社区卫生服务。认真研究高校社区的特点，及时解决在高校开展社区卫生服务面临的问题，积极探索在高校开展社区卫生服务的形式和内容，自觉进行高校医院结构和职能的双重改造，对全面推进高校的社区卫生服务工作，无疑具有重要的理论意义和实践意义。     

Patients with advanced cancer and family caregivers' knowledge of health and community services: a longitudinal study

The present study examines the knowledge of health and community services reported by patients with advanced cancer and their family caregivers, and compares patient-stated use with their knowledge of availability. A longitudinal study of the quality of life of patients with advanced cancer was conducted out of the cancer services of The Canberra Hospital, a teaching service, in Canberra, Australian Capital Territory, Australia. Some 317 subjects were recruited sequentially, comprising patients (n = 181) and their nominated family caregivers (n = 136). Patients were more aware of the available health and community support services compared with their caregivers, and differences were significant for most allied professional services, as well as some key supportive care institutions and community programmes. Knowledge of community support services was variable and low for those specifically associated with terminal care. While congruence of knowledge for dyads was quite low in some areas, overall household knowledge was high. The identified sources were mainly non-medical. Nurses, social workers and alternative practitioners, as well as family, friends and commercial sources were the main categories which were identified. No statistically significant changes in knowledge or sources of information occurred over time. Further longitudinal research would assist healthcare teams to understand the role of health and community services in the advanced cancer setting. The identification of systemic and regional weaknesses in communication may assist in improving family knowledge and improve timely access to important supports in the advanced cancer setting.     

社区卫生服务机构促进基本公共卫生服务均等化调查分析

目的:了解我国社区卫生服务机构促进基本公共卫生服务均等化实施进展.方法:在2007～2009年由卫生部组织开展连续性监测,采用统一的调查表对全国36个城市(区)所有社区卫生服务机构进行普查.结果:三年来各项基本公共卫生服务量增长迅速,2009年中心和站的服务人口建档率已达68.00%和59.70%;中心和站平均开展孕产妇保健1180.5人次和127.2人次、儿童保健2061.7人次和198.9人次、计划生育服务1334.3人次和272.2人次;中心和站慢性病有效控制率:高血压72.22%和71.15%、糖尿病70.95%和68.36%.结论:社区公共卫生服务体系已基本建立,但在体系支撑、经费投入和人员配置上仍需加强,应建立社区长效发展机制,从制度建设、内涵建设和绩效考核等方面着力提升均等化服务的质量和水平.     

Implementing a national approach to universal child and family health services in Australia: professionals' views of the challenges and opportunities

Australia has a well‐accepted system of universal child and family health (CFH) services. However, government reports and research indicate that these services vary across states and territories, and many children and families do not receive these services. The aim of this paper was to explore professionals' perceptions of the challenges and opportunities in implementing a national approach to universal CFH services across Australia. Qualitative data were collected between July 2010 and April 2011 in the first phase of a three‐phase study designed to investigate the feasibility of implementing a national approach to CFH services in Australia. In total, 161 professionals participated in phase 1 consultations conducted either as discussion groups, teleconferences or through email conversation. Participants came from all Australian states and territories and included 60 CFH nurses, 45 midwives, 15 general practitioners (GPs), 12 practice nurses, 14 allied health professionals, 7 early childhood education specialists, 6 staff from non‐government organisations and 2 Australian government policy advisors. Data were analysed thematically. Participants supported the concept of a universal CFH service, but identified implementation barriers. Key challenges included the absence of a minimum data set and lack of aggregated national data to assist planning and determine outcomes; an inconsistent approach to transfer of information about mothers and newborns from maternity services to CFH nursing services or GPs; poor communication across disciplines and services; issues of access and equity of service delivery; workforce limitations and tensions around role boundaries. Directions for change were identified, including improved electronic data collection and communication systems, reporting of service delivery and outcomes between states and territories, professional collaboration, service co‐location and interprofessional learning and development.     

社区医学学生标准化病人情景模拟实习带教探索

目的:探索在社区医学临床实习中运用学生标准化病人进行情景模拟教学的效果。方法:把在菏泽市4个社区卫生服务中心实习的学生随机分为两组,实验组采用学生标准化病人情景模拟方法教学,对照组采用传统教学模式教学,调查和比较两种方法的教学效果。结果:实验组的患者或居民评价、临床实践综合笔试、实践技能考核分数均高于对照组(P<0.001)。结论:学生标准化病人情景模拟教学方法适合社区医学临床实习教学,教学效果较好。