全科医生执业方式和服务模式改革试点启动会议暨第一次工作会议召开

日前,在全科医生执业方式和服务模式改革试点启动会议暨第一次工作会议上,国务院医改办相关负责人指出,全科医生执业方式和服务模式改革试点地区要按照"6+X"的推进思路,把试点工作抓紧、抓好、抓出成效。会议指出,开展全科医生执业方式和服务模式改革试点,是建立全科医生制度中的一项重大改革措施和制度创新。各试点地区要做好6项改革探索,即组建分工合作的     

全科医生执业及服务方式的国际经验与启示

本文比较了部分典型国家和地区全科医生的执业及服务方式,发现全科医生执业以自雇为主、多种雇佣形式并存;以自由多点执业为主、固定执业为补充;服务方式从单独服务向跨专业联合团队服务过渡。启示:全科医生自由多点执业需要一定的社会环境和条件,组建跨专业的联合团队正在成为全科医生服务方式的发展方向,不同卫生体制国家全科医生在建立转诊制度中的作用不同。建议:创造多元、宽松的执业环境,为全科医生执业方式转变提供条件;加强多学科服务团队建设,推动全科医学服务方式在社区的转变;通过医保基金调控,逐步建立"守门人"制度,实现分级诊疗;鼓励社会力量举办全科医学服务机构,促进健康服务产业发展。     

2020年要初步建立全科医生制度

近日,国务院下发了《关于建立全科医生制度的指导意见》,提出到2020年,在我国初步建立起充满生机和活力的全科医生制度,基本形成统一规范的全科医生培养模式和“首诊在基层”的服务模式,全科医生与城乡居民基本建立比较稳定的服务关系,基本实现城乡每万名居民有2～3名合格的全科医生,全科医生服务水平全面提高,     

综合信息

<正>我国建立全科医生制度。国务院总理温家宝6月22日主持召开国务院常务会议,决定建立全科医生制度。会议指出,全科医生是综合程度较高的医学人才,主要在基层承担预防保健、常见病多发病诊疗和转诊、病人康复和慢性病管理、健康管理等一体化服务,被称为居民健康的"守门人"。目前,     

如何与“全科医生”接轨？

焦点一：全科医生怎样培养？ 陈社新：国务院最近下发了《关于建立全科医生制度的指导意见》,提出到2020年要在我国初步建立充满生机和活力的全科医生制度。一是基本形成统一规范的全科医生培养模式和“首诊在基层”的服务模式;二是基本实现城乡每万居民有2～3名合格的全科医生,全科医生服务水平全面提高;     

成都市全科医生服务方式及培训需求定性研究

目的:探讨成都市全科医生服务和培训模式.方法:通过立意抽样与方便抽样相结合,采用参与式观察法与个别深入访谈法对成都市3个区4个社区卫生服务中心的全科医生进行调查.结果:目前全科医生以门诊和家庭访视为主,不同资质的全科医生承担的主要工作内容有所不同.全科医学培训的形式有高等学校学历教育和全科医师转岗培训,部分全科医生未参加任何形式的培训.结论:各中心可在现有社区卫生人力资源基础上,建立以接受了全科医生转岗培训的主治及以上职称的医生为组长、退休医生为顾问、初级职称为后备的全科医生服务团队,构建服务、培训一体化的模式     

建立全科医生制度值得期待

6月22日召开的国务院常务会议上,为全科医生制度的建立和发展提出了目标,2012年,全国每个城市社区卫生服务机构和农村乡镇卫生院,都将有合格的全科医生。再经过几年努力,基本形成统一规范的全科医生培养模式和首诊在基层的服务模式,基本实现城乡每万名居民有2至3名合格的全科医生,更好地为群众提供连续协调、方便可及的基本医疗卫生服务。计划到2020年争取通过多种途径培养30万名全科医。     

