A qualitative exploration of alternative strategies for building community health partnerships: Collaboration-versus issue-oriented approaches

Broad-based community partnerships are seen as an effective way of addressing many community, health issues, but the partnership approach has had relatively limited success in producing measurable improvements in long-term health outcomes. One potential reason, among many, for this lack of success is a mismatch between the goals of the partnership, and its structure/membership. This article reports on an exploratory, empirical analysis relating the structure of partnerships to the types of issues they address. A qualitative analysis of 34 “successful” community health partnerships, produced two relatively clear patterns relating partnership goals to structurel membership: (1) “collaboration-oriented” partnerships that included substantial resident involvement and focused on broader determinants of health with interventions aimed at producing immediate, concrete community improvements; and (2) “issueoriented” partnerships that focused on a single, typically health-related issue with multilevel interventions that included a focus on higher-level systems and policy change. Issue-oriented partnerships tended to have larger organizations governing the partnership with resident input obtained in other ways. The implication of these results, if confirmed by further research, is that funders and organizers of community health partnerships may need to pay closer attention to the alignment between, the membership/structure of a community partnership and its goals particularly with respect to the involvement of community residents.     

基于扎根理论的社区应用型精神卫生项目评价框架初探

目的:构建社区应用型精神卫生项目评价框架,为项目管理和评价提供依据,引导项目向好发展,促进社区精神卫生工作.方法:2019年7月采用目的抽样和理论抽样方法,对北京市朝阳区和海淀区41名精神卫生领域利益相关者,就社区精神卫生项目应具备的价值开展半结构式访谈,并运用扎根理论深入归纳、分析.结果:梳理自由节点1 467个、树...     

Collective health and regional integration in Latin America: An opportunity for building a new international health agenda

ABSTRACT

From its origins, the Latin American Social Medicine and the Collective Health (LASM/CH) movements have focused on thinking about health from and for the region. After the implementation of neoliberal policies, social improvements and the geopolitical strengthening of the region became the roots of new regional integration projects in South America. The objective of this article is twofold. First, we explore the legacy of long-standing efforts in the region that address the social and political dimensions of health, associated with the LASM/CH movements and their influence on the contemporary regional health agenda. Second, we analyze the UNASUR Health policy, its role in the construction of a regional health agenda, and the principles of South-South cooperation it supports. In order to accomplish this, a qualitative analysis was conducted, involving primary and secondary data. Through UNASUR, a new framework of regional health integration and regional health diplomacy emerged in South America and a ‘window of opportunity’ opened for the ideas of Social Medicine and Collective Health to occupy a dominant place on the regional health agenda. It is possible to observe a confluence between the principles and values of these movements and those of the main constituent bases of UNASUR Health.     

On the Goals of Medicine, Health Enhancement and Social Welfare

Bengt Brülde in his article ``The Goals of Medicine. Towards a Unified Theory' has proposed a normative theory of the goals of medicine within which the concept of quality of life plays a crucial role. In Brülde's analysis, however, the very concept of medicine is deliberately left quite vague and it is therefore difficult to see how the goals of medicine are related to the goals of closely allied enterprises such as health promotion and social welfare. In this reply I therefore propose an analysis of these related conceptual areas. I do this mainly in two respects. (1) Following the nomenclature in a previously published article (Nordenfelt, 1998) I propose a systematic conceptual framework for all varieties of health enhancement and distinguish different notions of medicine within this framework. A consequence of this analysis is, for instance, that the means and also the immediate goals of medicine in its broadest sense are more diversified than the means and immediate goals of medicine in its narrowest sense. (2) From this position I expand the topic further by comparing medicine and health enhancement with social welfare and try to trace the basic features between – as well as the common properties of – these different enterprises.     

