“十二五”时期康复医疗工作指导意见

康复医疗是医疗服务的重要组成部分,以疾病、损伤导致的躯体功能与结构障碍、个体活动以及参与能力受限的患者为服务对象,以提高伤、病、残人士的生存质量和重返社会为专业特征.疾病早期康复治疗可以避免残疾发生或减轻残疾程度,改善患者生活质量,减轻家庭和社会的经济负担.充分发挥康复医疗机构的作用,有利于提高医疗资源整体利用效率与效益. “十二五”时期是实现全面建设小康社会奋斗目标承上启下的关键时期,也是深化医药卫生体制改革的重要阶段.为适应人民群众不断增长的健康需求以及经济社会发展对康复医学事业发展的新要求,逐步构建完善的医疗服务体系,促进康复医学事业全面、协调、可持续发展,根据《中共中央国务院关于深化医药卫生体制改革的意见》和“十二五”卫生事业发展规划,制定本指导意见.     

社区残疾患者现状和康复需求的调查与研究

目的：对社区残疾患者进行调研,分析目前我国城市化建设服务中残疾患者生存现状和康复需求,为康复服务的制定提供参考依据。方法：对广州市4个社区18岁及以上不同类型肢体残疾患者的康复需求进行分析和比较。结果：中枢性损伤所致残疾患者比例较大,且残疾程度相对较重。对康复医疗和康复治疗需求,不同等级及不同残疾类型基本一致。全部患者都有康复治疗需求,对康复医疗和辅助器具的需求高。社区残疾患者自费医疗所占比例仍较大。结论：在社区康复服务中,需加大辅助器具投入和服务,强化医疗安全。医疗保障方面,需进一步完善相关残疾患者的医保覆盖范围,特别是儿童残疾。不同类型残疾患者生存状况仍有待进一步改善。     

166例女性残疾患者全面康复需求与服务状况调查

目的：调查女性残疾患者全面康复的需求和服务现状。方法：采用《中国残疾人》刊登的调查问卷对全国166例女性残疾患者通过邮寄方式进行问卷调查,内容包括社会保障措施,社会救助、保险、福利及慈善事业等。结果：166例患者对康复、教育、就业、无障碍环境改造等各方面需求迫切,但社会服务能力不足。结论：应尽快建立和完善康复保障和康复服务体系,不断扩大服务面,提高康复服务质量。     

高等护理教育体系下开设基于《国际功能、残疾和健康分类》理论框架的社区康复护理课程构想

<正>社区康复护理是指社区护理人员应用整体护理理念,根据总的康复医疗计划及康复目标,为病、伤、残者进行生理、心理、社会等各方面的康复指导,使其自觉坚持康复锻炼,减少残疾影响,以达到最大程度的康复,从而实现伤病残疾人员全面康复和回归社会的目标[1]。虽然社会对社区康复护理需求日益剧增,开设高等社区康复护理课程具有重要现实意义,但我国尚未开设高等教学体系下的社区康复护理课程。本文将从课程设置意义、具体课程设置构     

深圳市残疾人功能和残疾状况、康复需求与服务发展研究

目的探讨深圳市残疾人的功能和残疾状况、康复需求与服务状况。方法根据世界卫生组织《国际功能、残疾和健康分类》(ICF)和《世界残疾报告》相关理论和方法,构建本研究理论架构,对2015年深圳市残疾人康复服务需求和服务状况数据进行统计分析。结果深圳市残疾人中,肢体残疾人数最多(42.5%),言语残疾人数最少(1.5%);一、二级残疾超过总数的一半(52.8%);福田区残疾人数最多(19.7%),盐田区残疾人数最少(2.2%);0~18岁残疾儿童人数占17.4%,60岁以上占比较大(27.0%)。在康复需求方面,康复医疗占25.0%,功能训练占18.8%,辅助器具占23.2%,无需求占32.9%。在接受康复服务方面,年度内获得过康复医疗占24.4%,获得功能训练占17.4%,获得辅助器具占20.4%,未获得服务占37.6%。在无障碍需求改造方面,卫生间改造人数最多(4.6%),上网读屏软件人数最少(0.7%)。结论研究确认了深圳残疾人的残疾状况、康复需求与服务发展状况。深圳市残疾人康复服务需求与供给仍有差距。建议构建精准康复服务体系,提高康复服务覆盖率和服务质量。     

