社区家庭护理服务内容的探讨

目的探讨社区家庭护理(CHC)服务的内容。方法选择深圳市20家社康中心,抽取20名专家实施两轮针对CHC方面的问卷咨询。另选取社区护士120名,全科医生108名以评测量表对其开展CHC服务内容和工作情况的调查。结果 CHC基本服务项目总计31项:可拓展的服务项目主要是一次性导尿和导尿管更换,以及二期以上的压疮护理等;不适合提供的服务项目有替代疗法、静脉高营养的护理、气管切开的护理、B超检查以及性功能改变的调试指导等。社区护士组在基础护理和社区保健方面的工作比例,显著高于全科医生组,而在社区预防和社区康复等方面则显著低于全科医生组,差异均有统计学意义(P均<0.05)。结论 CHC已取得一些进展,但仍需明确职责,规范实施,以最佳水平服务社区人群。     

社区护理人员服务内容及有效工时研究

对社区护理人员l周服务量及服务内容的调查分析表明，社区护理服务以家庭护理、输液、常规体检、注射、各种治疗为主，预防保健、康复、健康教育服务量不足。社区护理人员的实际服务时间占有效工作时间的60．4％．工作时间内闲置时间较长。建议转变社区护理职能，加强居民预防保健、健康教育服务，完善社区护理内容，规范社区护理服务，提高工作效率和质量，促进社区护理健康持续发展。     

中国与澳大利亚社区护理内容比较及借鉴

社区护理是指由护理学和公共卫生学理论综合而成的．并以促进和维护人群健康,提供连续性的、动态的、全科性的服务。社区护理是社区卫生服务工作的重要内容之一．随着人们对健康需求的提高,给社区护理工作带来了新的挑战。社区护士的服务对象是社区的每一个人、团体和家庭,担负着社区群体保健工作,如保健咨询、预防保健、康复指导以及妇幼儿童少年、成人、     

对社区护理服务的调查

随着社会经济的发展和人民生活水平提高,社区卫生服务势在必行。城市居民80％以上的医疗问题应在社区解决。所以,社区护理将成为21世纪护理发展的方向。为了提高我国社区服务水平,我们设计了此研究,对目前从事社区的护理人员和社区居民对社区卫生服务的宗旨、内涵和服务内容、社区护士角色等进行调查,现将调查结果介绍如下。     

社区护理服务进入市场的趋势和基本策略探讨

1 社区护理服务进入市场的必然趋势1.1 社区护理服务进入市场是经济体制改革的必然 当前,我国的经济体制改革处于攻坚阶段,正从传统的计划经济体制向社会主义市场经济体制转变。社区卫生服务体制必须适应市场经济体制的要求。市场经济是由市场供求关系和价格变动进行调节的商品经济。市场是商品或劳务等的供给与有支付能力需求间的关系。社区护理服务是为满足广大人民群众的健康需求而向社会提供的技术劳务性服务。社区护理     

开展社区家庭护理的探讨

随着医学模式由单纯生物医学模式向生物心理——社会医学模式的转变，人们已不满足医院里精确的生物学诊断和治疗，他们更需要得到以整体护理为指导的社区家庭护理，走出医院为不同层次不同需求的群众服务，越来越得到大家的欢迎。我院自1999年9月成立社区服务中心以来，服务对象已达2335人。社会效益和经济效益不断提高，现将具体情况介绍如下：     

社区家庭护理中心项目计划和实施的探讨

随着社会人口急剧老龄化、疾病谱改变以及医疗体制改革的深化，公众特别是老年人期待更经济、便利和有效的社区家庭护理服务。建立社区家庭护理中心，充分发挥社区护士的多重作用成为发展社区护理、完善社区卫生服务功能的必然趋势；也是达到满足公众基本医疗和护理需求、提高其健康水平和生活质量、合理使用有限卫生资源的重要途径。本文将就社区家庭护理中心项目的计划和实施作一探讨。     

社区居民对社区护理服务满意度调查

目的探讨社区居民对社区护理服务的满意度及其影响因素。方法采用自行设计并在专家指导和查阅相关文献、预调查的基础上进行修改后确定正式的问卷进行调查,选择Epidata3.0软件进行数据双录入以保证数据的质量,采用SPSS13.0统计软件进行统计描述与分析。结果不同的满意度项目分布不同,其中服务态度很满意率最高(21.83%),各项较满意率均较高,其中>50%的有6项。将研究考虑因素进行多因素Logistic回归分析显示,有意义的因素主要为年龄、熟悉程度、家庭访问和工作年限。结论不断了解居民对社区护理服务的需求,积极改善社区护理服务质量,将有助于发挥社区护理服务在社区医疗中的作用。     

社区护理服务分析

目的：为了探讨合理的社区卫生服务的医比和适宜护项目。方法：采用任务分析法＋专家咨询＋社会学方法＋文献复习相结合。结果：依照医疗咨询等耗时1105分钟，测血压等耗时141．5分钟，护理输液等耗时493．5分钟，肌肉注射耗时44．5分钟，采血耗时77．5分等结果，医护比依情况不同分别为3．18：1、0．94：1、2．02：1。并对国内已开展护理项目作比较分析，并结合实际，提出社区应开展的护理服务项目的建议。结论：这一项研究结果对卫生行政部门及医疗机构有参考价值。     

社区护理服务对社区慢性病管理的意义

社区医院能够为各级医院提供良好的职能补充,对慢性非传染性疾病的预防和控制,具有积极的推进作用.综合护理干预强调以基础护理工作为前提,通过多种护理干预方法,为慢性疾病患者提供更为全面的诊疗服务.本研究随机选取所在社区医院2013年2月至2015年11月登记的200例慢性疾病老年患者作为研究对象,分析社区护理服务的应用效果,现详细总结如下.     

