建立和使用健康档案提高社区卫生服务质量

目的为了探讨提高社区卫生服务质量的途径和方法。方法从社区卫生工作的实际出发，参照国内文献，分析建立健康档案的意义、内容、基本要求以及存在的现状．寻求科学管理和有效利用的方法。结果健康档案内容和格式应标准化，管理和利用应计算机化与网络化。结论建立和用活健康档案是提高社区卫生服务质量的基础途径。     

Centralising acute stroke care and moving care to the community in a Danish health region: Challenges in implementing a stroke care reform

In May 2012, one of Denmark's five health care regions mandated a reform of stroke care. The purpose of the reform was to save costs, while at the same time improving quality of care. It included (1) centralisation of acute stroke treatment at specialised hospitals, (2) a reduced length of hospital stay, and (3) a shift from inpatient rehabilitation programmes to community-based rehabilitation programmes. Patients would benefit from a more integrated care pathway between hospital and municipality, being supported by early discharge teams at hospitals.A formal policy tool, consisting of a health care agreement between the region and municipalities, was used to implement the changes. The implementation was carried out in a top-down manner by a committee, in which the hospital sector – organised by regions – was better represented than the primary care sector—organised by municipalities. The idea of centralisation of acute care was supported by all stakeholders, but municipalities opposed the hospital-based early discharge teams as they perceived this to be interfering with their core tasks. Municipalities would have liked more influence on the design of the reform.Preliminary data suggest good quality of acute care. Cost savings have been achieved in the region by means of closure of beds and a reduction of hospital length of stay. The realisation of the objective of achieving integrated rehabilitation care between hospitals and municipalities has been less successful. It is likely that greater involvement of municipalities in the design phase and better representation of health care professionals in all phases would have led to more successful implementation of the reform.     

发展中国家的医疗卫生服务体系

考察了发展中国家的卫生筹资和服务提供体系,并认为发展中国家需要扩大医疗保障覆盖面,需要重新关注初级卫生保健和公共卫生,只有这样才能不断完善其卫生体系。     

香港社区护理的发展(综述)

香港社区护理发展于六十年代中期,经过三、四十年的发展,现今社区护理颇具规模.在2000年,香港医院管理局辖下有三十个社区护理中心及三百二十五名社康护士,每年提供家访共554269次,其中18637次是产科个案,454697次采访者是高于六十五岁.香港社区护理的发展是经过不少人各方的努力而达至今天的境地.概略来说,服务发展可分四个阶段,包括开垦期(1967-1973),探索期(1973-1978),演进期(1979-1991)及增进期(1992-现今).以下讨论这几个时期的发展,香港社康护士的职能及角色.     

Unresolved legal questions in cross-border health care in Europe: liability and data protection

Objectives

Directive 2011/24/EU was designed to clarify the rights of EU citizens in evaluating, accessing and obtaining reimbursement for cross-border care. Based on three regional case studies, the authors attempted to assess the added value of the Directive in helping clarify issues in to two key areas that have been identified as barriers to cross-border care: liability and data protection.

Study design

Qualitative case study employing secondary data sources including research of jurisprudence, that set up a Legal framework as a base to investigate liability and data protection in the context of cross-border projects.

Methods

By means of three case studies that have tackled liability and data protection hurdles in cross-border care implementation, this article attempts to provide insight into legal certainty and uncertainty regarding cross-border care in Europe.

Results

The case studies reveal that the Directive has not resolved core uncertainties related to liability and data protection issues within cross-border health care. Some issues related to the practice of cross-border health care in Europe have been further clarified by the Directive and some direction has been given to possible solutions for issues connected to liability and data protection.

Conclusions

Directive 2011/24/EU is clearly a transposition of existing regulations on data protection and ECJ case law, plus a set of additional, mostly, voluntary rules that might enhance regional border cooperation. Therefore, as shown in the case studies, a practical and case by case approach is still necessary in designing and providing cross-border care.     

老年人社区卫生服务意愿及影响因素

目的:研究福建省老年人的社区卫生服务意愿及影响因素,更好地开展老年人社区卫生服务工作.方法:对福建省24个县市的2100名60岁以上老年人进行调查.结果:福建省老年人的社区卫生服务意愿较强,其影响因素主要为医疗费用负担方式、文化程度及经济收入.结论:应积极探索和完善老年人社区保健体系,改善老年人的社会经济状况,加强健康教育,增强老年人自我保健意识,以满足他们的社区卫生服务要求.     