Over-the-counter advice seeking about complementary and alternative medicines (CAM) in community pharmacies and health shops: an ethnographic study

In many ways, consumers of complementary and alternative medicine (CAM) embody the values that current policies aim to encourage such as self-caring and private consumption. For example, the British Government's choice agenda suggests patient choice and self-management are key government priorities and state that good information should be at the heart of all services. However, research on community pharmacies suggests that there is a continued lack of knowledge about CAM, especially herbal medicines and the limited research on health shops indicates that advice about CAM products is varied and inconsistent. Recognising the underlying tension of community pharmacies and health shops which combine both retail roles and promotion of patient wellbeing, we set out to examine customer advice seeking about CAM. The settings included independent and chain stores, selling varying amounts and types of CAM products. Data collection was ethnographic involving observation of staff–customer interactions, and semi-structured interviews with counter staff and people who purchased CAM products. The findings identified six main types of staff–customer interactions regarding over-the-counter CAM products. This typology ranged from needing significant amounts of help to needing very little including: help with diagnosis; help finding a general remedy; help with a specific product; free advice; pastoral care; and 'just buying'. The implications of these findings are discussed in the light of ongoing debates about the place of CAM in UK mainstream medicine and the evidence base for CAM. Potentially a highly valuable community resource, there is a lack of support for community pharmacies and health shops despite the government's choice agenda.     

The next phase of Title VII funding for training primary care physicians for America's health care needs

Health care reform will add millions of Americans to the ranks of the insured; however, their access to health care is threatened by a deep decline in the production of primary care physicians. Poorer access to primary care risks poorer health outcomes and higher costs. Meeting this increased demand requires a major investment in primary care training. Title VII, Section 747 of the Public Health Service Act previously supported the growth of the health care workforce but has been severely cut over the past 2 decades. New and expanded Title VII initiatives are required to increase the production of primary care physicians; establish high-functioning academic, community-based training practices; increase the supply of well-trained primary care faculty; foster innovation and rigorous evaluation of these programs; and ultimately to improve the responsiveness of teaching hospitals to community needs. To accomplish these goals, Congress should act on the Council on Graduate Medical Education's recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk.     

Autonomy,Well-Being,and the Value of Genetic Testing for Adopted Persons

This paper argues that the value of genetic-relative family health history (GRFHx) information and the notion that lack of this information is a disadvantage can be established through its role as a nested goal in comprehensive life projects independent of documentation of particular health outcomes. Health information often plays a significant role in a person's formulation of life goals and projects, as well as in identification of plausible effective means to realize these goals. If health outcomes are valuable in part because of the nested role these play in the successful realization of a person's life projects and goals, then other, similarly nested contributors to such success must also be valued on a similar scale. Some of these other contributors to a successful life may themselves be nested with health considerations, as illustrated in the relationship that will be the focus of this paper. Health information --independent of outcomes per se – influences relationships, reproduction, and the formulation of plausible comprehensive life goals in intricate and very influential ways. Although such information may be valued in part because it is predictive of health outcomes, this relationship does not reduce such information, nor the comprehensive life goals and projects such information promotes, to health outcomes. That is, while health status can both enhance and detract from the autonomous (successful) pursuit of life projects formulated in the context of health information, the value and weight of these projects is independent of particular health status or outcomes, even while in part shaped by them.     

Community Medicine in India — Which Way Forward?

Today, the Community Medicine professionals in India feel both “confused” and “threatened” by the mushrooming of schools of public health and departments of family medicine. The phenomenon of identity crisis and low-self esteem is not a recent one, nor is it restricted to India. The disciplines of community medicine and public health have evolved differently and despite some overlaps have differences especially in the need for clinical training. The core of the issue is that while the community medicine fraternity is keen to retain its clinical tag, what differentiates it from clinicians is the use of public health approach. I believe the strength of community medicine is that it bridges the gap between traditional fields of public health and clinical medicine and brings community perspective into health. The perceived threat from non-medical persons led public health is largely a result of us undervaluing our strength and our inability to foster partnership on equal footing with non-clinicians. While departments of community medicine have a fully functional rural or urban field practice area used for training at primary level care, these can serve as an excellent platform for training in secondary level care required for family medicine. National needs dictate that all three disciplines are required for improvement of population health, whether these are housed together or separately can be left to individual institutions to decide as long as they enable collaborations between them. We need to strengthen community medicine and market it appropriately to ministries of health.     

