大型综合医院开展社区服务的实践

介绍了黑龙江省医院在完善改革措施的同时，开展社区卫生服务工作的实践经验，其服务形式为：（１）以医院为中心，在本市区设卫生服务网点的同时与全省６７家基层医院建立友好医院服务网，做到内外结合，点面结合；（２）为社区居民建立一两卡，且提供全程医疗服务。并对开展好社区卫生服务工作提出了４点建议。     

构建医院托管社区新模式的思考

医院托管社区卫生服务中心后,可以加强了医院与社区卫生服务中心的双向转诊工作,实现了医疗资源共享,医院的优质医疗资源直接辐射到社区,中心可以充分利用医院的技术、管理资源优势,在较短时间内提升社区卫生服务中心的服务质量和医疗水平,更好地为社区居民健康服务,同时也为医院拓展了发展空间。     

军队中心医院在县级行政区域内社区卫生服务中角色的思考

近年来 ,全国各地均加快了开展社区卫生服务工作的步伐 ,各医院是社区卫生服务的后盾。在县级行政区域内 ,县医院是全县社区卫生服务的中心。驻县军队中心医院一般为三级甲等医院 ,在临床医疗、科研、教学等方面均处于驻地医院领先水平 ,如何发挥其自身的优势 ,以何种角色参与社区卫生服务 ,保障驻地人民群众的健康水平 ,值得大家思考。本文从与县医院的协调分工 ,建立社区卫生医学技术培训基地 ,直接参与社区卫生服务等 3个方面予以论述。1　与县医院协调分工不可否认 ,县医院是全县范围内的临床医疗、医学科研和教学中心 ,其作用不可替代…     

浅谈温馨服务在全科医疗模式中的应用

随着经济的高速发展和人们生活水平的不断提高，人口结构进入老龄化，疾病谱和死因谱发生了改变，对医疗工作卫生保健的要求越来越高，原有的健康服务模式巳远远不能满足社会的需求。笔者所在医院为了适应经济形式发展，深化城市医院改革，把发展社区卫生服务作为重点，在本区域内开展全科医疗服务，建立新的医疗卫生保健服务模式。     

基层医院管理者对社区卫生服务工作的认识

为了促进本市社区卫生服务工作的发展,了解并提高医院管理人员对社区卫生服务工作的认识,我们就上海市基层医院管理者对社区卫生服务工作的认识情况开展本次调查。1 材料与方法 运用医学社会学调查方法进行现场问卷调查。被调查对象为上海市部分区、县26所基层医院(承担地区初级医疗预防保健任务的一、二级医院)现任党政正、副职领导,医务科长、防保科长、社卫科(部)及家床科负责人共152人。调查内容包括被调查者的基本情况,医院开展社区卫生服务工作现状,对社区卫生服务的形式、     

综合性医院与社区卫生服务中心协作之探讨

通过与社区卫生服务中心开展医疗帮扶工作,总结了成立医疗帮扶管理科、签订帮扶协议、开展人才培养、实施专科技术扶持、建立双向转诊关系、医院品牌传播等方面的做法与成效.体会到开展医疗帮扶,必须依靠卫生行政部门的指导和支持、必须是互惠双赢百姓受益、必须成立专职的部门、必须努力提升社区卫生服务机构的医疗服务能力和水平等.     

综合性医院开展社区卫生帮扶工作的体会

目前,国家正大力发展社区卫生服务,并制定了多项政策,给予社区卫生服务机构制度和经济上的支持[1-2];同时要求大型综合性医院医师开展社区医疗服务帮扶工作,使患者在社区能够真正享有便捷、优质的医疗服务.我院自2005年以来,陆续向南京市各社区派驻医疗骨干进行长期帮扶,获得了很好的社会反响.     

