P.C. Sen Best Paper Award (2002). Profile of care providers in five blocks of Nasik Maharashtra. A window on rural health services in Maharashtra

Five blocks of Nasik district in Maharashtra were surveyed in 1999-2000 for distribution and academic degrees of doctors of all kinds. The five blocks have 84 % villages without any health care provider (read doctor) no matter qualified or quack. All the 555 doctors including Govt. doctors are concentrated in 16 % of villages, mainly in small townships and market centers. Physical access to any doctor is thus tedious. Often it requires travelling and hidden costs like loss of wages for the accompanying person. It also involves a hidden cost of deferred treatment. To ensure access to rational medical care at affordable cost a major overhaul of the existing health services is necessary.     

成都市家庭医生服务现状的定性研究

目的 本研究针对成都市基层医疗卫生服务机构,调查分析了家庭医生服务开展现况、存在的问题,以及家医服务平台的建设情况并提出了改进建议。方法 本研究共抽取了成都市六个基层社区卫生服务机构,对每家机构的1名管理人员和1个家庭医生团队分别进行深入访谈和专题小组访谈,调查时间为2020年12月—2021年2月。结果 成都市双向转诊取得一定成效,但下转难情况依然突出;有偿签约效果不好,居民就诊观念需转变;基层卫生技术人员不足,家医服务增加了日常工作量;家医信息化平台存在诸多问题,功能亟需改善;家医的绩效考核制度有一定激励作用,但仍需完善;基层卫生投入不足,家医政策落地难。结论 规范分级诊疗秩序,畅通双向转诊通道;加强官方媒体宣传力度,转变居民就诊观念;提升基层职业吸引力,培养优质人才;加强信息化建设,完善家庭医生信息化服务平台;健全家庭医生绩效考核制度,调动工作积极性;完善家医配套政策与措施,强化基层机构服务能力。     

医患沟通在医疗活动中的作用与意义

目的分析医患沟通的影响因素,探讨医患沟通在医疗活动中的作用及意义。方法采用医患座谈法、医护患访谈、问卷调查、电话随访等形式对医院2005～2007年的医患沟通现状进行调查和分析。结果调查结果信度和效度均高于0．70。结果可靠,基本达到预期目的。结论良好的医患沟通有助于提高医疗服务质量,保证医疗安全,提高医院的经济和社会效益,实现医患双赢;有利于实现以人为本,构建和谐的医患关系。     

某市参合农民对乡村医疗机构服务质量的评价

目的了解参合农民对乡村医疗机构服务质量的评价,为改进乡村医疗机构服务质量提供依据。方法通过分层抽样和单纯随机抽样相结合的方法,抽取昆明市14个县（市、区）的部分参合农民进行问卷调查。结果昆明市参合农民对村卫生室、乡镇卫生院的医技水平、服务态度、医疗收费、医生可信度、设备、所需药品的评价均有统计学差异（P〈0．05）,对总体满意度评价没有统计学差异（P〉0．05）。非条件Logistic回归分析表明,参合农民选择村卫生室的影响因素是医生服务态度、医生可信度、离家路程、总的医疗服务质量、需要的药品和总体满意度,选择乡镇卫生院的影响因素是医技水平、就医方便程度、离家路程及等待的时间。结论昆明市乡村医疗机构服务质量一般。建议相关部门合理配置卫生资源,加强乡村医疗机构（村卫生室、乡镇卫生院）的软硬件建设及管理,以提高乡村医疗机构服务水平。     

家庭医生签约服务对医防结合的影响

目的:分析家庭医生签约服务对于医防结合的影响及其作用机制。方法:采用典型抽样的方法,调查了七个地区的541名家庭医生团队成员,并对家庭医生团队和相关知情人进行了个人深入访谈和焦点组访谈。定量资料主要采用描述性统计分析;定性资料采用NVIV09.0软件进行编码、归纳和总结。结果:不同的签约服务模式对医防结合的影响不同。采用家庭医生团队的签约服务有助于促进医防结合;团队成员得到有效激励的签约服务有助于促进医防结合,个人付费的签约服务更有助于促进医防结合;服务内容包括基本医疗和公共卫生服务的家庭医生签约有助于促进医防结合。建议:家庭医生签约服务应实施团队签约和个性化有偿签约。设计综合服务包,融合基本公共卫生服务项目和基本医疗及个性化健康管理服务项目,体现医防结合理念。探索基本公共卫生经费与医保基金融合路径,加强医防结合,促使全科医生从服务守门人向健康守门人转变。     

Nurses' participation in audit: a regional study.