建立全科医生制度值得期待

6月22日召开的国务院常务会议上,为全科医生制度的建立和发展提出了目标,2012年,全国每个城市社区卫生服务机构和农村乡镇卫生院,都将有合格的全科医生。再经过几年努力,基本形成统一规范的全科医生培养模式和首诊在基层的服务模式,基本实现城乡每万名居民有2至3名合格的全科医生。     

国务院发布关于建立全科医生制度的指导意见

国务院近日发布了建立全科医生制度的指导意见。指导意见指出,将逐步建立统一规范的全科医生培养制度,到2020年,基本实现城乡每万名居民有2至3名合格的全科医生,全科医生服务水平全面提高,基本适应人民群众基本医疗卫生服务需求。     

确保“首诊在基层”

7月7日,《国务院关于建立全科医生制度的指导意见》出台。《指导意见》明确提出：到2012年,使每个城市社区卫生服务机构和农村乡镇卫生院都有合格的全科医生;再经过几年努力,基本形成统一规范的全科医生培养模式和首诊在基层的服务模式;到2020年,我国将初步建立起充满生机和活力的全科医生制度,基本实现城乡每万名居民有2～3名合格的全科医生     

Informal care and health care use of older adults

Informal care by adult children is a common form of long-term care for older adults and can reduce medical expenditures if it substitutes for formal care. We address how informal care by all children affects formal care, which is critically important given demographic trends and the many policies proposed to promote informal care. We examine the 1998 Health and Retirement Survey (HRS) and 1995 Asset and Health Dynamics Among the Oldest-Old Panel Survey (AHEAD) using two-part utilization models. Instrumental variables (IV) estimation controls for the simultaneity of informal and formal care. Informal care reduces home health care use and delays nursing home entry.     

互补还是替代：家庭照料与社区居家养老服务

文章使用国家卫生健康委2014年开展的中国计划生育家庭发展追踪调查数据,采用Probit模型和工具变量方法,实证检验家庭老年照料与社区上门生活护理服务和社区上门医疗服务之间的关系。研究发现：（1）家庭照料会显著减少老年人使用社区上门生活护理服务的概率,二者呈替代关系,但是在高龄和中、重度失能老人中,两者呈互补关系;（2）对于上门医疗服务则存在互补关系,家庭照料会显著增加老年人使用社区上门医疗服务的概率,但是在低收入老年人中,二者存在替代关系。文章建议社区居家养老服务体系建设要注重与家庭照料之间的协调发展,特别要关注高龄、中、重度失能和低收入老年人群体的照料需求,实现家庭照料与社区居家养老服务的优势互补。     

Patient-reported care coordination: associations with primary care continuity and specialty care use

PURPOSE Care coordination is increasingly recognized as a necessary element of high-quality, patient-centered care. This study investigated (1) the association between care coordination and continuity of primary care, and (2) differences in this association by level of specialty care use.METHODS We conducted a cross-sectional study of Medicare enrollees with select chronic conditions in an integrated health care delivery system in Washington State. We collected survey information on patient experiences and automated health care utilization data for 1 year preceding survey completion. Coordination was defined by the coordination measure from the short form of the Ambulatory Care Experiences Survey (ACES). Continuity was measured by primary care visit concentration. Patients who had 10 or more specialty care visits were classified as high users. Linear regression was used to estimate the association between coordination and continuity, controlling for potential confounders and clustering within clinicians. We used a continuity-by-specialty interaction term to determine whether the continuity-coordination association was modified by high specialty care use.RESULTS Among low specialty care users, an increase of 1 standard deviation (SD) in continuity was associated with an increase of 2.71 in the ACES coordination scale (P <.001). In high specialty care users, we observed no association between continuity and reported coordination (P= .77).CONCLUSIONS High use of specialty care may strain the ability of primary care clinicians to coordinate care effectively. Future studies should investigate care coordination interventions that allow for appropriate specialty care referrals without diminishing the ability of primary care physicians to manage overall patient care.     

