社区卫生服务的预防保健需求及建议

目前为止,国内社区卫生服务需求的调查大多集中于临床医疗方面,对于预防保健方面服务需求的调查报道不多（尤其是对流动人口需求往往被忽略）。搞清社区居民最需要的预防保健项目,对社区卫生工作者针对性地开展工作有着重要的意义。本文分析社区居民对预防保健的需求情况及影响因素,提出公共卫生、预防保健服务在社区进一步发展的建议。     

关于举办第六届全军保健医学学术研讨会暨保健医学进展学习班的通知

为加强干部保健队伍建设,不断提高医疗保健工作质量和服务水平,更新知识,从临床实用和提高出发,拟于2009年9月在天津举办全军保健医学学术研讨会暨保健医学进展学习班。届时将邀请军内外著名保健医学及老年医学专家作专题授课,同时进行保健医学学术交流。主要内容包括中老年常见病的诊治及临床基础、预防保健、疗养康复、心理及护理等方面的研究     

保健与康复：全科医学在社区卫生保健中的地位

全科医学理论源于社区医疗实践,是近三十年发展起来的一个初级保健领域内的新学科。全科医学以现代生物心理社会医学模式为基础,以病人为中心,以家庭为单位,以社区为范围,集医疗、预防、保健、康复为一体的全方位医疗保健服务为特点,提供连续的、协调的、综合的医疗服务。     

2017—2019年北京市西城区3~6岁儿童 患龋情况调查分析

摘 要：目的：了解柳州市基层孕产妇保健服务需求和满意度,为卫生行政部门制定相关政策提供参考依据。方法： 2019年8月—12月采用方便抽样方法抽取在柳州市社区卫生服务中心和乡镇卫生院就诊的孕妇进行基层医疗机构孕产妇保健 服务需求和满意度情况问卷调查。结果：此次调查共发放问卷580份,收回有效问卷553份。孕妇最需要的孕期保健知识为 胎教、常见妊娠并发症的预防、分娩方式的选择和孕期心理保健,最需要的产后知识为产后心理保健、婴儿护理、产后康复 和科学做月子;对基层医疗保健机构孕产保健人员服务态度和技术水平满意度分别为76.7%和68.4%;91.7%的孕妇认为所在 社区卫生服务中心和卫生院提供的孕产保健服务是可以满足其需求的。结论：孕妇对基层孕产妇保健服务需求较全面,柳州 市基层医疗保健机构应进一步提高孕产保健人员技术水平,为孕产妇提供更高质量的孕产保健服务。     

开展社区预防保健护理的影响因素调查

目的探讨社区卫生服务中开展预防保健护理的影响因素及对策。方法采用随机抽样方法选取全县13间社区卫生院、152间社区卫生站、2间县城综合性医院、2间专科医院,对其展开调查,分析预防保健护理工作开展中的阻碍因素,并制定针对性干预措施。结果加强预防保健护理管理工作后,预防保健经费短缺、预防保健护理开展可行性、社区护士综合素质、社区居民健康意识差等问题得到了明显的改善,差异有统计学意义(p>0.05)。结论针对社区卫生服务中预防保健护理工作开展的影响因素,制定针对性的解决方案,能够改善资金短缺等状况,提高可行性,为完善社区医疗服务、保障居民健康提供强有力的保障。     

柳州市基层孕产妇保健服务需求和满意度调查

目的:了解柳州市基层孕产妇保健服务需求和满意度,为卫生行政部门制定相关政策提供参考依据。方法:2019年8月—12月采用方便抽样方法抽取在柳州市社区卫生服务中心和乡镇卫生院就诊的孕妇进行基层医疗机构孕产妇保健服务需求和满意度情况问卷调查。结果:此次调查共发放问卷580份,收回有效问卷553份。孕妇最需要的孕期保健知识为胎教、常见妊娠并发症的预防、分娩方式的选择和孕期心理保健,最需要的产后知识为产后心理保健、婴儿护理、产后康复和科学做月子;对基层医疗保健机构孕产保健人员服务态度和技术水平满意度分别为76.7%和68.4%;91.7%的孕妇认为所在社区卫生服务中心和卫生院提供的孕产保健服务是可以满足其需求的。结论:孕妇对基层孕产妇保健服务需求较全面,柳州市基层医疗保健机构应进一步提高孕产保健人员技术水平,为孕产妇提供更高质量的孕产保健服务。     