OBJECTIVES: To find out to what extent nurses were perceived to be participating in audit, to identify factors thought to impede their involvement, and to assess progress towards multidisciplinary audit. RESEARCH DESIGN: Qualitative. METHODS: Focus groups and interviews. PARTICIPANTS: Chairs of audit groups and audit support staff in hospital, community and primary health care and audit leads in health authorities in the North West Region. RESULTS: In total 99 audit leads/support staff in the region participated representing 89% of the primary health care audit groups, 80% of acute hospitals, 73% of community health services, and 59% of purchasers. Many audit groups remain medically dominated despite recent changes to their structure and organisation. The quality of interprofessional relations, the leadership style of the audit chair, and nurses' level of seniority, audit knowledge, and experience influenced whether groups reflected a multidisciplinary, rather than a doctor centred approach. Nurses were perceived to be enthusiastic supporters of audit, although their active participation in the process was considered substantially less than for doctors in acute and community health services. Practice nurses were increasingly being seen as the local audit enthusiasts in primary health care. Reported obstacles to nurses' participation in audit included hierarchical nurse and doctor relationships, lack of commitment from senior doctors and managers, poor organisational links between departments of quality and audit, work load pressures and lack of protected time, availability of practical support, and lack of knowledge and skills. Progress towards multidisciplinary audit was highly variable. The undisciplinary approach to audit was still common, particularly in acute services. Multidisciplinary audit was more successfully established in areas already predisposed towards teamworking or where nurses had high involvement in decision making. Audit support staff were viewed as having a key role in helping teams to adopt a collaborative approach to audit. CONCLUSION: Although nurses were undertaking audit, and some were leading developments in their settings, a range of structural and organisational, interprofessional and intraprofessional factors was still impeding progress. If the ultimate goal of audit is to improve patient care, the obstacles that make it difficult for nurses to contribute actively to the process must be acknowledged and considered.     

Rural Community‐dwelling Elders' Reports of Access to Care: Are There Hispanic versus non‐Hispanic White Disparities?

CONTEXT: Consumer reports can provide useful information about the dimensions of access in need of improvement for particular population subgroups. PURPOSE: To determine if there are Hispanic versus non-Hispanic white disparities in rural elders' reports of their health care access. METHODS: A telephone survey was conducted among 2,097 rural community-dwelling elders in West Texas. Dependent variables included reports of the ability to obtain care (see personal doctor/nurse, see specialist, obtain help over phone, and obtain transportation to the clinic) and reports of the ability to obtain care without a long wait (get help over the phone without a long wait, see provider for illness/injury when wanted, see provider for routine care when wanted, and have short office waiting times). Independent variables included predisposing, enabling, and need factors. Univariate and multivariate logistic regression analyses were conducted. FINDINGS: In univariate logistic analyses, Hispanics had worse reports of their ability to always/ usually see their personal doctor, see a specialist, obtain transportation to the clinic, see a doctor for illness/injury when wanted, and see a doctor for routine care when wanted. When adding enabling factors to the models, only reports of the ability to see a doctor for illness or injury and for routine care when wanted remained significant. CONCLUSIONS: Though the rural medical care system may need to target directly Hispanics to improve their timely access to acute and routine care, the enhancement of health insurance coverage may lead to improved access to personal doctors and specialists among all rural elders.     

二级综合性医院构建医养结合服务模式的实践与探索*

本研究介绍了某二级综合性医院托管嘉定区第一社会福利院医务室的建设情况,总结取得的成效,如建立一整套医务室管理制度、按计划完成新生活区开设工作、为住养老年人开辟就诊"绿色通道"、医疗质量不断提高、沟通机制不断加强、加强人才储备及培训等。存在的主要问题,医生的相对固定仍未完全做到位、新入驻医师对工作环境不够熟悉及与护理员沟通和配合有待进一步加强等。提出二级综合性医院参与医养结合项目符合国家政策导向、二级综合性医院要发挥在医养结合项目中的优势和建立符合实际的人才储备机制,进一步探索医养结合项目长效常态管理机制等。医养结合项目可以成为集医疗、护理、康复、健康教育和临终关怀于一体的优质医疗服务模式。     

山西省贫困地区乡村医生离职意愿影响因素调查*

目的分析山西省乡村医生流失原因,为山西省制定乡村医生政策和精准培养提供建议。方法采用分层随机抽样法对山西省3个地区254名乡村医生进行横断面调查,通过卡方检验和多因素回归分析贫困地区乡村医生离职意愿的影响因素。结果 (1)与非贫困地区相比,贫困地区乡村医生离职意愿较高;(2)两组工作情况在入户访视人次、公共卫生服务占比有明显差异(P0.05),贫困地区收入水平及养老保障较非贫困地区有所差别;(3)回归分析显示,学历、月收入和每月巡诊时间是影响山西省贫困地区乡村医生离职意愿的主要因素。结论山西省贫困地区乡村医生较非贫困地区离职意愿高,影响其离职意愿的主要因素是学历、月收入和每月巡诊时间。     

Language barriers in Vienna hospitals

As part of a wider investigation of cross-cultural communication practices in health care and social service institutions of Vienna, a survey among hospital staff was conducted to establish the need for mediated communication between service providers and non-German-speaking patients. The responses of 508 doctors, nurses and therapists demonstrate a substantial need for interpreting services, which is currently met by family members (most often children) and bilingual hospital employees (most often cleaners). Most of the respondents were well aware of the shortcomings of ad hoc interpreting arrangements and voiced a clear preference and demand for a hospital interpreting service to improve communication with and health care provision to non-German-speaking patients.     

