The Effectiveness of a Health Promotion Program for the Low-Income Elderly in Taipei,Taiwan

This study assessed the effectiveness of a health promotion program for low-income elderly provided by trained low-income home health aides. Indicators of the effectiveness of this program included improvement in physical health, psychosocial health and functional status, including activities of daily living (ADL) and instrumental activities of daily living (IADL) as well as changes in perceived health promotion needs. This evaluation study used a single group pre- and post-test experiment design. After informed consent forms were signed by participants, 89 purposively selected low-income elderly (aged 64–96) completed pre-test structured surveys, while 60 participants (aged 68–96) completed post-test surveys. Post-test scores indicated improved nutritional status (paired t = 2.64, p < .05) and chore management of IADL abilities (paired t = 2.83, p < .01). No significant difference in psychosocial status were found between pre- and post-test scores. Perceived needs for health promotion services decreased after the intervention. The results show that the health promotion services were effective in improving health status and decreasing perceived needs for services among low-income elderly in Taipei. Recommendations based on this study for developing services for the low-income elderly must take health promotion intervention into consideration.     

4590张门急诊处方书写及用药质量分析

目的调查本院在执行新的《处方管理办法》过程中的门急诊处方质量。方法随机抽查分析2007年5—10月本院门急诊处方4590张。结果我院处方合格率为90．9％，其中书写不合格处方占不合格处方90．43％，不合理用药处方占不合格处方9．57％。结论本院门急诊用药基本合理，但也存在一些问题，应组织全院医生认真学习《处方管理办法》，提高处方质量，保障患者的用药安全。     

门诊中成药不合理用药分析

目的 调查我院门诊中成药不合理处方,分析中成药不合理用药原因.方法 选择我院2010年1月至2011年6月的门诊中成药处方进行抽查,对其用药情况进行汇总评价,共分离出中成药不合理用药处方146张,分析不合理用药原因.结果 146张不合理中成药处方经统计后,共分为6个不合理用药原因,分别为合并用药不当、用量不当、药物配伍不当、重复用药、禁忌证用药不当、诊断与用药不符.结论 门诊中药师应干预门诊中成药处方不合理用药现象,提高处方合格率,指导中成药合理使用.     

上海市某区社区卫生服务中心门诊用药合理性评价

利用6个合理用药国际指标以及TOPSIS法,综合分析和评价了2009年上海市某区12所社区卫生服务中心门诊用药状况。12所社区卫生服务中心门诊处方分析显示：平均药费为77.11元/张,平均药物数为2.30种,抗菌药物费用比例为12.02%,针剂费用比例为12.95%,抗菌药物处方比例为26.27%,国家基本药物使用比例为56.45%。根据Ci值分析,社区卫生服务中心的门诊用药基本合理,部分医疗机构门诊用药合理性有待提高。     

Use of the SF-36 in the Evaluation of a Drug Detoxification Program

OBJECTIVE: The aim of this study was to analyse whether the SF-36 questionnaire is a useful tool to evaluate the treatment outcome of a drug detoxification program. METHODS: A pre post assessment of consecutive referrals to a drug detoxification program of a psychiatric state hospital in north-western Germany was conducted. Seventy-nine males and twenty-one females with a diagnosis of multiple substance use were included. MOS short form 36 (SF-36) was used upon admission and discharge to assess changes in self-perceived health status. Severity scales from the addiction severity interview (ASI) were used to rate severity of illness by a physician at program entry. RESULTS: Patients with severe comorbidity (hepatitis B, depression, attempted suicide) reported significant worse health states, compared to those without. Positive correlations between physician rated addiction severity and patients' self-perceived health status were observed, most strongly for mental health status. For the 48 patients with 2 assessments significant improvements during the treatment period were observed on SF-36 subscales 'general health' and 'physical functioning'. Patients with severe physical and/or mental problems upon admission had more benefits from treatment than patients without. CONCLUSIONS: SF-36 questionnaire is a useful instrument to monitor the health status and to evaluate treatment effects in drug addicts.     

我国网售处方药报销面临的问题及对策分析——基于美国药品福利管理模式

我国医药电子商务发展已有十余年历史,然而在B2C(Business-to-Customers)业务尤其是处方药的互联网交易业务领域发展缓慢,其中,处方的审核及报销是相关部门制定政策时面临的主要问题之一。药品福利管理模式是美国广泛用于药品费用支出管理的一种手段,目前已经形成较为完善的运营方式和服务体系,在处方报销、处方集管理、疾病健康管理、药品利用评价等多个方面起到了重要作用。本文将基于文献分析法,深入讨论我国网售处方药中处方报销存在的问题,并借鉴美国药品福利管理模式,结合我国国情,最终构建出处方报销过程中以药品福利管理公司为核心的药品信息网络和处方报销流程。     

用药指导在门诊药房药品管理中的应用效果分析

目的 探讨用药指导在门诊药房药品管理中的应用效果,为医院新医改形势下药剂科药品管理改革提供更多方向和依据.方法 研究选取2018年1—12月实施用药指导前医院门诊药房105例患者(105张处方)作为对照组,选取2019年1—12月实施用药指导后医院门诊药房107例患者(107张处方)作为观察组;对用药指导前后医院门诊药...     