嘉定区基层医疗机构预防保健人力资源现状分析

目的对嘉定区基层医疗机构预防保健人力资源现状进行调查分析。方法对基层医疗机构预防保健人员数量、分布、学历、职称等方面进行调查并综合分析。结果基层医疗机构预防保健人员数量、学历结构、职称结构分布不平衡。结论嘉定区基层医疗机构对年轻、高素质预防保健人才有较大需求,应对在职人员开展有针对性的医学继续教育和项目培训等,以提高专业素质。     

广州地区大学生心理保健需求现状分析

为了在大学生中更有针对性的开展心理健康教育和心理咨询活动,普及心理保健知识,对广州市两所高校925名大学生的心理保健需求情况进行了调查.结果表明,大学生中的57.51%认为很需要心理保健,93.33%对心理保健方面的知识了解不多,62人认为自己目前存在较严重的心理问题,女大学生对心理保健的认识和需求均明显高于男大学生,男性更倾向于将心理问题藏在心里.不同年级和专业学生在心理困扰问题上都存在明显差异.可见对在校大学生普遍开展心理健康教育十分必要,同时应注意对不同年级不同专业学生的各自心理问题有所侧重.     

广州地区大学生心理保健需求现状分析

为了在大学生中更有针对性的开展心理健康教育和心理咨询活动，普及心理保健知识，对广州市两所高校９２５名大学生的心理保健需求情况进行了调查。结果表明，大学生中的５７．５１％认为很需要心理保健，９３．３３％对心理保健方面的知识了解不多，６２人认为自己目前存在较严重的心理问题，女大学生对心理保健的认识和需求均明显高于男大学生，男性更倾向于将心理问题藏在心里，不同年级和专业学生在心理困扰问题上都存在明显差异     

浅议护理适应21世纪保健需求的策略

我们针对保健护理所面临的任务，提出护理应该从思想观念、人才培训及机构及设施方面进行改进，以更好地适应２１世纪的保健需求。通过对护理发展进程的问题，认识到预防疾病和促进健康已经成为护理的主要职能之一，并结合我国的实际情况，提出重视公共卫生护士的培训是实现初级卫生保健的关键，设立和发展相应的护理机构是解决老龄人口、慢性病人保健需求的组织保证。     

城镇居民基本医疗保险制度对医疗及预防保健服务利用的影响研究

目的:研究城镇居民基本医疗保险制度对居民医疗和预防保健服务利用的影响,定量评估城镇居民基本医疗保险制度的实施效果。方法:采用中国健康与营养调查(CHNS)2006年和2011年参加城镇居民基本医疗保险制度数据,以2011年未参保居民为对照组,以2011年参保居民为处理组。通过倍差法(DID模型)和Probit模型比较两组在城镇居民基本医疗保险制度实施前(2006年)和实施后(2011年)的医疗和预防保健服务利用情况和差异。结果:参加城镇居民基本医疗保险制度的城镇居民医疗和预防保健服务的利用情况均高于未参保的城镇居民。年龄、教育程度、家庭人均年收入和有无高血压对城镇居民医疗服务的利用情况有影响,其中家庭人均年收入为保护因素。年龄和教育程度对城镇居民预防保健服务的利用有影响。结论:城镇居民基本医疗保险制度对医疗和预防保健服务利用有提升作用,在完成覆盖率的同时,需要不断增强人均收入对医疗卫生服务利用的保护作用。     

Educating doctors to provide counseling and preventive care: turning 20th century professional values head over heels