Conceptualization of a Toolkit to Evaluate Everyday Competence in Planning Transitions From Nursing Homes to the Community

Living independently in the community is a primary goal for older adults, particularly for the estimated 10% to 20% of long-stay nursing home residents who have low care requirements. According to the model of person-environment fit, individuals with high levels of everyday competence have the ability to solve problems associated with everyday life. Nursing home residents with high levels of everyday competence and low care needs have poor person-environment fit, placing them at risk for declines in function, maladaptive behavior, and affective disorders. The goal of this article is to present a framework for the integration of everyday competence with standardized goal-setting and care-planning processes to enable the transition of appropriate nursing home residents back to the community. Barriers to community transitions exist across several Key Domains: rehabilitation, personal assistance and services, caregiver support, finances, housing, and transportation. We propose a research agenda to develop and implement a toolkit based on this framework that nursing home staff can use to overcome barriers to transition by (1) assessing residents' everyday competence, (2) developing personally meaningful goals that facilitate transition, and (3) conducting structured care planning to support resident goals around returning to the community. If successful, this toolkit has the potential to reduce costs associated with nursing home care and to improve functional health, psychological well-being, and quality of life for older adults. The proposed framework and toolkit complement national efforts focused on transitioning nursing home residents back into the community.     

新医改背景下的义乌市基层防保队伍人力资源分析

目的 了解新医改背景下的义乌市基层防保人力资源情况,为推进新医改提供基础数据.方法 2012年10月对义乌市13个社区卫生服务中心从事基层防保工作的工作人员进行调查.结果 义乌市基层防保人员共有75名,每万名常住人口有0.61名基层防保人员,17.33％的人员为预防医学专业,初级职称占88.00％.结论 队伍总体数量不足,结构不十分合理,总体素质亟待提高.     

Transgender health in medical education

Transforming our world the 2030 agenda for sustainable development is working towards a world that reflects equity, with universal respect for human dignity, pledging to leave no one behind. However, transgender and gender-diverse individuals experience significant health inequities, including negative health outcomes and multiple barriers to accessing care. In this article, we first highlight the health inequities that transgender and gender-diverse people face globally. We describe important aspects of transgender and gender-diverse health care, including the design and provision of health services, epidemiological considerations, transition-related care, changes in transition-related goals, cultural considerations, and political and legal issues. We then review the existing global literature on incorporating transgender health into medical curricula. We make a case for prioritizing improved education in medical schools on the specific health needs of transgender and gender-diverse people as part of addressing global health inequities in care. Our recommendations for comprehensive education on transgender health include cultural humility and anti-oppression training; involvement of transgender and gender-diverse community members; integration of transgender and gender-diverse health into curricula; practice-focused and in situ training; staff development in medical schools; and improving access to careers in medicine for transgender and gender-diverse people.     

Can health promotion and primary health care achieve Health for All without a return to their more radical agenda?

Primary health care (PHC) and health promotion (HP), codifiedin the Alma Ata Declaration of 1978 and the Ottawa Charter of1986, and aiming to achieve Health for All by the year 2000(HFA 2000), are strikingly similar in their conception and evolution.Originally conceived as global strategies to reduce inequitiesin health between and within nations and emphasising intersectoraland community action, both have tended to be reduced to a morelimited and technical approach to selected diseases within nations. In the implementation of these strategies, four trends threateningthe achievement of HFA 2000 are analysed. Managerialism, manifestingin a goals and targets approach to health promotion has cometo dominate and constrict its implementation in Australia andother industrialised countries, detracting from social and environmentalimperatives and community action in addressing these. The increasingdominance of market economics and the promotion of economicgrowth at all costs is reinforcing inequities in health experienceglobally and within countries. Individualism, the philosophicalaccompaniment of market economics, has reinforced a behaviouraland lifestyle focus and undermined a collective approach toHP and PHC. Environmental degradation, a growing global threatto public health and ultimately amenable only to global economicrestructuring has been perilously ignored in the managerialistimplementation of HFA. The elements of an agenda for action are identified with somesuggested broader goals. A return to the original more radicalphilosophy underpinning the strategies of PHC and HP, it isargued, is fundamental to the achievement of HFA, even if thisis no longer possible by the year 2000.     

