天津市社区卫生服务中心开展家庭病床服务的SWOT分析

目的 了解天津市18家社区卫生服务中心目前家庭病床开展情况、开展家庭病床的优势和开展过程中所遇到的困难,为天津市今后是否以及如何开展家庭病床提供依据.方法 从医疗卫生服务提供方的角度,采用定性研究的方法,对天津市18家社区卫生服务中心院长进行一对一访谈,采用SWOT分析法进行研究.结果 此次调查的天津市18家社区卫生服务中心院长对目前开展家庭病床的情况满意度均不高.主要表现为居民对家庭病床知晓程度低、人员工作积极性有限、政策制度不完善、人力财力支持不到位和医务人员工作风险大等问题.结论 天津市目前开设家庭病床的情况并不理想,需要从政府政策、医院硬件设施和软件条件以及居民的认知度等方面进行进一步改进和加强.     

Meeting Health Needs Through Kentucky's New Family Resource Centers and Youth Services Centers

ABSTRACT: Family Resource Centers/Youth Services Centers were mandated by law as part of the Kentucky Education Reform Act in response to changing needs of children and their families. These school-based centers provide services to maintain basic necessities for children and their families, enhancing the children's health and their ability to learn. This article describes how centers are developed, funded, staffed, governed, and evaluated as well as what services they provide.     

计划生育优质服务与妇女健康

世界卫生组织(WHO)早在1947年就把健康定位为"不只是没有疾病,而是人们的身体、心理和社会相融性都处于一个良好的状态".生育健康的定义正是基于这一广义的视角,1994年世界卫生组织全球政策理事会,将生殖健康定义为"生殖系统及其功能和过程涉及的一切事宜在身体、心理和社会方面的安好状态,而不仅仅是没有疾病或不适".人发大会进一步解释"生育健康意味着人们能有满意而安全的性生活、有生育能力,并享有决定是否、何时及间隔多久要孩子的自由,为此,人们应有权了解和获得安全、有效、负担得起、及时可接受的生育调节方法,并有权获得使妇女能安全通过妊娠和分娩的保健服务",生育健康是大众健康不可分割的组成部分.     

社区健康服务中心医用灭菌物品下收下送流程管理

目的探讨社区健康服务中心医用灭菌物品下收下送的供应流程,确保医用灭菌物品质量。方法对下收下送车辆、下送护士、领用计划信息和交接换物实施流程化管理。结果医用灭菌物品的质量得到保证,未发生过消毒质量安全问题;对需求供应及时,连续3年下送无差错。结论对下收下送流程适度调整,加强管理,能保证社康中心医用灭菌物品消毒质量和供给,对防范医院感染、保障患者安全起着重要的作用。     

The Impact of Reproductive Health Legislation on Family Planning Clinic Services in Texas

We examined the impact of legislation in Texas that dramatically cut and restricted participation in the state’s family planning program in 2011 using surveys and interviews with leaders at organizations that received family planning funding.Overall, 25% of family planning clinics in Texas closed. In 2011, 71% of organizations widely offered long-acting reversible contraception; in 2012–2013, only 46% did so. Organizations served 54% fewer clients than they had in the previous period. Specialized family planning providers, which were the targets of the legislation, experienced the largest reductions in services, but other agencies were also adversely affected.The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women’s access to family planning services.Publicly funded family planning clinics have been a key component of the health care safety net for low-income women in the United States and will remain essential points of access under the Affordable Care Act.1,2 Title X, the federal program dedicated to family planning, provides crucial infrastructural support for a network of clinics and subsidizes the cost of family planning services for uninsured women. In many states, Medicaid family planning waivers or state plan amendments constitute another source of support, and they reimburse clinics for services provided to eligible women. These programs can help fill gaps in coverage for those who lose other insurance because of changes in income or employment or other life events.3However, the degree to which low-income women can rely on publicly funded providers for subsidized family planning services has become increasingly dependent on policies enacted by state legislatures, which recently have taken on a large role in determining not only the amount of funding that goes to family planning but also the types of organizations that are eligible to receive it. Since 2010, several states have made significant cuts to their family planning budgets, and in 5 states, funding for family planning services was disproportionately reduced relative to other health programs.4 Additionally, since 2011, 16 states have proposed legislation that effectively blocks specialized family planning providers from receiving any public funding such as Title X or bars those that also provide abortion services from receiving funds, including Medicaid.5,6 This legislation may be aimed at defunding entities providing abortion care, such as Planned Parenthood, even though federal dollars cannot be used to pay for abortions in almost all cases.One of the most striking examples of legislation affecting the delivery of publicly funded family planning services took place in Texas, which in 2011 both dramatically cut and restricted participation in the state’s family planning program. We examined the impact of the 2011 legislation on family planning providers in Texas. We have reported on our findings from surveys and in-depth interviews with leaders at organizations across the state that received public funding before the legislation and our analysis of state administrative data. The Texas experience provides valuable insight into the potential effects that legislation proposed in other states may have on low-income women’s access to family planning services.     