社区卫生服务体系建设项目理论评价案例：来自新疆石河子市的经验

新疆石河子市社区卫生服务在以政府投入为主体的运行模式下运行,管理上以市区两大综合医院为依托,建立了医院与社区卫生服务机构的有效合作机制,为全体居民按成本提供基本医疗服务和免费的公共卫生服务。该市在社区卫生服务政策制定上的经验对中小城市社区卫生服务体系建设具有参考价值。     

社区卫生服务对居民健康和医院效益的影响

社区卫生服务是社会进步的一个标志。建立以医院为依托 ,以社区居委会为纽带的社区卫生服务站 ,明确社区卫生服务的目标 ,发挥社区卫生服务的作用 ,满足社区居民对医疗服务的需求 ,及时为居民提供医疗保健卫生服务 ,不仅方便了群众 ,提高了居民的生活质量 ,而且医院通过社区卫生服务 ,综合利用医院的技术、设备、人力资源 ,提升了医院的形象 ,开拓了医院的医疗市场 ,是提高医院效益的途径之一。     

加强条块结合 提高妇幼保健质量

1995年上海市召开了城区工作会议，提出卫生、文化、教育、科技、体育、司法“六位一体”进入社区为广大居民服务。瑞金地段医院继1994-1997年开展“发挥社区功能，开展优生优育”特色项目后，1998年进入第二阶段——“开展中心城区妇幼保健工作管理及服务模式研究”：探索在大力加强社区卫生服务及开展社区医疗服务点的同时，将妇幼保健融入整个社区卫生工作，使原来仅仅靠妇幼组负责的妇幼保健工作（条）改由整个社区医疗眼务点医务人员共同承担（块），如此率先进行了“条块结合”的妇幼保健新模式试点。总结两年的工作，体会到“条块结合”强化了社区妇幼保健工作，有利于对流动人口中孕妇及儿童进行深入管理。同时，为保证“条块结合”后的工作质量，必须对全科医生和妇幼保健人员进行再培训以适应新的社区卫生保健工作模式。     

四类农村地区卫生人力配置效率的现状分析

利用１９９３年国家卫生服务总调查资料,结合农村改良医院规划模型的计算结果,参照１９８９年卫生部颁布的《医院分级管理办法》,分析我国农村卫生人力的配置效率及影响因素的现状;提出了全国农村及四类农村地区生力配置效率均有待提高,Ⅰ,Ⅱ,Ⅲ类地区病床使用率有待提高,Ⅳ类地区平均住院天数有待缩短Ⅰ类地区床工比有所降低。     

美国长期照护服务体系对中国的启示

本文综述了美国长期照护服务体系的服务机构、服务方式和服务提供者及其角色。美国长期照护服务机构可提供长期入住照护、短期入住照护、成人日间照护及居家照护服务,服务方式逐渐从机构服务向居家与社区服务转变。长期照护服务由正式照料者和非正式照料者共同提供,正式照料者提供有偿服务,非正式家庭照料者以女儿(29.3%)和配偶(21.2%)为主,随着居家和社区服务可用性增加,家庭照料者与有偿的正式照料者分担长期照护的可能性更大。美国长期照护服务体系结构完善,准入机制严格且系统,强调服务质量和效果评价,且重视老年人个人意愿,尊重其服务偏好和选择权利。基于美国的经验,我国在探索长期照护服务体系时,应以居家和社区照护为主,充分发挥社区卫生服务机构、社会和家庭的力量,注重服务机构和内容的多样化,建立完善和详细的服务使用评估标准,强调服务质量的有效性评价,体现人性化。     

‘If they’re helping me then how can I be independent?’ The perceptions and experience of users of home‐care re‐ablement services

Home‐care re‐ablement is a short‐term, intensive service that helps people to (re‐) establish their capacity and confidence in performing basic personal care and domestic tasks at home, thereby reducing needs for longer term help. Home‐care re‐ablement is an increasingly common feature of English adult social care services; there are similar service developments in Australia and New Zealand. This paper presents evidence from semi‐structured interviews conducted in early 2010 with 34 service users and 10 carers from five established re‐ablement services in England. The interviews formed part of a larger, mixed‐methods study into the immediate and longer term impacts and cost‐effectiveness of home‐care re‐ablement services. There was clear evidence that interviewees felt that they had benefitted from re‐ablement services; most service users and their families valued the intervention. However, the interviews also identified potential barriers to optimal independence for some service users, particularly those with progressive conditions, sensory impairments, specific cultural needs, or who lived alone. The beneficial impacts of re‐ablement could also be reduced if users failed to understand the aims of the service, or if the service failed to provide support with activities or outcomes that were particularly important to the service user or carer. Putting the lived experiences of people receiving re‐ablement at the centre of analysis, this paper concludes that re‐ablement services have the potential for enhanced effectiveness, particularly if there is more understanding of users’ own priorities and concepts of independence.     