人口老龄化背景下西部城市社区居家养老现状及养老服务需求的调查分析

目的：了解西部城市老年居民的养老现状及养老服务需求,为政府进行合理的服务供给提供参考依据。方法：对重庆市渝中区6个社区180名老人进行问卷调查。结果：社区目前所提供的养老服务与老人实际需要的服务项目在供需之间存在着一定差距,老年人对社区养老服务的整体满意度不高。结论：政府及相关部门应加大经费投入和统筹规划、加大宣传力度,同时不断完善和丰富养老服务内容,以促进社区居家养老模式的良性发展。     

某市社区护理服务运行现状分析及建议

目的 了解北京市社区护理服务运行现状,为构建新型社区护理服务管理体系提供参考.方法 从动力机制、整合机制、激励机制、控制机制、保障机制等5方面,对北京市2所医院、4所社区卫生服务中心、1家社区卫生服务站、2家社管中心及1家医管中心的10名社区管理者进行半结构焦点团体访谈.结果 社区护理动力机制不足,护理整合机制尚需完善,激励机制不足,三级质量控制机制不完善,护理安全保障机制缺乏.结论 政府积极改变社区卫生投入方式,以科学投入保证社区卫生服务绩效和政府资金绩效;相关部门完善护理整合机制,加大激励幅度,建立健全三级质量控制机制,建立护理安全保障机制等.     

基本公共社区卫生服务项目界定原则的研究

社区公共卫生服务项目的界定将有利于社区公共卫生服务补偿政策的建立和完善，有利于社区公共卫生服务与城镇职工基本医疗保险相配套、保障基本医疗和基本卫生服务，有利于社区公共卫生服务的可持续发展。界定基本社区公共卫生服务范围是个比较复杂的命题，不同国家或地区的基本卫生服务的范围因各国或地区的具体情况不同而有所差别，但界定时所运用的标准或原则还是基本一致的。同时结舍我国的基本国情和卫生事业发展的实际情况提出了基本社区公共卫生服务项目和服务包界定的依据。     

Association Between Clinician Specialization in Nursing Home Care and Nursing Home Clinical Quality Scores

ImportanceWhile the number of prescribing clinicians (physicians and nurse practitioners) who provide any nursing home care remained stable over the past decade, the number of clinicians who focus their practice exclusively on nursing home care has increased by over 30%.ObjectivesTo measure the association between regional trends in clinician specialization in nursing home care and nursing home quality.DesignRetrospective cross-sectional study.Setting and ParticipantsPatients treated in 15,636 nursing homes in 305 US hospital referral regions between 2013 and 2016.MeasuresClinician specialization in nursing home care for 2012–2015 was measured using Medicare fee-for-service billings. Nursing home specialists were defined as generalist physicians (internal medicine, family medicine, geriatrics, and general practice) or advanced practitioners (nurse practitioners and physician assistants) with at least 90% of their billings for care in nursing homes. The number of clinicians was aggregated at the hospital referral region level and divided by the number of occupied Medicare-certified nursing home beds. Nursing Home Compare quality measure scores for 2013–2016 were aggregated at the HHR level, weighted by occupied beds in each nursing home in the hospital referral region. We measured the association between the number of nursing home specialists per 1000 beds and the clinical quality measure scores in the subsequent year using linear regression.ResultsAn increase in nursing home specialists per 1000 occupied beds in a region was associated with lower use of long-stay antipsychotic medications and indwelling bladder catheters, higher prevalence of depressive symptoms, and was not associated with urinary tract infections, use of restraints, or short-stay antipsychotic use.Conclusions and ImplicationsHigher prevalence of nursing home specialists was associated with regional improvements in 2 of 6 quality measures. Future studies should evaluate whether concentrating patient care among clinicians who specialize in nursing home practice improves outcomes for individual patients. The current findings suggest that prescribing clinicians play an important role in nursing home care quality.     

Adverse Drug Reaction Monitoring in Mississippi Home Mealth Care Agencies

A statewide survey of home health care agency directors in Mississippi was conducted to determine the extent of Adverse Drug Reaction (ADR) monitoring and reporting by health care professionals. A 24-item questionnaire was sent to agency directors eliciting responses on agency characteristics, rate of occurrence of ADRs, and attitudes toward responsibility for monitoring ADRs. A total of 77 questionnaires were returned yielding a response rate of 48%. The average program enrolled 104 patients with 3.5 ADRs reported by health care professionals per year (range 0-65). Agency directors reported that physicians, nurses, pharmacists, and members of the pharmacy and therapeutics committee should monitor ADRs. Results indicated a need for all health-care professional involved in home health care to increase their ADR monitoring and reporting activities.     