中医药服务对社区医疗机构发展影响探讨

目的了解社区医疗机构中医药服务开展情况及存在问题,探索新时期背景下基层中医药服务发展模式。方法对湖北省十堰市M区下辖的7家社区卫生服务中心和20家社区卫生服务站进行了调研,并对中医药服务相关数据进行统计分析。结果在政策引导下,社区医疗机构中医药服务不断发展;既能为社区居民提供中医药服务,也能够促进社区卫生服务机构提高收入,呈现双赢局面;社区中医药服务能力总体向好,但仍然比较薄弱。结论社区医疗机构应认识到中医药服务对机构发展的重要性,通过加大资金投入,积极主动宣传,强化人员培训,创建发展特色中医药项目来不断推进基层卫生事业的良性发展。     

基于J2EE云平台大数据的居民健康管理服务体系构建与应用

目的:设计基于云平台、大数据的健康管理系统,以满足居民自身健康管理需求。方法:采用J2EE组合框架平台,利用Oracle数据库软件设计开发居民健康管理系统,建立基于云计算、大数据等新型数据深度融合于应用技术的智慧居民健康管理服务系统。系统由用户管理、健康数据、健康管家、家庭健康及网上医院等模块组成,以互联网为载体,为社区居民提供专业、便利、高品质的全数据和多元化智慧健康服务。结果:设计建立的居民健康管理服务系统可实现远程预约就诊,已有2000余名家庭医生完成居民健康管理平台注册,平台已服务居民>500万余人次,对居民健康进行系统化、网络化管理,利用有限的资源在社区居民疾病发生前了解家庭健康情况,有针对性地进行预防,并可提高慢性病管理效率,助力推动个性化医疗的发展。结论:基于J2EE云平台大数据的居民健康管理系统,对实现自我、动态、在线和集成健康管理以及完善居民健康管理信息化具有积极的参考价值,有利于促进居民健康。     

Complementary and alternative medicine: the next generation of health promotion?

This paper reports on a research study into the professional interface between health promotion and complementary and alternative medicine. The study was conducted in the UK, the USA and, to a lesser extent, Eastern Europe. Professionals from both sides of the interface were interviewed. The findings suggest that health promoters committed to individual empowerment and community action are the most likely to support some form of involvement with complementary and alternative medicine, while the least likely are those committed to structural changes through a public health agenda. The paper identifies the potential for closer integration but also reports on substantial barriers to collaboration between these two professional groups.     

Community-based projects in rural internships: an alternative approach

Supervision of medical interns posted to various primary health centres and rural health training centres by specialists in preventive and social medicine and other clinical disciplines is becoming less and less effective for a number of unavoidable reasons. Because of lack of proper and timely guidance, interns feel that during the 6-month rural internship they do not get enough experience of rural life. In order to provide them with learning experiences in community medicine and orient them in the social dynamics of the community, a new approach involving interns in small community-based projects, probably for the first time, was tried on a pilot basis at the Rural Health Training Centre (RHTC), Sirur, a field practice area of B.J. Medical College, Pune, Maharashtra, India. Interns working at RHTC Sirur completed these community-based projects successfully. Identification of problems, study design analysis and drawing conclusions, based on observation, were all undertaken by the interns under the guidance of the staff of the Department of Preventive and Social Medicine, B.J. Medical College. The opinion poll at the end of the rural internship revealed that 76% of interns considered this experience valuable for improving their knowledge and skills, and 56% though that interaction during these projects was beneficial to the community as well. This experience with community-based projects for interns during their rural posting provides them with an opportunity for interaction with the community.     