Rural case management: a pilot study

The long term goal of this research is to improve the quality, effectiveness and efficiency of home and community-based services for rural long term care clients. Case management has been espoused as one method to improve services. Long term care case management models have been tested in urban areas with good results, but it is not known to what extent these models are applicable to the special circumstances of rural home and community-based care. The purposes of this pilot study are: 1. To describe case management in long term home health care as practiced in rural Kentucky. 2. To analyze case management for factors that promote or impede effective and efficient delivery of long term home health care for older rural Kentuckians. 3. To propose a model appropriate to case management in long term home health care for older rural Americans.     

Disease Management as a Part of Total Health and Productivity Management

When adults become ill they typically use more than just medical care services. They often miss time from work or incur periods of short term disability. In some cases, they also use workers’ compensation, occupational health or long term disability programme services and, in some situations, sick employees may attend work but be substantially less productive. Disease management programme vendors can enhance their services by managing the full spectrum of health and productivity programme services that people use, not just medical care services.Health and productivity management (HPM) refers to the coordination of the many types of services that employees use. These services include medical care, disability programmes, workers compensation programmes, employee assistance programmes, absenteeism and occupational safety programmes. HPM also refers to activities meant to enhance on-the-job productivity. HPM requires that disease management programme managers take a broader view of health and disease management than is typical. These programme activities may include deciding which disease(s) to address as priorities; developing treatment guidelines that focus on more than just clinical care; choosing appropriate and relevant outcome measures to address; implementing interventions that enhance productivity, improve health, and limit unnecessary medical care use; and supporting continuous quality improvement efforts.Considering these activities under an HPM umbrella requires a focus on productivity and quality of life that will add substantial value to the services offered by disease management programmes. The HPM approach will be more costly initially, but should prove more cost effective in the long term, since it considers a much wider array of potential benefits from health and disease management.     

Unmet health and rehabilitation needs of people with long‐term neurological conditions in Queensland,Australia

The survival and life expectancy rates of people with traumatic and degenerative neurological conditions are increasing, sometimes up to several decades. Yet compared to the general population, people with a disability continue to experience poorer health and are at greater risk of developing secondary health problems and facing barriers to services they require. These trends have significant implications for provision of health and rehabilitation services. In this study, the adequacy of health and rehabilitation services provided to people with long‐term neurological conditions and their unmet needs were explored from the perspectives of individual users, their nominated family members and key service providers. A qualitative research design with maximum variation sampling was used. Data were collected from semi‐structured interviews with 65 participants comprising 25 long‐term care service users, nominated family members or friends (n = 22) and care service providers (n = 18) in Queensland, Australia. All service users needed assistance with usual daily activities, and 22 were wheelchair dependent. The hours of funded personal care ranged from 2 to 201 hours per week. Data were analysed using framework analysis. Participants generally perceived that specialist medical and hospital services were adequate and satisfactory. They valued supportive health and rehabilitation professionals and receiving client‐centred physical rehabilitation. However, the majority of participants (n = 17) had perceived unmet needs for physical rehabilitation (n = 14), other health or rehabilitation services (n = 10) or counselling (n = 6). Community‐based physical maintenance rehabilitation was often perceived as inadequate, costly or inconveniently located. Participants highlighted the importance of personal and family counselling and information provision at time points such as diagnosis. The findings contribute to the limited international evidence on the gaps in health and rehabilitation services for people with neurological conditions receiving lifetime care services in the community. A continuum of integrated rehabilitation services to minimise avoidable impairments, optimise independence and functioning, and sustain quality of life is warranted.     

Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario,Canada: a cross-sectional study

Background

Given that immigration has been linked to a variety of mental health stressors, understanding use of mental health services by immigrant groups is particularly important. However, very little research on immigrants’ use of mental health service in the host country considers source country. Newcomers from different source countries may have distinct experiences that influence service need and use after arrival. This population study examined rates of use of primary care and of specialty services for non-psychotic mental health disorders by immigrants to Ontario Canada during their first five years after arrival. Service use by recent immigrants in broad source region groups representing all world regions was compared to use by age-matched Canadian-born or long term immigrants (called long term residents).