辽宁与河南两地新农合需求弹性及影响因素分析

目的:通过对辽宁和河南两地的337户农民进行家庭调查,以了解农民的参合意愿和支付能力,分析影响农民的新农合需求因素。方法:通过对两地农民参合的意愿支付额和支付能力进行描述性分析,同时测算两地农民参合的价格需求弹性,以及收入五分组后自付医疗费用的家庭负担。结果:A县意愿筹资额为24.70元,价格需求弹性为-0.832,属于缺乏弹性类;B县意愿筹资额为36.15元,价格需求弹性为-1.458,属于富有弹性类。两地应根据本地的实际情况,适当考虑新农合的价格需求弹性来确定资金的筹集水平及方式。同时发现,最低收入组自付医疗费用是其家庭收入的2倍多。结论:新农合对改善因病致贫、因病返贫的作用不显著;各级政府应加大对贫困地区贫困户的基金支持,促进新农合的受益公平性。     

我国城乡门诊医疗服务需求弹性研究

目的：了解我国城乡居民门诊医疗服务需求弹性,为政府部门提供相应的政策和战略依据。方法：利用需求的弹性经济学模型对影响门诊医疗服务需求的因素进行分析。结果：价格和收入对门诊医疗服务需求均有显著性影响,城市地区的价格弹性系数和收入弹性系数分别是-0．518和0．600,农村地区分别是-0．498和0．298。结论：政府在对医疗服务机构进行调控时,要兼顾价格和收入的影响。     

数字化管理对门诊西药房药品管理与发放的影响

目的：探讨数字化管理对门诊西药房药品管理与发放的影响。方法回顾分析开展数字化管理前与开展数字化管理后的药房药品管理与发放情况,比较两组库存药品盘点时间、患者取药等候时间、药品报损率以及账实相符率。结果在实施数字化管理后,门诊西药房的取药等候时间、药品盘点时间均较实施数字化管理前明显缩短;而在实施后的帐实相符率和报损率则较实施前明显下降,且差异具有统计学意义(t=6.98、5.11、8.16、3.88,P<0.05)。结论数字化管理应用于门诊西药房可以极大提高门诊西药房的工作效率,改善账实相符率、降低西药报损率以及缩减各类失误的发生率,缩短取药等候时间,提高患者满意度,值得各医院广泛推广。     

上海市闸北区共和新社区老年人社区卫生服务利用与需求意愿调查分析

目的了解上海市闸北共和新社区老年人卫生服务利用状况以及对社区医疗的需求意愿情况。方法采用入户问卷调查的方式,对共和新社区90岁以上老年人进行普查,60～89岁老人进行整群随机抽样调查,获得有效问卷697份。结果53.8%的老人患病后首选社区卫生服务机构就诊,社区老年保健服务的满意度为37.5%。40.5%的人表示在社区最希望就近医疗服务,有31.8%的老年人表示暂时不需要任何形式的服务。结论老人的社区医疗保健服务需进一步提高。     

某远郊地区养老院老年人营养状况调查分析

目的探讨养老院内老年人的营养状况及相关影响因素,为改善老年人的营养状况提供依据。方法2013年4月采用整群随机抽样法,随机抽取上海市某远郊地区2个养老院进行调查,以养老院中年龄≥60岁的老年人为调查对象,采用简易营养评价精法（MNA．SF）量表调查研究对象的营养状况及相关影响因素,并以单因素f检验、Logistic多因素回归模型分析营养状况的影响因素。结果105例老年人中,营养不良者有33例（占31．4％）。不同饮食方式（X^2=4．131,P〈0．05）、有无疾病（3（2=3．919,P〈0．05）、不同医疗费支付情况（X^2=4．242,P〈0．05）的老年人营养状况比较,差异具有统计学意义。Logistic多因素回归分析结果显示,年龄和医疗费支付情况是养老院老年人营养不良发生的重要影响因素妒〈0．05）。结论远郊地区养老院老年人的营养状况不容乐观,应引起社会的重视。养老院应根据老年人的饮食习惯和特点合理调整膳食结构,同时还应加强心理健康宣教。     