成年残疾人康复需求与康复服务发展研究

目的研究成年残疾人的残疾状况、主要康复需求特征、康复服务发展状况及其影响因素。方法以2019年度省级2315498名成年残疾人实名制数据为样本,运用多重响应分析统计成年残疾人的残疾状况,分析其康复需求特征和康复服务发展状况;Logistic回归分析影响康复需求与康复服务的相关因素。结果省级成年残疾人的残疾分布从高到低分别为肢体残疾(62.2%)、视力残疾(9.9%)、智力残疾(8.4%)、精神残疾(7.3%)、听力残疾(6.9%)、多重残疾(2.8%)和言语残疾(2.5%)。成年残疾人报告康复需求从高到低分别为辅助器具需求(49.0%)、药物需求(33.3%)、护理需求(27.7%)、功能训练需求(20.2%)和手术需求(1.9%)。成年残疾人报告获得康复服务从高到低分别为辅助器具服务(44.1%)、护理服务(26.6%)、药物服务(25.9%)、功能训练服务(22.2%)和手术服务(1.3%)。Logistic回归显示残疾类别和残疾等级对成年残疾人报告康复需求和康复服务的概率有非常显著影响(P<0.001)。结论残疾人功能状态影响到其康复需求报告,康复需求与康复服务之间仍然存在结构性差异,为提升精准康复服水平,应根据ICF关于功能、残疾和健康分类的理论模式和方法,制定针对特定残疾类别的康复需求报告方法并开发精准的个别化的康复服务项目。     

视力残疾人康复需求和康复服务发展状况Logistic回归分析研究

目的研究视力残疾人的康复需求特点和康复服务发展状况。方法研究样本为2018年度241865名视力残疾人省级康复需求与康复服务实名制数据,统计分析视力残疾人康复需求特征和康复服务发展状况及其相关因素。结果共有50882人报告康复需求(21.0%),从高至低依次为辅助器具56.5%、药物29.0%、护理24.6%、功能训练15.5%和手术4.2%。共有43492人报告获得康复服务(18.0%),从高至低依次为辅助器具55.0%、药物21.6%、护理20.8%、功能训练20.7%和手术2.3%。Logistic回归模型显示,残疾等级对视力残疾人报告康复需求和接受康复服务均有显著影响(P<0.001)。结论视力残疾人报告康复需求主要集中于视力辅助器具、药物和护理三个方面。获得的康复服务与其报告的康复需求结构一致。为视力残疾人提供信息无障碍环境支持是非常重要的康复服务,需要采用现代信息和通讯技术,提升视力残疾人获取信息的能力,以提升其社会参与水平。     

听力残疾人康复需求与康复服务发展状况Logistic回归分析研究

目的研究听力残疾人的康复需求特点和康复服务发展状况。方法使用2019年219473名省级听力残疾人实名制数据作为研究总样本,多重响应分析康复需求特点和康复服务发展状况,Logistic回归分析相关影响因素。结果共47657名听力残疾人报告康复需求(21.7%),从高至低分别为辅助器具65.5%、药物22.7%,护理19.1%,功能训练16.2%和手术2.2%。共34684名听力残疾人报告接受康复服务(15.8%),从高至低分别为辅助器具59.8%、药物22.5%、功能训练19.7%,护理19.4%和手术1.8%。Logistic回归模型显示,年龄、户口性质和残疾等级对听力残疾人报告康复需求和获得康复服务有显著影响(P<0.001)。结论听力残疾人康复需求主要集中于听力辅助器具、药物和康复训练。获得的相关服务与康复需求结构上匹配度高。运用现代科技,发展听力残疾相关的康复服务,以进一步提高听力残疾人的康复服务的可及性和服务质量。     