健康中国背景下家庭医生签约服务发展中的问题与对策研究

  目的  比较已签约和未签约居民卫生服务利用差异,为进一步优化家庭医生服务制度提供参考。  方法  利用2018年江苏省第六次卫生服务调查中家庭健康调查表中数据,采用2周患病率、高血压和糖尿病患病率、其他慢性病患病率反映卫生服务需求情况,采用2周就诊率、住院率、自我治疗率、自行购药率、医疗费用及就诊和住院机构反映卫生服务利用情况。  结果  签约居民2周患病率、慢性病患病率及高血压、糖尿病患病率均高于非签约居民,差异具有统计学意义（P < 0.05）;签约居民住院率、自我治疗率、自行购药率均高于非签约居民,差异具有统计学意义（P < 0.05）;签约居民与非签约居民在首诊机构和住院机构的选择上差异具有统计学意义（P < 0.05）。  结论  签约居民卫生服务需求更高,同时卫生服务利用水平也更高;签约居民更倾向于去基层就诊;签约对医疗费用的控制作用尚未体现。     

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,信息查询。居民希望通过互联网享受排名前5位的医疗服务:预约挂号,在线复诊,医保支付,信息查询,健康教育。医护对互联网医疗持积极参与态度。医护使用过的互联网医疗服务排序前5位:预约挂号、信息查询、健康档案、查询、健康科普教育。结论社区层面互联网医疗建设,需加大政府扶持力度,加强百姓宣传引导,对促进发展互联网医疗服务具有现实意义。     

住院患者满意度实证分析

目的运用期望确认理论分析住院患者满意度的影响因素,为进一步提高医院服务质量提供参考。方法采用随机抽样法分层选取2015年7月某三甲综合医院的住院患者,对住院患者进行期望程度与满意度对比研究。结果该院住院患者期望程度与满意度在医疗技术、医患沟通、医生责任心、医疗费用方面有显著性差异。结论该院住院患者满意度总体较好,但仍需在医疗技术、医患沟通、医生责任心、就诊环境等问题上进行专项改进,以持续改进医疗服务,提高患者满意度。     

United We Stand — Divided We Fall

ABSTRACT: In June, 1992, the NSW Health Department released their Discussion Paper on 'The Role and Function of Nurse Practitioners in NSW'. The paper recommends legislative changes to enable nurse practitioners to initiate certain diagnostic tests, prescribe from a limited list of drugs, refer directly to specialist medical officers in certain circumstances and be reimbursed for some of the services they provide. Strict criteria for accreditation and evaluation are also recommended. Overseas literature confirms that nurse practitioners provide a safe, competent and cost effective service, which is well accepted by consumers. Opponents of the nurse practitioner concept in Australia have argued that it would be 'dangerous practice' and a 'duplication of services' to implement the Discussion Paper's recommendations. These arguments can not be substantiated. Of more concern is the attempt to divide nurses and nursing on the issue. To suggest that it is acceptable for nurse practitioners to provide services where doctors don't choose to practice or to provide service to disadvantaged groups of people, with whom doctors don't choose to work is unacceptable to nursing. Nurses provide nursing care, they do not provide medical care. Wherever nurses happen to be located, nurses are nurses and do nursing. Whether or not there is a doctor available is not the issue. Nurses do not seek to be doctors. Nurses do not seek to practice medicine. Nursing as a profession stands alone. This paper discusses the nurse practitioner concept as it is proposed for NSW, the implications for urban, rural and remote area nurses, the deliberate attempts to create division amongst nurses on the issue and the need for nurses to stand together to protect, validate and legitimise nursing practice.     

病房护士与病人沟通的技巧

随着现代医学模式的转变及人们的自我保健意识的提高,人们对医疗机构医护服务质量提出了更高的要求.护士处在临床第一线,与患者接触最多,其服务质量的高低直接关系着患者的满意度和临床效果.为了给患者提供优质的护理服务,护士不但要有丰富的理论知识和娴熟的操作技能,也要有独到的沟通技巧.     