The Negative Impact of Psychotropic Drug Use on Quality of Life in Nursing Home Patients at Different Stages of Dementia: Cross-Sectional Analyses from the COSMOS Trial

ObjectivesThe quality of life (QoL) in nursing home (NH) patients with dementia is threatened by neuropsychiatric symptoms. This may trigger the use of psychotropic drugs, yet it is unknown if this practice improves the QoL. We investigated the association between the number of psychotropic drugs and QoL at different stages of dementia, adjusted for neuropsychiatric symptoms.DesignCross-sectional analysis of baseline data from the COSMOS study, a multicenter, cluster-randomized, single-blinded, controlled trial.Setting and ParticipationFour hundred thirty-one patients (aged ≥65 years) with and without dementia from 33 Norwegian NHs comprising 67 wards.MeasuresQoL assessed by Quality of Life in Late Stage Dementia (QUALID) and Quality of Life in Dementia (QUALIDEM), neuropsychiatric symptoms by Neuropsychiatric Inventory–Nursing Home version, and cognition by Mini-Mental State Examination.ResultsAt least 1 psychotropic drug was prescribed to 71% of the 431 participants included in the final sample. We estimated the trend in mean QoL scores over the number of psychotropic drugs in patients with clinical significant neuropsychiatric symptom load. QoL assessed by QUALID and QUALIDEM decreased by increasing number of psychotropic drugs (P < .001). No psychotropic drugs (mean QUALID score 20 ± 0.5, mean QUALIDEM score 40 ± 8.1) compared to ≥3 psychotropic drug (mean QUALID score 25 ± 7.8, mean QUALIDEM score 33 ± 8.0). This association was evident in mild, moderate, and severe dementia but absent in people without dementia. Use of antidepressant agents in mild and moderate dementia was associated with increased QoL compared with no use of antidepressant agents.Conclusions and ImplicationsOverall, our findings suggest that psychotropic drugs might pose a threat to QoL in NH patients at all stages of dementia, possibly with the exception of use of antidepressant agents in mild to moderate dementia. This underlines the need for updated knowledge on psychopharmacologic treatment and implementation of procedures for maintaining QoL in dementia care facilities.     

肿瘤创新药纳入全国医保目录的政策效果与思考

采用文献综述法建立社会影响、可及性、可负担性评估体系,评估肿瘤创新药(包括分子靶向药物、免疫治疗药物)自2017年逐步纳入国家医保目录的政策实施效果.结果发现,实施纳入国家医保目录政策后的正面社会影响突出、可及性获得满足、可负担性显著提高.建议在恶性肿瘤创新药纳入全国医保报销后,要考虑政策可持续、药物规范使用、保障不足或者滥用基金等问题.     

The Effect of Aerobic Exercise Training Frequency on Arterial Stiffness in a Hyperglycemic State in Middle-Aged and Elderly Females

The frequency of aerobic exercise training in reducing the increase in arterial stiffness during acute hyperglycemia, a risk factor for cardiovascular disease, is unknown. The aim of the study was to determine the aerobic exercise training frequency on arterial stiffness in a hyperglycemic state in middle-aged and elderly females. Twenty healthy elderly people were randomly assigned to a two-times-a-week (T2, n = 10) and four-times-a-week (T4, n = 10) exercise group. All participants exercised for 35 min per session, which consisted of jogging exercises with a heart rate intensity of 65%. Brachial-ankle (ba), and heart-brachial (hb) pulse wave velocity (PWV) were measured before, 4 and 8 weeks after intervention; before the oral ingestion of 75-g of glucose; and 30, 60, and 90 min after ingestion. The baPWV before and 4 weeks after the intervention increased in both groups (p < 0.05), but only increased 8 weeks after intervention in the T2 group. hbPWV was unchanged before, 4 and 8 weeks after intervention in both groups. These findings show that frequent aerobic exercise suppresses the increase in arterial stiffness following glucose intake. The results of this study can be used to support the implementation of exercise programs for middle-aged and elderly patients.     

实施新型农村合作医疗前后农村居民收入与医疗服务需求及其弹性的比较研究

目的 通过对新农合实施前后农村居民收入与医疗服务需求及其弹性的比较研究,为进一步完善和发展新农合提供依据.方法 采用多阶段分层整群随机抽样方法,在实施新农合前后分别对浙江省桐乡市农村居民进行入户访谈式问卷调查,按家庭收入高低分成5组,分别比较其医疗需求及收入弹性状况.结果 需求收入弹性从0.17降为0.01,医疗费用支出是一个增长趋势,低收入人群医疗费用支出占收入比重均高于高收入人群.结论 经济收入虽然对医疗服务需求有一定影响,但农村居民对医疗服务消费未给予足够重视,医疗服务支出不与经济收入同比例增加.