澳大利亚残疾人辅助技术服务政策与发展研究

目的 探讨澳大利亚残疾流行率、辅助技术服务的需求、服务政策、服务体系。方法 参照世界卫生组织《健康服务体系中的康复》相关政策建议和指标清单,通过内容分析和发展研究的方法,分析澳大利亚辅助技术服务的政策架构、服务发展以及未来发展趋势。结果 澳大利亚统计残疾人约440万,其中重度或极重度残疾人140万(32%);澳大利亚联邦、州、地方政府分别出台了《国家残疾战略》《国家残疾协议》《国家残疾保险计划》《国家残疾服务标准》和其他残疾人援助项目等法律和政策以及相关的服务项目。澳大利亚每年约200多万残疾人获得辅助技术服务的资助,提供辅助器具各类达1万多种,涵盖了“世卫组织优先辅助器具清单”列举的所有类别。结论 澳大利亚根据残疾人辅助技术服务需求,制定了联邦的《国家残疾战略》、辅助技术服务政策和标准,并且建立了联邦和州的残疾人辅助技术保险和财政支持项目,联邦和各州建立了辅助技术服务网络,并且通过《国家残疾协议》的形式建立联邦和州之间的服务协调机制,覆盖了全澳各类有辅助技术服务需求的残疾人,符合《健康服务体系中的康复》政策指南中涉及辅助技术服务的政策建议和评估指标要求;澳大利亚辅助技术服务的热点将集中于辅助技术服务政策完善、ICF应用、服务体系发展、服务质量与标准升级,以及新技术应用等领域。     

上海市闸北区残疾人基本康复服务需求现况分析

目的 调查影响残疾人基本康复服务需求的因素.方法 用问卷调查方式对上海市闸北区9个街道(镇)10 311名持证残疾人的基本康复服务需求与服务现状进行调查.结果 残疾人基本康复服务需求筛出率为83.5%;性别、年龄、残疾类型、残疾等级、文化程度、就业情况对残疾人的基本康复服务需求有影响.结论 不同残疾类型残疾人的基本康复服务需求有差异,应在残疾人康复服务体系广泛覆盖的基础上开展有针对性的服务.     

医养结合机构失能老年人服务供需匹配现状研究

目的 了解医养结合机构失能老年人服务供需现状及供需匹配差距,为缩小医养服务供需匹配差距提供参考依据.方法 采用一般资料调查表和医养结合机构失能老年人服务供需匹配问卷对361名失能老年人进行调查.结果 医养结合机构361名失能老年人的服务供给总分为(61.84±15.31)分处于低等水平;失能老年人服务需求总分为(90....     

残疾儿童康复需求与康复服务发展研究

目的研究残疾儿童的残疾状况、康复需求特点和康复服务发展状况。方法以130290名残疾儿童康复需求与康复服务实名制数据为样本,对残疾儿童的残疾现状、康复需求特征和康复服务发展状况及其影响因素进行统计分析。结果残疾儿童占总残疾人口的5.33%。其中,男性60.4%,女性39.6%;0~6岁16.3%,7~18岁83.7%;农业户口88.4%,非农业户口11.6%。残疾程度由重度到轻度占比依次为28.3%、39.5%、17.7%、14.6%。在报告的康复需求中,从高至低依次为辅助器具40.3%、功能训练37.4%、护理32.2%、药物24.9%、手术5.7%。在报告获得的康复服务中,从高至低分别为辅助器具37.9%、功能训练33.7%、护理服务31.0%、药物19.7%、手术2.9%。根据Logistic回归结果显示,残疾等级对于报告康复需求和获得康复服务均存在非常显著的影响(P<0.001)。结论残疾儿童的功能特点直接影响到其服务需求,应该根据残疾儿童的康复需求特点布局康复服务发展规划,要根据不同类型残疾儿童的功能特点,开发个别化和结构化的康复服务项目,提升残疾儿童康复服务的可及性和质量。     

Disability concentration and access to rehabilitation services: a pilot spatial assessment applying geographic information system analysis

Purpose: Due to geographical disparities, many people with profound or severe disabilities experience considerable delays in rehabilitation treatment, resulting in threats to quality of life. This pilot study aims to identify areas in Greater Brisbane, Australia, with a higher concentration of people with profound or severe disabilities and to evaluate access to rehabilitation services in these areas.