Internationally, 20th century medical education concentrated on equipping new graduates with technical skills and pushing the frontiers of technological sciences to extend and enhance life in ways unimaginable in previous decades. In the 21st century, health services are expected to be characterized not by the "fix-up-when-things-go-wrong" type of care that 20th century physicians have become so good at, but by preventive care that can obviate much of the need for these fix-up services. Enabling doctors to deal with the different health care needs of future patients will require a values shift in medical education. The United States leads the world in per capita health care expenditure yet trails in many important measures of health status. It epitomizes many elements of both the good and the bad in current medical education that may be less obvious in other countries that are less wealthy, less technologically oriented, and less committed to individual freedoms. In this paper we use the US as a case study to argue the need for a fundamental shift in values away from the 20th century emphasis on disease, specialization and treatment, and towards health, generalization and prevention. We draw on data from the National Ambulatory Medical Care Survey to compare roles of primary care physicians and other office-based medical specialties in delivering preventive health care. We also estimate the cost of providing preventive care in terms of physician time. Finally, we contemplate how medical education values must change in the US and other countries if 21st century physicians are to be prepared to meet the health care needs of their communities.     

Electronic medical records and prevention quality: the prevention index

BACKGROUND: The Prevention Index is a methodology for using electronic medical records to identify and evaluate practice variations in the delivery of preventive care. METHODS: The Prevention Index was used to evaluate the provision of 10 recommended adult preventive services using electronic medical record data for the years 1999 through 2002 among the 450,000 members of a large Northwest integrated care system. The analyses were conducted in 2005. The Prevention Index determines the proportion of person-time that is covered using consensus guidelines as a standard of care. It is analyzed at the population level and produces quality measures at the individual, practice, clinic, and system levels. The Prevention Index also removes diagnostic services in evaluating preventive care. RESULTS: Overall, about 47% of recommended person-time was actually covered by the services in 2002. For nine services with care guidelines, the percent of covered person-time ranged from 19% for chlamydia screening to 80% for blood pressure screening. The percent of recommended person-time covered by these preventive services varied widely across clinical practices. From 17% to 53% of preventive screening tests were delivered for non-screening purposes. CONCLUSIONS: There are wide variations across clinical practices in the adherence to standard prevention guidelines, and also wide variations across different recommended clinical services. The Prevention Index methodology may allow the identification of the source of these variations, allowing system corrections and other remedial actions to be applied precisely and efficiently.     

Trends in quality during medical home transformation

PURPOSE We describe changes over time in performance on measures of technical quality and patient experience as a group of primary care clinics transformed themselves into level III patient-centered medical homes. METHODS A group of 21 Minnesota primary care clinics achieving level III recognition as medical homes by the National Committee for Quality Assurance has been tracking a variety of quality and patient satisfaction measures for years. We analyzed trends in these measures and compared them with those of other medical groups in the community to estimate what we might expect as other primary care sites gear up to achieve medical home status. RESULTS The clinics in this group achieved a 1% to 3% increase per year in patient satisfaction and a 2% to 7% increase per year in performance on quality measures for diabetes, coronary artery disease, preventive services, and generic medication use. When compared with the average for other medical groups in the region, the rates of increase were greater for satisfaction, but similar for the quality measures. CONCLUSIONS Achieving medical home recognition was associated with improvements in quality and patient satisfaction for these clinics, but the rate of improvement is slow and does not always exceed levels in the surrounding community in Minnesota (which are also improving). Expectations for large and rapid change are probably unrealistic.     

Preventive health patient education and counseling: a role for medical assistants?

Collaborative office-based team approaches may provide a unique means to increase the low rates of preventive services delivery. This study aimed to assess what role medical assistants may have in the delivery of preventive services to patients. A 35-item questionnaire was mailed to 402 medical assistants living in Maryland in July 2005. The questionnaire assessed current levels of preventive service delivery, attitudes toward patient education, and willingness to educate patients. A total of 281 surveys were returned for a response rate of 71%. Study findings revealed that a fair amount of preventive services delivery was already being delivered in health care settings by medical assistants. Medical assistants were more likely to discuss diet/nutrition and exercise with patients. Findings also highlight that medical assistants held positive beliefs about educating patients and nearly all respondents (90%) were willing to deliver preventive services. Given the increased presence of medical assistants in the health care setting, it may be feasible to delegate some preventive care delivery to this willing team member. Future research needs to explore how to better incorporate and delegate preventive health care delivery in medical settings.     

