农村远程医疗开展过程中的问题及对策

分析了开展农村远程医疗中出现的沟通、技术、人才、设备等问题,深入剖析问题根源并提出解决方案,以此为农村远程医疗顺利实施提供依据。     

Technology and managed care: patient benefits of telemedicine in a rural health care network

Rural health providers have looked to telemedicine as a technology to reduce costs. However, virtual access to physicians and specialists may alter patients' demand for face-to-face physician access. We develop a model of service demand under managed care, and apply the model to a telemedicine application in rural Alaska. Provider-imposed delays and patient costs were highly significant predictors of patient contingent choices in a survey of ENT clinic patients. The results suggest that telemedicine increased estimated patient benefits by about $40 per visit, and reduced patients' loss from rationing of access to physicians by about 20%.     

Food insecurity and food choices in rural older adults with diabetes receiving nutrition education via telemedicine

ObjectiveTo evaluate differences between rural older adults with diabetes reporting the presence or absence of food insecurity with respect to meal planning, preparation, shopping, obesity, and glycemic control after receiving nutrition counseling through telemedicine.MethodsFood insecurity data were obtained by telephone survey (n = 74). Group differences for continuous variables were measured by t tests; categorical variables by Pearson chi-square tests.ResultsParticipants reporting mild food insecurity (23%) had higher body mass index (35.5 ± 7.1 kg/m² vs 30.5 ± 6.0 kg/m², P = .01) and lower household incomes (P = .03) and were more likely to consider cost of ingredients in food preparation compared to food-secure participants (P = .03). Most purchased fresh produce (97%) and considered the dietitian's advice when purchasing food. Both groups report similar adherence to dietitians' advice and had similar glycemic control.Conclusions and ImplicationsStrategies to address higher levels of obesity associated with food insecurity are needed.     

远程医学技术的发展与应用

介绍了远程医学技术的发展概况,从某院远程医疗会诊、远程医学教育、远程医疗教学查房、远程手术示教、远程在线考试等方面阐述了远程医学应用模式与实践效果,提出了进一步规范远程医疗会诊流程、完善远程医学相关法律法规、制定继续教育学分政策、提高从业人员素质、加强野战化远程医学应用研究和训练等远程医学发展策略与思考。     

Alcohol consumption among urban, suburban, and rural Veterans Affairs outpatients

Purpose: United States rural residents tend toward poorer health than urban residents. Although alcohol use is associated with multiple medical conditions and can be reduced via brief primary care‐based interventions, it is unknown whether alcohol consumption differs by rurality among primary care patients. We sought to describe alcohol consumption among urban, suburban, and rural Veterans Affairs (VA) outpatients. Methods: Outpatients from 7 VA facilities responded to mailed surveys that included the validated Alcohol Use Disorders Identification Test Consumption (AUDIT‐C) screening questionnaire. The ZIP code approximation of the US Department of Agriculture's rural‐urban commuting area (RUCA) codes classified participants into urban, suburban, and rural areas. For each area, adjusted logistic regression models estimated the prevalence of past‐year abstinence among all participants and unhealthy alcohol use (AUDIT‐C ≥ 3 for women and ≥ 4 for men) among drinkers. Findings: Among 33,883 outpatients, 14,967 (44%) reported abstinence. Among 18,916 drinkers, 8,524 (45%) screened positive for unhealthy alcohol use. The adjusted prevalence of abstinence was lowest in urban residents (43%, 95% CI 42%‐43%) with significantly higher rates in both suburban and rural residents [45% (44%‐46%) and 46% (45%‐47%), respectively]. No significant differences were observed in the adjusted prevalence of unhealthy alcohol use among drinkers. Conclusions: Abstinence is slightly more common among rural and suburban than urban VA outpatients, but unhealthy alcohol use does not vary by rurality. As the VA and other health systems implement evidence‐based care for unhealthy alcohol use, more research is needed to identify whether preventive strategies targeted to high‐risk areas are needed.     

Interpractitioner communication: telephone consultations between rural general practitioners and specialists

ABSTRACT: The results of a study that sought to investigate the utility of and satisfaction with telephone consultations from the perspective of general practitioners and specialists are reported. Semi-structured interviews with rural general practitioners and specialists were used to elicit information about their most recent telephone consultations. The telephone was found to be an important means of communication for rural practitioners, primarily in terms of organising referrals. General practitioners tended to called specialists who they knew and appeared to have fairly well-formed networks of specialists who they called for most of their concerns. Trust is an important element of interpractitioner communication as it increases understanding and confidence in the reliability of the information exchanged. Good working relationships ensure that rural general practitioners have an accessible source of acceptable specialist support.     

