St. Agnes: a study of a health centre in evolution.

The growth of St Agnes Health Centre is described, with its transition from simple group practice to a comprehensive health centre over a five-year period. Its position in a rapidly growing suburb is analysed and illustrated by usage and referral patterns. The sucessful integration of general practice, sessional specialists and allied health workers under one roof makes it unique as a primary health care project in Australia.     

Does Enhanced Primary Care enhance primary care? Policy-induced dilemmas for allied health professionals

One aim of Medicare's Enhanced Primary Care (EPC) initiative is to encourage multidisciplinary care of patients with chronic disease by funding five allied health treatment sessions per patient per year. In many cases, the number of funded treatments is far less than standard clinical practice indicates, particularly when the five visits are shared between service providers. We believe clinical outcomes may be compromised by adhering to the funded hours, and inequity of outcome may arise based on socioeconomic status and the ability of patients to pay. Research that determines how patients and allied health practitioners are responding to this initiative is required. Research is also required to evaluate whether EPC enhances clinical outcomes compared with no allied health intervention and standard allied health practice.     

Student attrition. A challenge for allied health education programs

The Committee on Allied Health Education and Accreditation (CAHEA) attrition data, collected annually by the American Medical Association (AMA), are nationally representative and constitute the largest source of information on attrition and retention in allied health education. These data provide a cornerstone for education and manpower planning. Consistent with previous years, men who were enrolled in CAHEA-accredited allied health education programs for the 1989-1990 academic year were significantly more likely to be lost to attrition than were women. When compared with all other categories of race and ethnic origin, black students not of Hispanic origin showed a significantly higher attrition rate (25.4%), while students designated as Asian or Pacific Islander showed a significantly lower rate (13%). Congruent with attrition data documented in the literature, CAHEA attrition data show wide variances across 26 allied health occupations and within the three disciplinary groupings that comprise approximately 75% of all CAHEA-accredited programs. Attrition rates measured by the type of sponsoring institution range from 7.1% (academic health centers and medical schools) to 24.3% (vocational and technical schools). Programs sponsored by for-profit institutions and federal government-owned institutions report substantially higher attrition rates, 25.1% and 21.1%, respectively.     

The value of acute care simulation

Simulation of crises has long been a component of training in the aviation and nuclear industries. This technology has been successfully transferred and adapted to acute care medicine and allied health care. In this article, we describe the capabilities and uses of human acute care simulation at West Virginia University Hospital.     

开办呼吸治疗专业高等教育的七年实践与探索

呼吸治疗专业教育的任务是培养与现代医学相关的高级呼吸治疗技术人员,以尽快弥补我国在高等教育层次上缺乏相应的专业设置的缺陷,从而促进医疗服务质量。作者介绍本校开办呼吸治疗本科教育的七年实践,并就我国开展呼吸治疗专业教育的必要性、方向、策略和存在的问题进行了讨论。     

Multidisciplinary care plans for diabetes: how are they used?

OBJECTIVE: To understand how multidisciplinary care plans are being used in the management of patients with diabetes, and to explore the role of collaboration in care planning. DESIGN: Grounded theory interview study. SETTING: Primary care, June 2005 to October 2006. PARTICIPANTS: Thirty-eight people from three New South Wales Divisions of General Practice: 19 general practitioners, eight diabetes-related allied health providers, two endocrinologists, and nine adults with type 2 diabetes. Sampling was purposeful then theoretical. RESULTS: GPs use care plans to organise clinical care and help patients access allied health providers. Written plans are used to educate patients about their care and to motivate change. GPs rarely discuss care plans with other providers, and providers are unlikely to change their approach to patients on the basis of care plans. Patients do not expect to participate in care planning. CONCLUSIONS: Care planning may increase evidence-based multidisciplinary care for patients with diabetes, but it rarely results in genuine collaboration between providers and patients. This suggests a difference may exist between Australian policymakers' and providers' definitions of patients with complex needs. Care plans could facilitate patient self-management by including more personalized information. Further research is needed to clarify which patients would benefit from a truly collaborative approach to their care.     