Patient‐centred care training needs of health care assistants who provide care for people with dementia

It is well documented that Health care assistants (HCAs) provide the most hands‐on care to residents in aged care facilities, and play a critical role in the provision of care to dementia residents. Over the last 25 years, a philosophy of person‐centred care has become the preferred approach to care and this has meant that HCAs are encouraged to get to know the resident very well. This paper reports the experiences of HCAs in caring for people at end‐of‐life, identifies the skills required for their work and examines the education provided against these skills. Semi‐structured interviews were conducted in 49 facilities (n = 34) across New Zealand and data analysed thematically, with the aim of critically examining the adequacy of education for health care assistants which meets their needs within a person‐centred environment. The results confirm that the skills include traditional tasks of care (showering, feeding, toileting, and dressing) but the increasingly important communication and de‐escalation skills, both verbal and non‐verbal, have become central to their care skills. Education provided has not sufficiently shifted focus to include these more complex skills. Provision of educations that acknowledges the increased complexities of their role needs to be provided. As well, facilities need to be challenged to reconsider the HCA's position in the facility care tem.     

心理护理在助产护理中的应用效果

目的评价在分娩助产护理过程中,心理护理是否具有良好的应用效果。方法选取我院2012年4月—2014年4月收治的156例产妇作为研究对象,将其随机分为A、B两组,A组为观察组,B组为对照组,A组在进行常规的助产护理的基础上同时应用心理护理,B组仅进行基本的助产护理。在治疗期间详细地记录两组产妇的剖宫产率、产后大出血比例以及产后抑郁的概率,并用统计学方法将两组数据进行对比分析。结果 A组患者的剖宫产率为12.8%,发生产后大出血的比例为6.4%,产后抑郁的概率为5.1%,B组患者的剖宫产率为30.8%,发生产后大出血的比例为23.1%,产后抑郁的概率为16.7%,A组的三种情况均低于B组患者,其差别具有统计学意义（P〈0.05）。结论心理护理在分娩助产护理中有良好的应用效果,可有效地降低患者产后大出血、产后抑郁的概率,同时降低剖宫产的比率,具有较高的临床价值,是分娩质量提高的重要前提。     

The costs of care: An ethnography of care work in residential homes for older people

The cost of social care, the work conditions experienced by care workers and the quality of care provided by residential homes for older people are all linked, yet we know very little about how this relationship works in practice. Drawing upon an ethnography of two differently priced residential care homes for older people in Southern England, I examine the implications of different financial regimes for care-giving practices. I show how the scheduling and allocation of resources—conveyed, for example, in formal routines and staffing levels—structure the care workers’ time, tasks and activities in each setting. This acts to symbolically demarcate what, or who, is valued. I argue that the availability of resources facilitates and impedes the symbolic culture of care work, shapes care workers’ ability to afford dignity to the individuals in their care and affects how care workers experience, and relate to, their labour. I conclude by discussing how current practices of funding and pricing social care have effects seeping beyond the practical and measurable, and into the realm of the symbolic.     

Unmet health care and health care utilization

The objective of this study is to examine the causal effect of health care utilization on unmet health care needs. An IV approach deals with the endogeneity between the use of health care services and unmet health care, using the presence of drug insurance and the number of physicians by health region as instruments. We employ three cycles of the Canadian Community Health Survey confidential master files (2003, 2005, and 2014). We find a robustly negative relationship between health care use and unmet health care needs. One more visit to a medical doctor on average decreases the probability of reporting unmet health care needs by 0.014 points. The effect is negative for the women‐only group whereas it is statistically insignificant for men; similarly, the effect is negative for urban dwellers but insignificant for rural ones. Health care use reduces the likelihood of reporting unmet health care. Policies that encourage the use of health care services, like increasing the coverage of public drug insurance and increasing after hours accessibility of physicians, can help reduce the likelihood of unmet health care.     

Foster family care in Korea

The main thrust of this article is to present a strategy for foster family care operation in Korea. The article is organized with five themes: a brief history of Korean foster care operation, the present condition and problems of foster family care, an operational plan, recommendations, and an overview of the American experience with foster family care to explore its implications for Korea. The authors make these recommendations in order to bring the true nature of foster care operation to Korea: strengthen financial aid and arrange special benefits for foster care families, provide intervention of professionals in foster care agencies, and increase community awareness and citizen participation.     