Methods: Data came from the 2016 Australian Census of Population and Housing and the National Health Services Directory. Four frequently used rehabilitation services by individuals with profound or severe disabilities (i.e., occupational therapy, physiotherapy, speech pathology and psychology) were the focus of the analysis. The data were analyzed using geospatial analysis methods (e.g., spatial scan statistic and network analysis).

Results: A higher concentration of rehabilitation services was found in the regions with lower disability prevalence and lower potential demand for rehabilitation services. In contrast, the regions with higher disability prevalence and higher potential demand for rehabilitation services experienced poorer access to rehabilitation services.

Conclusion: The findings are expected to inform policy decisions about the prioritization of rehabilitation resources and derive evidence for planning more responsive service delivery.

• Implications for rehabilitation

• The current study has demonstrated the utilization of geographic information system methods to facilitate rehabilitation service planning.

• Identification of disability concentration may inform locally responsive rehabilitation service delivery.

• Spatial assessment of mismatch between supply and potential demand may assist policy makers and service providers in the prioritization of rehabilitation resources.

• The current study contributes to the World Health Organization’s call for action to ensure adequate access to rehabilitation services by people with profound or severe disabilities.

     

A research study into the requirements of disabled residents for rehabilitation services in Beijing

Purpose.?Rehabilitation services need strengthening further. This study explores a sample of the population in Beijing in order to establish the extent of medical impairments and disabilities. It describes the present utilization of rehabilitation by different economic groups of the population and also explores the attitudes of these same groups to the concepts inherent in rehabilitation. The conclusions are that a considerable information program is needed to help people with disabilities to access and utilize services appropriately. Finally, it concludes that the present Rehabilitation Services need to be professionally improved and expanded.

Background.?In China, the spectrum of disease is changing, along with the development of society, and progress in science and technology. The requirements of people for medical rehabilitation following major accidents, and acute or chronic disease, leading to disability and handicap, increase year by year. This is especially so now, with the added geriatric problems of an aging population. At present, rehabilitation services and resources within this country are limited. It is difficult to meet the immediate or long-term needs of disabled persons. Recently, there have been many national publications describing the requirements and discussing those factors which influence Rehabilitation Service provision, but much of this discussion has been theoretically based, rather than facing practical issues. We can find no studies describing the nature and extent of disabling disorders in the Beijing population and, in particular, few formal studies relating the provision of rehabilitation services to that population in need of this essential management process. We have therefore carried out a survey-based study to demonstrate the present rehabilitation service requirements for disabled residents in some typical Beijing urban districts. We have also looked at those factors which influence clients to accept the various services which are available to them at present. This will, we suggest, provide an epidemiological and demographic analysis with data on which to base future policies for government services to best meet these requirements.

Method.?A series of comprehensive questionnaires were designed, in order to investigate the demographic characters, health conditions, knowledge of rehabilitation services, and social status of the interviewees. Some 460 disabled residents from three districts in the city of Beijing were selected. They were randomized, with multi-stage cluster sampling for in-house survey.

Results.?Some 74.78% of interviewees expressed a need for rehabilitation, at different levels, but only 26.73% received any services. Factors influencing requests for community rehabilitation services for disabled residents in Beijing included income, nature of disability, awareness of rehabilitation services and the nature of services supplied. The expressed needs for rehabilitation services by disabled residents in communities in Beijing urban districts are real, and are largely unmet. Only a few of the disabled received any services. Factors influencing disabled residents' abilities to access rehabilitation service, included the nature and degree of disability, the economic status of the residents, the quality and nature of the rehabilitation programs and treatment available, and the knowledge by clients of the existence and availability of these services.

Conclusion.?More effective measures need to be taken to make the appropriate Rehabilitation Services more available to community residents with medical disabilities.     