常用卫生领域绩效评价框架的发展和比较研究

目的:为我国卫生领域绩效评价提供借鉴。方法:阐述常用卫生领域绩效评价框架的发展,从评价对象、主要目标、评价维度、评价指标、应用情况等方面进行比较分析,并讨论其对我国的启示。结果与结论:在进行绩效评价时,需借鉴国外绩效评价理论,辩证地看待评价框架的优缺点,根据评价对象和实际情况选取合适的评价框架。     

Evaluating the impact of integrated health and social care teams on older people living in the community

Although it is perceived wisdom that joint working must be beneficial, there is, even at this stage, little evidence to support that notion. The present study is an evaluation of two integrated co-located health and social care teams which were established in a rural county to meet the needs of older people and their carers. This study does identify that patients from the 'integrated teams' may self-refer more and are assessed more quickly. This might indicate that the 'one-stop shop' approach is having an impact on the process of service delivery. The findings also suggest that, in the integrated teams, the initial stages of the process of seeking help and being assessed for a service may have improved through better communication, understanding and exchange of information amongst different professional groups. However, the degree of 'integration' seen within these co-located health and social care teams does not appear to be sufficiently well developed to have had an impact upon the clinical outcomes for the patients/service users. It appears unlikely from the available evidence that measures such as co-location go far enough to produce changes in outcomes for older people. If the Department of Health wishes to see benefits in process progress to benefits to service users, then more major structural changes will be required. The process of changing organisational structures can be enhanced where there is evidence that such changes will produce better outcomes. At present, this evidence does not exist, although the present study does suggest that benefits might be forthcoming if greater integration can be achieved. Nevertheless, until the social services and National Health Service trusts develop more efficient and compatible information systems, it will be impossible to evaluate what impact any further steps towards integration might have on older people without significant external resources.     

Equity and efficiency in funding long-term care from an EU perspective

A combination of demographic, social and macroeconomic developments have put European Union (EU) long-term care schemes under severe pressure with which they were never intended to cope. Adopting a cross-national comparative approach and combining existing literature with empirical findings, this article discusses advantages and disadvantages of different long-term care funding options using equity and efficiency criteria as an evaluation framework. Thereby, it shows the usefulness of spreading the risk of long-term care funding over the entire population by a national public scheme that works on a pay-as-you-go basis. From the point of both efficiency and equity in countries with a tradition of financing health care from tax revenues, care provision should be paid for by general taxation. In countries with an established tradition of social insurance schemes, it would seem most profitable to integrate a universal scheme alongside other insurance sectors combined. This, however, should be combined with a reduction of dependency on labour markets.     

青海省湟中县医疗联合体改革实践

我国西部经济相对不发达的县级地区普遍面临着县域内医疗服务体系碎片化,乡镇卫生院医疗卫生服务能力严重不足的问题。在有限的公共财政资源约束下,如何提高乡镇卫生院服务能力,改善医疗服务体系的服务质量、连续性和便利性成为我国县级医疗卫生体系改革的现实挑战。本文以青海省湟中县为典型案例,调研当地通过医疗服务联合体纵向整合县域医疗资源的改革实践,分析其行政管理一体化、人力资源整合、双向转诊、信息系统互联互通以及资源与检查结果共享等方面的改革措施及相应结构特点,为我国类似地区改革提供参考案例。     

医疗保障制度改革对医院的影响

该文根据云南省曲靖市1997年实施医疗保障制度、改革医疗市场供求关系发生的变化、医院运营情况(包括医疗服务量、医疗效率、业务收入、医疗费用等)、医院经济效益等方面的具体情况,结合翔实的数据,就医改运行对医院的影响进行了比较分析。     

Child health care centres: an academic model for comprehensive child health care in the community

The challenge of the discipline of paediatrics in the 21st century is to promote health and development of children in a way that will enable them to maximize their biological and social potential. The community child health centre (CHC) in Israel is a model of community health care service built to provide comprehensive health care to children and adolescents, as well as an academic setting for under- and postgraduate paediatric training. Today there are 34 CHCs in Israel, serving a population of 220 000 children from birth to 18 years of age. The CHC combines the advantages of group practice with those of an academic medical centre and enables flexibility and mutual learning. Further expansion and development are required to realize the CHC's mission of a true comprehensive academic centre for paediatric community health.     

The excess health care costs of KardioPro,an integrated care program for coronary heart disease prevention

Coronary heart disease (CHD) is a major cause of death and important driver of health care costs. Recent German health care reforms have promoted integrated care contracts allowing statutory health insurance providers more room to organize health care provision. One provider offers KardioPro, an integrated primary care-based CHD prevention program. As insurance providers should be aware of the financial consequences when developing optional programs, this study aims to analyze the costs associated with KardioPro participation. 13,264 KardioPro participants were compared with a propensity score-matched control group. Post-enrollment health care costs were calculated based on routine data over a follow-up period of up to 4 years. For those people who incurred costs, KardioPro participation was significantly associated with increased physician costs (by 33%), reduced hospital costs (by 19%), and reduced pharmaceutical costs (by 16%). Overall costs were increased by 4%, but this was not significant. Total excess costs per observation year were €131 per person (95% confidence interval: [€−36.5; €296]). Overall, KardioPro likely affected treatment as the program increased costs of physician services and reduced costs of hospital services. Further effects of substituting potential inpatient care with increased outpatient care might become fully apparent only over a longer time horizon.     