Predictors of support service use by rural and regional men with cancer

Objective: The current study examined how sociodemographic, psychological, physical and social support variables predict participation in formal support services. Design: Cross‐sectional study. Setting: Participants were recruited from oncology clinics, cancer specialist clinics and cancer support groups. Participants: Seventy‐six men living outside major Australian cities, the majority with prostate cancer (n = 55). Main outcome measures: Participants completed the Brief Symptom Inventory, the List of Physical Complaints, the Social Support Subscale of the Coping Resources Inventory and questionnaires related to levels of awareness of, and participation in support services. Results: Most (82%) of the men were aware of at least one formal service offering emotional support, and 49% of the men had used such a service. Telephone‐ and Internet‐based services were the most used type of support. The only predictor of participation in a formal service was lower age. Conclusions: Use of a support service was not predicted by psychological or physical symptoms, levels of social support or distance from service centres. Attitudes to different types of services, and support services in general, might be more predictive of actual use. The current findings point to the potential of telephone‐ and Internet‐based support as an acceptable means of formal support for rural and regional men who experience cancer‐related distress.     

农村基层医疗服务双向转诊及影响因素实证研究

目的：定量评价广东省农村基层医疗服务双向转诊的现状并分析其影响因素。方法：构建影响因素的概念框架,通过乡村医生问卷调查和多变量统计回归模型,掌握广东省农村医疗服务转诊特征,探讨影响因素,并结合现实情况分析各环节的相互作用。结果：村卫生站举办模式、统一的转诊标准和规范、村医生的服务能力、村卫生站的硬件建设均对转诊有影响,且村卫生站举办模式与其它因素相互作用。     

Mental health referral role of rural financial counsellors

OBJECTIVE: To quantify the proportion of rural financial counsellors' (RFC) clients requiring social, emotional and stress-related (SESR) assistance and the referral of these clients to other services. DESIGN: Survey of all Australian RFCs. SETTING: Rural and remote agricultural locations in Australia. PARTICIPANTS: Australian RFCs employed over the months of November and December 2004. MAIN OUTCOME MEASURES: The proportion of counsellors' clients who required assistance with SESR problems and the proportion of these who were referred. Counsellors' usual referral networks, rating of referral difficulty and ranking of strategies to improve referrals. RESULTS: Counsellors reported that on average 20% of their clients required SESR assistance and half of the counsellors referred more than 75% of these clients. Referrals were mainly to GPs, mental health teams, personal counselling and health and welfare organisations. Almost half (49%) reported that referrals were difficult because of rural clients' reluctance to acknowledge such problems and use mental health services, as well as the lack of these services. Counsellors were placed in a practical role dilemma when clients raised personal issues that were beyond the counsellors' role but were linked to the financial reason for presentation. Strategies identified to improve referrals were to network with mental health and personal counsellors in the region, training and a referral guide. CONCLUSIONS: Because RFCs are a first contact for rural people in crisis, they could be brought into a local counselling network. This network could improve the process of referrals and build local mental health system capacity.     

新型农村合作医疗病人上转的影响因素及对策研究

文章列举出新型农村合作医疗（简称新农合）病人上转的影响因素：患者的病因及病情、患者家庭经济状况及家庭关系、患者的择医心理状态及医疗广告诱导、当地医疗机构技术水平和就医环境,探讨干预这些因素的基本对策,以控制新农合基金不良支出,达到患者、新农合基金管理机构和当地医疗机构三方和谐的局面,促进新农合工作健康有序地发展。     

Similar secondary stroke prevention and medication persistence rates among rural and urban patients