Instructional uses of computing in the health sciences

Literature on the use of computers for instruction in the medical and health professions was surveyed for a 20-year period. More than 150 articles were located dealing with actual or proposed applications of computer-assisted instruction (CAI) to the education of physicians, nurses, dentists, pharmacists, and allied health professionals. The resulting bibliography provides an overview of the history of CAI and a summary of CAI activities as reflected in the published literature.     

新医改与我国医疗卫生体制的公平性

医疗体制的公平是每个人基本权利的保证条件之一,我国经济快速平稳增长,医疗体制的公平性却不断受到质疑。在宏观形势与医疗体制自身需要的契机下,2009年中国开始了被称为"新医改"的医疗卫生体制改革。从医疗体制公平性角度,分析了改革方案中对医疗筹资、医疗支付和医疗服务机构3个方面的公平性考虑,提出加强累进性最强的税收筹资的力度,以及将财政资金更多地用于医疗需求方,即社会医疗保险的支持,以提高医疗筹资和支付的公平程度。坚持公立医院为主导,充分体现医院服务机构的公益性,也是改革方案中对公平性地体现,反映了新医改对公平性问题的高度关注。最后提出有待进一步明确的关于政府主导与市场调节的兼顾问题,农村医疗保障的完善、医疗筹资中公共资金的适度比例以及中医药的重新定位和重点发展。     

Public health and health reform in Australia

The national health reform agenda appears to have omitted public health. In this article, I outline how public health is different from primary care, and why a holistic approach to reform should include public health. The current reform agenda is very much focused on addressing the problems in acute care and the hospital system, with the focus on primary care being a means to this end. Until the health system is addressed as a whole, with all its essential components integrated and interlinked, truly successful reform of the health system, with genuine long-term vision and sustainability, will not be possible.     

Federal health financing

The CMA believes that financial support from the federal government for health care should provide for the following. [List: see text]

The CMA is committed to preserving the right of reasonable access to high-quality health care regardless of ability to pay. It is also committed to maintaining the national health care standards (accessibility, universality, portability, comprehensiveness and public administration) and developing health goals to ensure that all Canadians receive the best possible care when required. The CMA supports the goal of maintaining the national integrity of the health care system. It encourages the federal government to be sensitive to the concerns of equity and to ensure that provinces and territories that have not attained a level of health care services and facilities equivalent to those of other provinces and territories, because of fiscal incapacities, have access to additional funding requirements to reduce the gap. The CMA views stability in funding as essential to effective health care planning and believes that unplanned and unilateral federal reductions may compromise accessibility and quality of patient care.

     

Relationship between modifiable health risks and short-term health care charges

CONTEXT: If physical inactivity, obesity, and smoking status prove to contribute significantly to increased health care charges within a short period of time, health plans and payers may wish to invest in strategies to modify these risk factors. However, few data are available to guide such resource allocation decisions. OBJECTIVE: To examine the relationship of modifiable health risks to subsequent health care charges after controlling for age, race, sex, and chronic conditions. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of a stratified random sample of 5689 adults (75.5% of total sample of 7535) aged 40 years or older who were enrolled in a Minnesota health plan and completed a 60-item questionnaire. MAIN OUTCOME MEASURE: Resource use as measured by billed health care charges from July 1, 1995, to December 31, 1996, compared by health risk (physical activity, body mass index [BMI], and smoking status). RESULTS: The mean annual per patient charge in the total study population was $3570 (median, $600), and 15% of patients had no charges during the study period. After adjustment-for age, race, sex, and chronic disease status, physical activity (4.7% lower health care charges per active day per week), BMI (1.9% higher charges per BMI unit), current smoking status (18% higher charges), and history of tobacco use (25.8% higher charges) were prospectively related to health care charges over 18 months. Never-smokers with a BMI of 25 kg/m2 and who participated in physical activity 3 days per week had mean annual health care charges that were approximately 49% lower than physically inactive smokers with a BMI of 27.5 kg/m2. CONCLUSIONS: Our data suggest that adverse health risks translate into significantly higher health care charges within 18 months. Health plans or payers seeking to minimize health care charges may wish to consider strategic investments in interventions that effectively modify adverse health risks.     