西宁、银川两市社区卫生服务提供现状分析

目的通过调查UHPP项目试点市的社区卫生服务机构的服务提供情况来了解其卫生服务发展的实际情况．分析存在的问题，为服务功能的进一步完善及贫困医疗救助的开展提供依据。方法采用定量与定性调查相结合的方法．了解机构的一般情况、人力资源的配置及服务提供等情况。结果服务项目开始朝着社区卫生服务的六大功能方向发展．但项目多少、服务量多少不一，还是以医疗为主。不同机构由于规模、环境及运行状况不同．年服务量差异较大．结论社区卫生服务机构提供的服务内容不断拓展，但机构的功能定位和人员的观念有待加强，需要进一步从医保及医疗服务市场的管理等相关配套政策和资金上支持社区卫生服务的开展，推进双向转诊工作．合理开发和利用健康档案．     

Community and Migrant Health Centers

"Research Reviews" are a regular feature of The Journal of Rural Health, presenting current research about a particular theme or topic of interest     

社区健康服务中心实施家庭医生健康管理服务路径的效果评价

目的评价社区健康服务中心实施家庭医生健康管理服务路径的效果。方法选取我社区健康服务中心2014年1月-2015年12月自愿签约家庭医生服务的高血压、2型糖尿病患者共298例作为研究对象,对其实施家庭医生健康管理服务路径,比较实施前后患者档案完整率、社区就诊率、心理状态、生活质量及对慢性病的认知情况。结果实施后患者档案完整率、社区就诊率分别为88.26%、79.19%,较实施前的76.85%、64.43%明显上升,心理状态和生活质量也显著改善,差异均有统计学意义(P<0.01)。实施后,患者对慢性病的认知情况明显优于实施前(P<0.01)。结论在社区健康服务中心实施家庭医生健康管理服务路径能有效规范管理行为,提高患者认知及生活质量,具有较高的可行性。     

Dental Services for Migrant and Seasonal Farmworkers in US Community/Migrant Health Centers

CONTEXT: Migrant and seasonal farmworkers are recognized as a medically underserved population, yet little information on need, access, and services is available-particularly with regard to oral health care. PURPOSE: This study describes the facilities, services, staffing, and patient characteristics of US dental clinics serving migrant and seasonal farmworkers, and identifies trends and issues that may impede or improve dental care access and service. METHODS: National databases were used to identify community and migrant health centers providing oral health care to migrant and seasonal farmworkers. Mailed surveys collected information on clinic history, operational details, services provided, patient demographics, employment and resource needs, and perceived barriers to care. FINDINGS: Among the 81 respondents (response rate 41%), hours of operation varied from 1 evening a week to more than 40 hours a week; 52% had no evening hours. Almost all the clinics offered preventive, diagnostic, and basic restorative dental services, and roughly two thirds also offered complex restorative services. Patients most frequently sought emergency dental care (44%) followed by basic restorative services (32%) and preventive services (26%). The dentist position was the most difficult to fill, and new funding sources were cited as the most important resource need. Respondents perceived cost of services, lack of transportation, and limited clinic hours as primary barriers to care. CONCLUSIONS: While some barriers to care have been almost universally addressed (eg, language), there is evidence that some impediments remain and may present significant obstacles to a broad improvement in oral health care for migrant and seasonal farmworkers.     

The Role of Community Health Centers in Providing Behavioral Health Care

The prevalence of behavioral health problems is higher for low-income individuals, yet this population is less likely to receive behavioral health treatment. Community health centers have their advantages as behavioral health-care providers because they serve a majority low-income population and are located in medically underserved areas. Their role in providing behavioral health care is expected to expand under health reform as they are expected to double their patient capacity, and due to increased insurance coverage for individuals with behavioral health problems. However, the ability of community health centers to provide behavioral health care is compromised by provider shortages and funding shortfalls.