Preconception care: practice and beliefs of primary care workers

BACKGROUND: A number of lifestyle modifications and medical interventions can be of benefit to maternal and neonatal health, when applied prior to conception. These include smoking cessation, supplementation with folic acid, cessation or moderation of alcohol intake and improvement of diabetic control. However, preconception care (PCC) is not widely practised in the UK, despite being apparently acceptable to health professionals and to women of childbearing age. OBJECTIVES: The aims of the study were to describe the current practice of PCC in Barnsley and to assess the beliefs and attitudes of primary health care practitioners. This information would help direct appropriate educational and clinical governance intervention to this service in the locality in the light of other evidence about the effectiveness of PCC. METHODS: A questionnaire was devised to explore the beliefs about, and practice in providing, PCC in primary care in the Barnsley Health Authority area and sent to all known GPs, practice nurses (PNs), health visitors (HVs) and midwives (MWs) in practices in the area in July 2000. A total of 163 completed questionnaires were received (one reminder, response rate 60.1%). RESULTS: Few practices had a written policy on PCC. Most respondents were providing it mainly on an opportunistic basis and had done so less than five times in the previous 3 months; GPs and PNs were most commonly involved. They agreed that advice about smoking, drug use, folic acid, genetic counselling, chronic disease, alcohol, and maternity care and screening for rubella, genital infections, hepatitis, human immunodeficiency virus and cervical cytology were important. They felt that advice about diet, exercise, supplements, food safety, occupational hazards and State benefits, and screening for nutritional status were less important. Although respondents felt that PCC was effective, and important to women of childbearing age, it was not a high priority in their workload. They indicated that this care was best provided in general practice and that they had the appropriate skills. Barriers to providing PCC included lack of resources and lack of contact with women planning to conceive. Few had received any training on PCC since qualifying in their discipline. CONCLUSIONS: The practitioners who responded to this survey agreed to a large extent about the importance of the subject, and about the content and effectiveness of PCC. Factors hindering the delivery of this service include resource constraints, lack of training and practice policies and procedures, and difficulty in targeting couples planning conception. Further research is needed into ways to increase the provision and uptake of PCC.     

Transitional care: A new model of care from young age to adulthood

IntroductionTransition of care represents the transfer from child to adult care. An effective transition maintains continuity of care and presents better clinical outcomes. This process has assumed growing relevance, thanks to improved survivorship of chronic paediatric patients. Actually, there is no a one-size model fitting for all transitions, but each Service organizes its own clinical pathway.AimThe study proposes an organizational model for transition, differentiated according to patient complexity.MethodsThe working group discussed, through regular meetings, the appropriate transitional model for our Hospital. The working group defined a common scheme of transition and elaborated a synthetic document for patients. Then, the common model is adapted, through clinicians’ contribution, for different diseases. The complexity assessment includes clinical data, nursing and social information.ResultsThe working group defined a common model identifying the main information to be included and detailed in each transition report. The team defined two pathways based on patient’s complexity. In case of good compensation and autonomous management, the adolescent is addressed towards standard transition process, a smoother transition from paediatric to adult care with direct connection among healthcare professionals. In case of complex clinical and/or social conditions, an Interdisciplinary Transition Group (ITG) is activated. The group preventively evaluates each patient in periodic meetings and provides a personalized planning of care. In order to define the complexity of a patient, clinical and social determinants are considered. Some diseases are considered complex by default, while others require ITG involvement in case of multiple comorbidities, severe clinical situation, concomitant social criticality and/or cognitive impairment.DiscussionTransition of care represents an important phase in chronic diseases management. The proposed model assures a multidisciplinary approach, involving all specialists of both paediatric and adult teams. A key determinant of transition is information transmission. Then, the model proposes a common transition report format. Finally, a further perspective study is already in program, in order to assess clinical effectiveness.