工作场所暴力与医务人员健康状况的相关分析

目的:探讨医务人员遭受工作场所暴力和健康状况之间的关系,为预防工作场所暴力的发生、改善职业人群的健康状况提供理论依据。方法:采用工作场所暴力量表(WVS)和职业健康量表对某市361名医务人员遭受工作场所暴力的情况和健康状况进行调查。结果:361名调查对象一年来遭受不同类型暴力者241人,发生率为66.8%;遭受工作场所暴力与职业健康量表总分及生理功能、心理功能、社会适应能力分量表得分呈负相关,相关系数r分别为:r=-0.297,-0.253、-0.304、-0.134(P<0.05);多因素分析表明,在控制了其它因素后,遭受工作场所暴力是健康状况下降的危险因素,其OR值为10.47。结论:遭受工作场所暴力对医务人员的健康有影响,应采取措施预防和控制工作场所暴力的发生。     

浅谈社区卫生工作者在健康教育中应树立的意识

在当前实施的社区卫生保健过程中，健康教育工作发挥着极其重要的作用。医务工作者为了适应形势的发展，将健康教育工作引向社区，首先应该树立十种意识：即更新观念意识、社区卫生服务意识、竞争意识、经济效益意识、信息意识、创新意识、引导意识、参与意识、忧患意识、现代意识，以此来提高社区卫生保健中的健康教育工作的水平。     

医护人员心理和谐与心理健康的关系研究

目的 探讨医护人员心理和谐与心理健康之间的关系.方法 采用心理和谐量表 和症状自评量表测试了唐山市某医院313名医护人员.结果 医护人员心理和谐与心理健康总体水平低于全国均值,心理和谐与心理健康状况呈显著负相关;影响医护人员心理和谐及其各维度的因素包括情绪稳定性、病患合作程度、假日值班情况、工资待遇、疑难杂症解决率、医疗纠纷数量及偏执症状等,其中"能否有效解决疑难杂症"是最重要的影响因素.结论 心理和谐总体状况并不对医护人员心理健康产生影响,这可能说明心理和谐与心理健康是两套独立的评价体系.     

Foregone health care among adolescents

CONTEXT: No annual national population estimates exist of the numbers of adolescents who think they need but do not receive health care or their risk of health problems. OBJECTIVE: To describe the proportion of adolescents who report foregone health care each year and the influence of sociodemographic factors, insurance status, past health care, and health risks/behaviors on foregone care. DESIGN: Cross-sectional analyses of data from wave 1 of the National Longitudinal Study of Adolescent Health, conducted during 1995. SETTING: In-home interviews conducted throughout the United States. PARTICIPANTS: Of 27000 adolescents in grades 7 through 12 who were invited to participate, 20746 (76.8%) completed the in-home interview. MAIN OUTCOME MEASURE: Reported foregone health care in the preceding year by individual and family characteristics, insurance status, past health care, health/behavior risk factors, and symptoms. RESULTS: On average, 2268 (18.7%) of 12 079 adolescents reported foregone health care within the past year. Factors associated with decreased risk of foregone care included continuous private or public insurance (adjusted relative risk [95% confidence interval], 0.64 [0.50-0.82] to 0.82 [0.70-0.96]), and having a physical examination within the past year (0.87 [0.78-0.97] for male and 0.79 [0.70-0.88] for female adolescents). Factors associated with increased risk of foregone care included older age (1.12 [1.06-1.15] for male), minority race/ethnicity (1.25 [1.06-1.46] to 1.50 [1.30-1.73]), single-parent home (1.31 [1.18-1.46] for female), and disability (2.03 [1.61-2.52] for male and 1.66 [1.20-2.10] for female). Adolescents participating in the following behaviors were more likely to report foregone care than those who did not: daily cigarette use (26.0% vs 16.8%; 1.34 [1.16-1.55]), frequent alcohol use (30.3% vs 18.1%; 1.34 [1.11-1.62] for male), and sexual intercourse (25.1% vs 15.1%; 1.23 [1.09-1.39] for male and 1.39 [1.23-1.56] for female). From 32.4% to 38.2% of adolescents with symptoms suggesting health problems reported foregone care (1.61 [1.13-2.26] to 2.03 [1.81-2.28]). CONCLUSIONS: Our study suggests that adolescents who forego care are at increased risk of physical and mental health problems. Efforts to improve adolescent health through health care should address factors influencing foregone care.     