Purpose: Rural residents are less likely to obtain optimal care for many serious conditions and have poorer health outcomes than those residing in more urban areas. We determined whether rural vs urban residence affected postdischarge medication persistence and 1 year outcomes after stroke. Methods: The Adherence eValuation After Ischemic Stroke‐Longitudinal (AVAIL) study is a multicenter registry of stroke patients enrolled in 101 hospitals nationwide. Medications were recorded at hospital discharge and again after 3 and 12 months. Persistence was defined as continuation of prescribed discharge medications. Participants were categorized as living in rural or urban settings by cross‐referencing home ZIP code with metropolitan statistical area (MSA) designation. Findings: Rural patients were younger, more likely to be white, married, smokers, and less likely to be college graduates. There was no difference in stroke type or working status compared to urban patients, and there were minor differences in comorbid conditions. There were no differences based on rural vs urban residence in medication persistence at 3 or 12 months postdischarge and no differences in outcomes of recurrent stroke or rehospitalization at 12 months. Conclusion: Despite differences in patient characteristics, there was no difference in medication persistence or outcomes between rural and urban dwellers after hospitalization for ischemic stroke or transient ischemic attack (TIA).     

Collaboration and referral practices of general practitioners and community mental health workers in rural and remote Australia

OBJECTIVE: To assess an important part of Australia's National Mental Health Strategy by examining the collaboration and referral practices between general practitioners and community mental health workers in rural and remote areas. DESIGN: Semistructured interviews. SETTING: Rural and remote health service region in Australia. PARTICIPANTS: In total, 31 general practitioners and 14 mental health workers. RESULTS: Meaningful collaboration and referral practices between general practitioners and mental health workers are prevented by contradictory and ambiguous definitions involving professional roles and mental health. A pattern of negative collaboration was further magnified by the rural and remote context. CONCLUSION: The implementation of Australia's National Mental Health Strategy faces serious problems in rural and remote area due to the negative collaboration and referral practices between general practitioners and mental health workers.     

农村高血压患者认知状况及服药依从性分析

目的了解农村地区高血压患者药物治疗的依从性,并探讨其影响因素。方法采用自填式问卷的形式,对正在/曾经服用降压药的378例35～75岁高血压患者进行调查;内容包括一般情况、体格检查、服药依从性、高血压防治知识知晓情况。结果高血压患者药物治疗依从性好者仅45例,占11.90%;依从性好组的2周治疗率42例,占93.33%;在医生指导下规律服药者36例,占80.00%,均明显高于依从性差组(P0.05);378例服药患者高血压防治知识的平均得分为(8.61±4.96)分,其中依从性差组为(8.47±4.96)分,依从性好组为(9.64±4.88)分:依从性好组认为超重、高盐饮食是高血压发生的主要危险因素者所占比例明显高于依从性差组(P0.05)。结论农村高血压患者药物治疗依从性很低,应积极开展健康教育,提高药物治疗依从性和高血压治疗率、控制率。     

农村妇女病患者卫生知识及行为调查分析

目的:了解农村妇女病患者生殖保健知识的普及情况,为有关部门今后进一步开展健康教育工作提供依据。方法:采用随机抽样的方法,对1367名妇女病患者进行生殖保健知识知晓和卫生行为的问卷调查。结果:大部分农村妇女已经养成了良好的卫生习惯,但对妇女保健知识的知晓情况还不够乐观,一些基本的防治知识缺乏,超过三分之一的人未接受过相应的健康教育。结论:应广泛宣传妇女常见病、多发病的防治知识,提高农村妇女的健康水平。     

Internet-based mental health programs: a powerful tool in the rural medical kit

OBJECTIVE: To discuss, using two case examples, the potential utility of Internet-based depression information and automated therapy programs in rural regions. DESIGN: Systematic review of evaluations of two Australian web-based mental health programs: MoodGYM and BluePages Depression Information. SETTING: Community, school, university. PARTICIPANTS: A total of 12 papers and reports derived from nine separate studies of MoodGYM and BluePages involving sample sizes ranging from 78 to 19 607 people. OUTCOME MEASURES: Depressive symptoms, anxiety symptoms, dysfunctional thoughts, depression literacy, stigma, help seeking and cost-effectiveness. RESULTS: Internet-based applications were effective in reducing depressive symptoms and stigmatising attitudes to depression and in improving depression literacy. School-based programs also showed promise in decreasing depressive symptoms. CONCLUSIONS: Depression self-help and information programs can be delivered effectively by means of the Internet. As accessibility of face-to-face mental health services in rural areas is poor and as there is a strong culture of self-reliance and preference for self-managing health problems among rural residents, the Internet might offer an important platform for the delivery of help for depression in rural regions. Consideration should be given to developing programs tailored to rural settings and future research should evaluate the efficacy and effectiveness of such programs in rural settings.