广东省城乡残疾人社会参与状况的比较

目的:对广东省各类残疾人的社会参与状况进行分析,探讨城乡之间各类残疾人社会参与状况的异同,并提出相应的康复对策。方法:采用广东省第二次全国残疾人抽样调查中WHO-DAS Ⅱ分项目残疾人社会参与评定的数据进行等级资料的统计分析。结果:总体上,乡村各类残疾人比城市所占比例大,社会参与较为困难。城市与乡村视力、言语、智力残疾人的社会参与能力的等级差异无显著性意义;听力、肢体及精神残疾人的社会参与能力的等级差异有显著性意义。结论:广东省绝大多数各类残疾人均存在不同程度的社会参与局限,尤其是乡村残疾人数量多、比例大,是今后康复工作的主要对象。建议完善三级康复网络,建立社区卫生服务中心及新农合康复站,以及重大专项疾病的防治康复网。     

A research study into the requirements of disabled residents for rehabilitation services in Beijing

Purpose. Rehabilitation services need strengthening further. This study explores a sample of the population in Beijing in order to establish the extent of medical impairments and disabilities. It describes the present utilization of rehabilitation by different economic groups of the population and also explores the attitudes of these same groups to the concepts inherent in rehabilitation. The conclusions are that a considerable information program is needed to help people with disabilities to access and utilize services appropriately. Finally, it concludes that the present Rehabilitation Services need to be professionally improved and expanded.

Background. In China, the spectrum of disease is changing, along with the development of society, and progress in science and technology. The requirements of people for medical rehabilitation following major accidents, and acute or chronic disease, leading to disability and handicap, increase year by year. This is especially so now, with the added geriatric problems of an aging population. At present, rehabilitation services and resources within this country are limited. It is difficult to meet the immediate or long-term needs of disabled persons. Recently, there have been many national publications describing the requirements and discussing those factors which influence Rehabilitation Service provision, but much of this discussion has been theoretically based, rather than facing practical issues. We can find no studies describing the nature and extent of disabling disorders in the Beijing population and, in particular, few formal studies relating the provision of rehabilitation services to that population in need of this essential management process. We have therefore carried out a survey-based study to demonstrate the present rehabilitation service requirements for disabled residents in some typical Beijing urban districts. We have also looked at those factors which influence clients to accept the various services which are available to them at present. This will, we suggest, provide an epidemiological and demographic analysis with data on which to base future policies for government services to best meet these requirements.

Method. A series of comprehensive questionnaires were designed, in order to investigate the demographic characters, health conditions, knowledge of rehabilitation services, and social status of the interviewees. Some 460 disabled residents from three districts in the city of Beijing were selected. They were randomized, with multi-stage cluster sampling for in-house survey.

Results. Some 74.78% of interviewees expressed a need for rehabilitation, at different levels, but only 26.73% received any services. Factors influencing requests for community rehabilitation services for disabled residents in Beijing included income, nature of disability, awareness of rehabilitation services and the nature of services supplied. The expressed needs for rehabilitation services by disabled residents in communities in Beijing urban districts are real, and are largely unmet. Only a few of the disabled received any services. Factors influencing disabled residents' abilities to access rehabilitation service, included the nature and degree of disability, the economic status of the residents, the quality and nature of the rehabilitation programs and treatment available, and the knowledge by clients of the existence and availability of these services.

Conclusion. More effective measures need to be taken to make the appropriate Rehabilitation Services more available to community residents with medical disabilities.     

Getting Beyond the Plateau: Bridging the Gap Between Rehabilitation and Community-Based Exercise

Rehabilitation specialists have a unique opportunity to serve as the drivers of change in promoting the use of exercise facilities by people with newly acquired disabilities. Identifying programs that are effective and sustainable for extending recovery in a community-based exercise facility after rehabilitation may reduce the risk of secondary health complications and optimize health and function. This article describes an approach for closing the gap between inpatient and outpatient rehabilitation and the use of community-based exercise facilities by people with disabilities. Extending recovery from rehabilitation to community-based exercise requires a transitional setting (eg, hospital-based fitness facilities and specialized fitness centers and programs for people with disabilities) that provides greater support and supervision in teaching individuals with disabilities (and, when necessary, their caregivers) how to exercise safely and effectively and access the programs, equipment, and services available in these facilities. With the shortened amount of rehabilitation time that many patients are given after acquiring a disability or being treated for a new health condition, community-based exercise facilities and the fitness professionals who are employed in them must become part of the rehabilitation continuum and obtain additional training to better serve the needs of people with newly acquired disabilities who are leaving rehabilitation.     