围产期孕产妇保健状况及健康教育效果调查分析

目的 调查围产期孕产妇的保健状况,并分析健康教育的效果.方法 选择全程参加孕妇学校的初产妇300名为孕妇学校组,另选择没有参加孕妇学校的初产妇300名为对照组.调查围产期孕产妇的保健状况及其对健康教育相关内容的需求,调查围产期健康教育对剖宫产率、自然分娩率、并发症等的影响情况.结果 两组对围产期相关保健知识掌握平均得分比较,差异有统计学意义,孕妇学校组显著高于对照组（P＜0.01）.两组产前检查的平均次数比较差异有统计学意义,孕妇学校组显著大于对照组（P＜0.01）.是否参加孕妇学校、产妇年龄、保健知识得分、家庭月收入、孕产妇的文化水平、丈夫的文化水平是影响孕产妇产前检查的相关因素.结论 健康教育能够增加孕产妇对围产期保健知识的掌握,促进自然分娩,降低孕产期并发症.     

Ethics and geographical equity in health care

Important variations in access to health care and health outcomes are associated with geography, giving rise to profound ethical concerns. This paper discusses the consequences of such concerns for the allocation of health care finance to geographical regions. Specifically, it examines the ethical drivers underlying capitation systems, which have become the principal method of allocating health care finance to regions in most countries. Although most capitation systems are based on empirical models of health care expenditure, there is much debate about which needs factors to include in (or exclude from) such models. This concern with legitimate and illegitimate drivers of health care expenditure reflects the ethical concerns underlying the geographical distribution of health care finance.     

Operationalizing universal health coverage in Nigeria through social health insurance

Nigeria faces challenges that delay progress toward the attainment of the national government''s declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria''s federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme.     

医疗质量分析要略

医疗质量分析要略应包括:(1)依据医疗质量概念和医疗质量管理结构,建立统计信息指标体系,提供和运用针对性强的医疗质量管理统计数据和信息。(2)面向医疗质量管理需求,分析的内容重点上应突出医疗质量的总体综合分析、未达到的指标分析以及影响医疗质量因素的专题词查分析。(3)针对医疗质量管理的规律性和特殊性,注重不同时段医疗质量分析中突出各月或季度医疗质量的特点。     

新疆克拉玛依市医疗机构卫生人员需求预测分析

目的：探讨新疆克拉玛依市2006-2010年医疗机构提供医疗卫生服务以及社会发展情况,测算2011-2015年医疗机构的卫生技术人员数量和机构,为合理配置与规划医疗机构的发展提供有效的依据。方法根据2006-2010的卫生服务需求数据,利用等维灰数递补动态模型预测2011-2015年的卫生服务需求数据,再利用卫生服务需求法计算2011-2015年的医生数,最后利用相应的指标推算其他人员的数据量。结果根据卫生服务需求法测算2011年克市医疗卫生机构总人数应为3508名,其中医生926名、护士1111名,2015年为3663名,其中医生967名、护士1160名;截止2010年底卫生人员是2987名,与2011年测算的卫生人员总数相差521名,卫生技术人员2010年数量与2015年测算的卫生技术人员相差643名。结论克市医疗机构卫生人员总量不足,卫生人员结构不合理,工勤人员比例偏高,其他卫生技术人员比例偏低;2011-2015年克市卫生技术人才引进工作压力大。