长沙市基层卫生人才队伍建设研究

目的了解长沙市基层卫生人员现状,分析存在的问题并提出建议。方法采用自行设计的调查表对196家基层医疗机构的卫生人力现状进行调查并对基层卫生人员的数量、年龄、学历、职称、工作年限以及流动情况进行描述性分析,采用灰色模型法预测目标年的卫生人员需求量。结果截止到2011年底,长沙市共有基层卫生人员12594人,每万人口拥有医生5．6名,拥有护士3．9名,医护比例为1：0．70。基层卫生人员年龄以25-44岁为主,占51．9％;学历以大专为主,占42．6％;职称以初级为主,占61．2％,工作年限以5年以下为主,基层卫生人员流动频繁,流入大于流出。结论长沙市基层卫生人才队伍数量基本满足居民需求,年龄结构适宜,但是专业构成不合理,护理人员相对缺乏,素质还有待提高。     

某大学附属医院住院患者满意度调查

目的对患者满意度进行调查分析,以期为提升医院医疗服务水平提供参考。方法采用武汉市卫生局统一制定的住院患者满意度调查表,以问卷的方式开展调查,对2011年5月至2012年5月期间住院满一周的患者共1 300例进行调查。调查内容包括医院环境、医师服务、护士服务、后勤服务等11个项目。结果 95.2%对医院的总体印象满意。医院环境,对导医标识、卫生设施的满意率为97%、96%,内外环境患者的满意率为90%;医师服务,对服务态度、诊疗技术患者的满意率为98%、97%,对医师耐心解答患者问题的满意率为94%;护理服务,对服务态度、护理技术患者的满意率为99%、97%;医技科室服务态度,对放射科工作人员的患者满意率为94%,对B超室工作人员的患者满意率为90%,对心电图工作人员的患者满意率为97%,对检验科工作人员的患者满意率为95%;病房管理,健康教育、对住院患者入、出院介绍的患者满意率最高为100%,对住院膳食的患者满意度最低为85%。结论该院的医疗服务水平还有提升的空间,病房膳食品种和质量有待改善。     

Horizontal inequities in Australia's mixed public/private health care system

Recent comparative evidence from OECD countries suggests that Australia's mixed public-private health system does a good job in ensuring high and fairly equal access to doctor, hospital and dental care services. This paper provides some further analysis of the same data from the Australian National Health Survey for 2001 to examine whether the general finding of horizontal equity remains when the full potential of the data is realized. We extend the common core cross-country comparative analysis by expanding the set of indicators used in the procedure of standardizing for health care need differences, by providing a separate analysis for the use for general practitioner and specialist care and by differentiating between admissions as public and private patients. Overall, our analysis confirms that in 2001 Medicare largely did seem to be attaining an equitable distribution of health care access: Australians in need of care did get to see a doctor and to be admitted to a hospital. However, they were not equally likely to see the same doctor and to end up in the same hospital bed. As in other OECD countries, higher income Australians are more likely to consult a specialist, all else equal, while lower income patients are more likely to consult a general practitioner. The unequal distribution of private health insurance coverage by income contributes to the phenomenon that the better-off and the less well-off do not receive the same mix of services. There is a risk that - as in some other OECD countries - the principle of equal access for equal need may be further compromised by the future expansion of the private sector in secondary care services. To the extent that such inequalities in use may translate in inequalities in health outcomes, there may be some reason for concern.     

Training doctors for family practice in primary health care work in Sri Lanka

Over one-third of the doctors in Sri Lanka are involved in the delivery of PHC. They form one of seven categories of PHC workers—others being the ayurveda physician, the assistant medical practitioner, nurse, midwife, traditional healer and unqualified practitioner. PHC workers function either in the government or private sector. Their functions in the PHC system are not defined and are dependent on state health policies and people's expectations of health care.The secondary and tertiary levels of the health system are managed by the government through a network of hospitals. These hospitals provide Western type health care facilities free to the people. Government PHC workers have access to referral facilities and back up services provided through this hospital system.Doctors functioning within the PHC system had neither undergraduate nor postgraduate training in PHC. Private general practitioners were the first to realise the need for training doctors in PHC. They sought and got government and university approval for postgraduate training in family practice.The family practice training programme is conducted by the Postgraduate Institute of Medicine of the University of Colombo. The course consists of educational and clinical components which could be completed in a minimum of 1 year or maximum of 4 years.Nine private general practitioners and 19 government medical officers registered for the course. Fifteen completed the course in 1 year.Family practice trained doctors will function in a PHC system in which the services provided are not coordinated. Changes in the PHC system are being considered. Government is proposing to establish health centres manned by doctors with sub-centres manned by lesser trained health workers.The medical profession has suggested a unified PHC system and a national health insurance scheme.The exact role of the family practice trained doctor in the country's PHC system cannot be defined. Family practice training should influence and be influenced by changes in the PHC system in Sri Lanka.