东中西部社区卫生服务站医保纳入及实施效果比较分析

目的：了解我国东、中、西部社区卫生服务站医保政策实施情况及其效果。方法：利用社区卫生服务全国重点联系城市常规监测数据,采用χ2检验、wilcoxon秩和检验和Kruskal-WallisH检验方法进行统计分析。结果：（1）2009年,东、中、西部地区社区卫生服务站医保定点比例分别为66.52%、56.35%、66.43%。（2）服务提供效率与利用率：东部地区医保定点站医生日均门诊服务数量高于非定点站,居民人均门诊服务利用数量低于非定点站;中部地区医保定点与非定点站医生日均门诊服务数量和居民人均门诊服务利用数量差异均无统计学意义;西部地区医保定点站医生日均门诊服务数量和居民人均门诊服务利用数量均高于非定点站。（3）门急诊服务量与业务收入：东、西部地区医保定点站平均门急诊服务量和业务收入均高于非定点站;中部地区医保定点与非定点站的平均门急诊服务量无统计学差异,医保定点站平均业务收入高于非定点站。有医保收入的站中,东、中、西部地区医保收入占业务收入的比例分别为44.80%、19.97%、37.57%。结论与建议：加大财政投入,提高社区卫生服务站医保定点比例;适度增加东部地区医保定点站人员数量,提高服务能力;促进社区卫生服务站与医保政策的有效衔接,充分发挥医保政策效果。     

Bridging the gap between professionals and the community in mental health services: findings and policy implications of two demonstration projects

This paper describes two projects which targeted citizens as key players in the well-being and mental health of local communities and have tapped the mutual aid resources of informal helping networks. One of these projects was implemented with people who had mental health problems, many of whom were homeless and dependant drug users, in Quebec's inner city. Two professional workers, who were experienced in neighbourhood interventions (a psychologist and an educator) and a researcher were employed for a period of 28 months (from September 1989 to December 1991). The other project was implemented within the context of primary care for a wide range of health and social problems in a rural LCCS (Local Centre for Community Services). A social worker, who specialized in rural network intervention, was employed for 2 years. The same research team worked on both of the projects. The main objective of both projects was the development and testing of a method of intervention which aimed to encourage citizen involvement, both in promoting the physical and mental health of those suffering from transitory problems, and in the rehabilitation process of those suffering from severe social or mental health problems. In order to accomplish that objective, the professional workers made themselves visible and accessible in the community. The projects generated two very different models of intervention. The inner city model of intervention was tied closely to pivotal citizens and placed a great emphasis on the helper-therapy principle. The rural model was founded on network intervention, mutual aid being more relevant for marginal people. Even though these models of intervention embody provincial and federal government policies, professionals are far from ready and able to change their practice accordingly.     

新医改背景下上海市居民对基层医疗卫生服务满意度的调查研究

目的 了解新医改背景下上海市居民对基层医疗卫生服务的满意度.方法 采用分层抽样方法,选取上海市中心城区、城乡结合区和郊区9家社区卫生服务中心,采用自行设计问卷对2 250名门诊患者就其对基层医疗卫生服务满意度进行测评.结果 居民对新医改的满意率为85.2％;对基本医疗保障制度的满意率为85.0％;对基层医疗服务比较满意,满意率为96.5％;对基本公共卫生服务的满意率为95.1％.年龄、城乡、职业、文化程度和收入是居民对基层医疗卫生服务满意度的主要影响因素.结论 总体而言,上海市居民对基层医疗卫生服务满意度较高,但也存在一些问题值得关注,如基本医疗保险保障水平和报销手续仍有待提高、基层医疗卫生机构的诊疗费用仍需合理控制和基本药物无法完全满足基层医疗机构的用药需要.