江苏省居民医疗保健支出的实证分析

随着经济发展和生活水平的提高,人们对健康的关注逐步增强。从江苏省的发展现状来看,居民人均医疗保健支出逐年增加,医疗保健支出占消费性支出的比重不断提高。本文研究表明,人均收入水平、教育水平以及医疗服务水平对江苏省居民医疗保健支出有显著影响,而新型农村合作医疗对于解决农村居民的医疗需求更具成效性和必需性。为进一步提高居民总体的健康水平,江苏省应进一步提高居民收入水平;继续推行教育的普及化,切实提高全民教育水平;完善公共医疗服务设施,提高医疗服务水平;进一步推进农村合作医疗体制建设,提高农村医疗保障水平。     

Developing a computerized ambulatory medical record to document health promotion and disease prevention activities during the clinic encounter

The authors believe that the computerized medical record may enhance physician-delivered preventive services by providing timely individual feedback. Additionally, we note that interest in health promotion and disease prevention in the medical community as well as the general population has been increasing during the last decade. In response to this increased interest, we believe that health promotion and disease prevention activities should be conducted by every clinician and should include basic measures such as immunizations, appropriate screening tests, and advice and counseling about lifestyle. Additional investigation into the use of computers and computer-generated reminders to enhance the delivery of preventive services is needed.     

基于Kano模型的互联网医院患者就医服务需求分析

目的调查分析互联网医院患者就医服务需求,探讨服务质量改进措施。方法自行设计基于Kano模型互联网医院患者就医服务需求调查问卷,对某院线上和线下就诊患者进行问卷调查,运用Kano分析法对服务需求进行分类,根据满意度影响力矩阵分析提出改进措施。结果诊前、诊中、诊后三个维度下的互联网医院19个服务项目中,基本属性6个,期望属性7个,魅力属性6个。影响力矩阵分析显示,1个项目归属于提升服务标准区,7个项目归属于创新服务项目区,5个项目归属于维系服务质量区,6个项目归属于提升服务质量区。结论Kano模型的科学应用,可优化互联网医院就诊流程,提高患者就医满意度和医院工作效率,助力医疗服务质量提升。     

Advent of occupational health services research

After lagging behind health services research in general health care, research is now examining health services provided to workers suffering occupational injuries and illnesses. The National Institute for Occupational Safety and Health, the Robert Wood Johnson Foundation Workers' Compensation Health Initiative, the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality), and the Canadian Institute for Work and Health co-sponsored a June, 1999, conference to explore research needs in this area. Fundamental tenets for advancing occupational health services research include: adopting the goal of improving occupational health care, including better integration of preventive and curative care; creating standardized interstate occupational health care data sets that include medical, economic, and patient perspectives; better defining quality in occupational care and developing appropriate performance measures; in addition to medical costs, assessing social, economic, medical and functional outcomes of care; considering the connections between work and health, including general health services; and addressing the need to train qualified occupational health services researchers. Am. J. Ind. Med. 40:291-294, 2001. Published 2001 Wiley-Liss, Inc.     

城市社区医疗预防保健人员知识与技能的需求调查

通过对405名城市基层医疗预防保健人员的知识和技能的需求调查看出,面对医学模式的转变,社区居民医疗预防保健需求的不断增长,他们现有的知识和技能已极不适应。2/3以上的人员认为以往所学的知识不够用,较普遍地要求增加预防医学、临床医学等课程的学习,提高疾病诊断、群众工作、组织交往、科研的能力。调查为基层在职医学教育提供了参考依据。