互联网医疗在社区的需求探讨

目的 通过调查了解及分析居民和医护人员对互联网医疗的应用和需求情况,为合理开发互联网医疗社区层面平台提供数据支撑.方法 选择北京市房山区某8家社区卫生服务中心针对就诊居民和医护人员开展问卷调查,居民和医护人员各发放100份问卷.结果 居民接触过的互联网需求排序前5位:预约挂号,档案查询、化验,健康科普,家医签约,信息查...     

The Association of Long-Term Opioid Use With Health Care and Home Care Service Use Among Aged Home Care Clients

ObjectivesTo compare health care and home care service utilization, mortality, and long-term care admissions between long-term opioid users and nonusers among aged home care clients.DesignA retrospective cohort study based on the Resident Assessment Instrument–Home Care (RAI-HC) assessments and electronic medical records.Setting and ParticipantsThe study sample included all regular home care clients aged ≥65 years (n = 2475), of whom 220 were long-term opioid users, in one city in Finland (population base 222,000 inhabitants).MethodsHealth care utilization, mortality, and long-term care admissions over a 1-year follow-up were recorded from electronic medical records, and home care service use from the RAI-HC. Negative binomial and multivariable logistic regression, adjusted for several socioeconomic and health characteristics, were used to analyze the associations between opioid use and health and home care service use.ResultsCompared with nonusers, long-term opioid users had more outpatient consultations (incidence rate ratio 1.26; 95% CI 1.08−1.48), home visits (1.23; 1.01−1.49), phone contacts (1.38; 1.13−1.68), and consultations without a patient attending a practice (1.22; 1.04−1.43) after adjustments. A greater proportion of long-term opioid users than nonusers had at least 1 hospitalization (49% vs 41%) but the number of inpatient days did not differ after adjustments. The home care nurses’ median work hours per week were 4.3 (Q₁-Q₃ 1.5−7.7) among opioid users and 2.8 (1.0−6.1) among nonusers. Mortality and long-term care admissions were not associated with opioid use.Conclusions and ImplicationsLong-term opioid use in home care clients is associated with increased health care utilization regardless of the severity of pain and other sociodemographic and health characteristics. This may indicate the inability of health care organizations to produce alternative treatment strategies for pain management when opioids do not meet patients’ needs. The exact reasons for opioid users’ greater health care utilization should be examined in future.     

成都市社区卫生服务发展成果分析

目的分析和总结成都市2003-2008年间社区卫生服务工作发展状况,为以后工作的开展提供参考及建议。方法采取文献法和问卷调查法相结合的方式,分析社区卫生服务机构在人力资源、硬件条件、工作量等方面取得的进展及成果。结果成都市社区卫生服务工作在6年间取得了较快较好的发展,各方面成绩显著。结论成都市社区卫生服务工作的发展机遇与挑战并存,需不断加强和完善,使其更好的为居民健康服务。     

Impact of Prior Home Care on Length of Stay in Residential Care for Australians With Dementia

ObjectivesTo assess the impact of home care on length-of-stay within residential care.DesignA retrospective observational data-linkage study.Setting and ParticipantsIn total there were 3151 participants from the 45 and Up Study in New South Wales, Australia with dementia who entered residential care between 2010 and 2014.MethodsSurvey data collected from 2006‒2009 were linked to administrative data for 2006‒2016. The highest level of home care a person accessed prior to residential care was defined as no home care, home support, low-level home care, and high-level home care. Multinomial logistic regression and Cox proportional hazards were used to investigate differences in activities of daily living, behavioral, and complex healthcare scales at entering residential care; and length-of-stay in residential care.ResultsPeople with prior high-level home care entered residential care needing higher assistance compared with the no home care group: activities of daily living [odds ratio (OR) 3.41, 95% confidence interval (CI) 2.14‒5.44], behavior (OR 2.61, 95% CI 1.69‒4.03), and complex healthcare (OR 2.02, 95% CI 1.06‒3.84). They had a higher death rate, meaning shorter length-of-stay in residential care (<2 years after entry: hazard ratio 1.12; 95% CI 0.89‒1.42; 2-4 years: hazard ratio 1.49; 95% CI 1.01‒2.21). Those using low-level home care were less likely to enter residential care needing high assistance compared to the no home care group (activities of daily living: OR 0.61, 95% CI 0.45‒0.81; behavioral: OR 0.72, 95% CI 0.54‒0.95; complex healthcare: OR 0.51, 95% CI 0.33‒0.77). There was no difference between the home support and no home care groups.ConclusionsHigh-level home care prior to residential care may help those with dementia stay at home for longer, but the low-level care group entered residential care at low assistance levels, possibly signaling lack of informal care and barriers in accessing higher-level home care.ImplicationsBetter transition options from low-level home care, including more timely availability of high-level care packages, may help people with dementia remain at home longer.