Method

This matched population-based cross-sectional study assessed likelihood of any use and counts of visits for each of primary care, psychiatric care and hospital care (emergency department visits or inpatient admissions) for non-psychotic mental health disorders from 1993–2012. Adult immigrants living in urban Ontario (n?=?912,114) were categorized based on their nine world regions of origin. Sex-stratified conditional logistic regression models and negative binomial models were used to compare service use by immigrant region groups to their age-matched long term residents.

Results

Immigrant were more or less likely to access primary mental health care compared to age-matched long term residents, depending on their world region of origin. Regarding specialty mental health care (psychiatry and hospital care), immigrants from all regions used less than long term residents. Across the three mental health services, estimates of use by immigrant region groups compared to long term residents were among the lowest for newcomers from East Asian and Pacific (range: 0.16–0.82) and among the highest for persons from Middle East and North Africa (range: 0.56–1.23).

Conclusion

This population-based study showed lower use of mental health services by recent immigrants than long-term immigrants or native born individuals, with variation in immigrants’ use linked to world region of origin and type of mental health care. Variation across source region groups underscores the importance of identifying underlying individual characteristics that affect service use to make services more responsive to newcomers.

     

Long-term benzodiazepine use by elderly people living in the community

Objective : To investigate the prevalence of long‐term benzodiazepine use in an elderly community sample, and factors associated with such use. Method : Data came from the Sydney Older Persons Study, a longitudinal study of people aged 75 or over. There were 337 subjects who were interviewed in 1991–93, and subsequently followed up after three and 4.5 years. At the first interview, subjects were assessed for socio‐demographic characteristics, physical and mental health, and use of health services. At the first and subsequent interviews, subjects were asked about use of medications, including benzodiazepines. Results : There were 16.6% who were using benzodiazepines at the time of all three interviews, while a further 19.6% were using them at one or two interviews. In a multivariate ordered logit regression model, long‐term benzodiazepine use was associated with treatment for nervous conditions, restless sleep, being female, being divorced and greater contact with medical services. Conclusions : The prevalence of benzodiazepine use in the elderly is high and much of this use is long term. The high prevalence of benzodiazepine use stands in contrast to the findings from national surveys that the elderly living in the community tend to have better mental health than younger age groups. Implications : Efforts are needed to reduce the number of elderly people becoming long‐term users. The use of benzodiazepines in this age group is of particular concern, because they may be a risk factor for falls and for cognitive impairment in the elderly.     

Changes in community health and welfare services with introduction of the long-term care insurance system in Japan

OBJECTIVE: In Japan, a long-term care insurance system for elderly people was introduced in April, 2000. We have conducted a survey using a questionnaire in order to explore consequent changes in community health and welfare services. METHODS: We sent questionnaires to all municipal governments (671 cities, 1,991 towns, 567 villages and 23 wards) in Japan in November, 2001, and obtained replies from 441 cities (response rate: 65.7%), 800 towns (40.2%), 197 villages (34.9%), and 16 wards (69.6%). The questionnaire included questions concerning the budget and manpower for community health and welfare services, the state of the long term care insurance system, and the activities of public health nurses. RESULTS: A total of 57% of all municipal governments was found to be carrying out the long term care insurance program in collaboration with other governments. In order to clarify the changes in welfare services for elderly people from the budgetary viewpoint, we calculated the ratios of the 2000 and 2001 fiscal budgets applied for welfare services for elderly people, in comparison with the 1999 fiscal year. The budgets for elderly people declined to about 40% in 2000 and 2001 compared with 1999, since the budget for care services was transferred to the account of the long term care insurance system. The activities of public health nurses employed by municipal governments were not affected by the introduction of long term care insurance system. About 80% of all municipal governments suggested that both the amounts of care services received by each elderly people and the number of elderly people who received care services were increasing, and about 70% indicated that the quality of care services was improved with introduction of the long term care insurance system. DISCUSSION: Most municipal governments consider that introduction of the long term care insurance system has had a good influence on community health and welfare services. Moreover, our results suggest that the long term care insurance has a beneficial impact on care services themselves.     

试论知识经济时代医院信息管理部门的信息服务模式

为探讨新时期医院信息管理部门的信息服务方式,提出了面向管理者、医务人员、病人的信息服务和以计算机网络技术为支持点的“三个面向”、“一个点”的信息服务模式,并对其特点、方法及依赖因素进行了论述。