Analysis of factors affecting demand for rehabilitation services in Ontario,Canada: A health-policy perspective

Demand for health services tends to outstrip supply in an environment of economic scarcity. Purpose. In this research, we first explore factors affecting demand for rehabilitation services in Canada's most populous province of Ontario; we then interpret these findings and discuss their implications for future demand.

Methods. Consistent with health-policy case-study methodology, we triangulated primary and secondary data sources (42 key-informant interviews and review of publicly available documents, respectively).

Results. Demand for rehabilitation seems to be rising quickly across Ontario's continuum of care, and informants identified four primary factors: (1) overall population growth along with an increasingly large cohort aged 65 years or older; (2) increasing rates of chronic and complex conditions, along with changes in hospital discharge patterns; (3) increasing public expectations; and (4) advances in treatment and management of diseases and condition.

Conclusions. Although demand may be rising, access to rehabilitation is now based more on eligibility than on demand alone. The presence of increasing demand does not ensure that there is, or will be, sufficient financial or human resources to meet such demand. This study signals the need to reflect on current policies regarding access, and highlights the need to consider the benefits of health-promotion and injury-prevention strategies in mediating demand.     

Disability,caregiver’s dependency and patterns of access to rehabilitation care: results from a national representative study in Peru

Purpose: To determine the prevalence of disability in Peru, explore dependency on caregiver’s assistance and assess access to rehabilitation care. Method: Data from Disability National Survey (ENEDIS), including urban and rural areas, were analyzed. Disability was defined as a permanent limitation on movement, vision, communication, hearing, learning/remembering or social relationships. Dependency was defined as the self-reported need for a caregiver to help with daily activities; and access to rehabilitation care was defined as the self-report of any therapy for disabilities. Estimates and projections were calculated using sample strata, primary sampling units and population weights, and prevalence ratios (PRs) and 95%CI were reported. Results: From 798?308 people screened, 37?524 (5.1%; 95%CI 4.9--5.2%) had at least one disability. A total of 37?117 were included in further analysis, mean age 57.8 (SD?±?24.1) years, 52.1% women. Dependency was self-reported by 14?980 (40.5%; 95%CI: 39.2–41.9%) individuals with disabilities. A family member, usually female, was identified as a caregiver in 94.3% (95%CI: 93.3–95.3%) of dependent participants. Only 2881 (10.7%; 95%CI: 9.7–11.9%) of people with disabilities reported access to rehabilitation care. Major inequality patterns of disability burden versus access to rehabilitation care were observed by age and education level. Older age groups had higher disability burden yet lower chances of access to rehabilitation care. Conversely, the higher the education level, the lesser the overall disability burden but also the higher chances of reporting receiving care. Private healthcare insurance doubled the probability of having access to rehabilitation compared with those without insurance. Conclusions: Approximately 1.6 million Peruvians have at least one disability, and 40% of them require assistance with daily activities. Informal caregiving, likely female and relative-provided, is highly common. Rehabilitation care access is low and inequitable. Our results signal a major need to implement strategies to guarantee the highest standard of health care for people with disabilities.

• Implications for Rehabilitation

• Major inequality patterns in terms of burden of disability versus access to rehabilitation care were observed: those groups who concentrate more disability reported receiving less rehabilitation care.

• Caregiving is mostly informal and provided by a direct relative, mainly a woman, who resigned to their usual activities in order to help care for the person with disability. As a result, there is a need to develop appropriate support and training for caregivers.

• Access to care services in Peru is low and inequitable, but especially for people with disabilities: they experience greater barriers when accessing healthcare services even in the case of having health insurance.