国际卫生改革经验对我国卫生体制改革的借鉴

通过对国际卫生改革经验的研究,作者建议,我国的基本卫生保健制度改革要立法先行;体现"公平优先、兼顾效率"的原则,确保人人享有公共卫生服务和基本医疗服务;基本卫生保健内容要与具体国情和财力相适应;正确认识政府和市场的作用,实现政府主导与市场机制的有效结合;做好卫生发展规划,发展社区卫生服务,建立健康"守门人"制度;建立社会化的老人照顾体系;拓宽卫生筹资渠道等。     

糖尿病宣教在社区保健中的作用

目的:探讨社区医疗对糖尿病患者治疗方法的宣传教育.方法:利用各种手段对糖尿病患者进行集体教育与个别指导相结合,使患者的血糖控制在正常范围.结果:社区医疗进行糖尿病的宣教可以使患者对糖尿病增加认识,进行自我保健,有效的控制并发症.结论:社区糖尿病宣教为糖尿病综合治疗的重要环节.     

Disparities in health care utilization among urban homeless in South Korea: a cross-sectional study

Objectives

We examined health care disparities in Korean urban homeless people and individual characteristics associated with the utilization of health care.

Methods

We selected a sample of 203 homeless individuals at streets, shelters, and drop-in centers in Seoul and Daejeon by a quota sampling method. We surveyed demographic information, information related to using health care, and health status with a questionnaire. Logistic regression analysis was adopted to identify factors associated with using health care and to reveal health care disparities within the Korean urban homeless population.

Results

Among 203 respondents, 89 reported that they had visited health care providers at least once in the past 6 months. Twenty persons (22.5%) in the group that used health care (n = 89) reported feeling discriminated against. After adjustment for age, sex, marital status, educational level, monthly income, perceived health status, Beck Depression Inventory score, homeless period, and other covariates, three factors were significantly associated with medical utilization: female sex (adjusted odds ratio [aOR, 15.95; 95% CI, 3.97 to 64.04], having three or more diseases (aOR, 24.58; 95% CI, 4.23 to 142.78), and non-street residency (aOR, 11.39; 95% CI, 3.58 to 36.24).

Conclusions

Health care disparities in Seoul and Daejeon homeless exist in terms of the main place to stay, physical illnesses, and gender. Under the current homeless support system in South Korea, street homeless have poorer accessibility to health care versus non-street homeless. To provide equitable medical aid for homeless people, strategies to overcome barriers against health care for the street homeless are needed.     

Choice and solidarity: the health sector in Eastern Europe and proposals for reform

The citizens of Eastern Europe have witnessed an unprecedented social and economic transformation during the past decade of transition from socialism to market-based economies. We describe the legacy of socialism and summarize the current state of the health sector in ten Eastern European countries, including financing, delivery, purchasing, physician incomes and the widespread phenomenon of under-the-table payments. The proposals for reform, derived from explicit guiding principles, are based on organized public financing for basic care, private financing for supplementary care, pluralistic delivery of services, and managed competition, with attention to incentives and regulation to impose a constraint on overall health spending.     

Consumer involvement in health care purchasing: the role and influence of the community health councils

Recent reforms in the National Health Service (NHS) place great emphasis on the importance of the ‘voice of the consumer’ in the provision of health care. Health purchasers are now required to adopt the role of ‘champion of the people’, traditionally that of the Community Health Councils (CHCs). In turn the CHCs have been encouraged to become more closely involved in the purchasing process. This paper draws on a national investigation of the operation of CHCs in order to examine the response of both the Councils and local purchasers to these developments. For many CHCs pressures for greater involvement may clash with their concern to retain an independent stance. This paper examines how closely CHCs are currently working with local purchasers and explores the central question of whether those prepared to work more collaboratively with their Health Authorities (HAs) are likely to have greater impact on purchasing decisions. The paper concludes that, while some CHCs are more closely involved than others, few perceive that they exert much real influence over the decision-making process. Councils share a general view that major purchasing decisions are increasingly being made without the opportunity for scrutiny by them or the wider public.     

创建全国社区卫生服务示范区 促进儿童保健事业发展

宝安区于1996年初在全省率先开展社区卫生服务,始终树立大卫生观念,坚持预防为主、中西医并重的原则,以社区文明建设为指导方针,以促进健康为目的,提供了以个人为中心、家庭为单位、社区为范围、老幼妇残为重点人群的卫生服务。经过多年的努力,全区现建有社区卫生服务中心(站)115个,覆盖人口160多万,已形成覆盖全区的社区卫生服务网络,并于2004年11月通过了全国社区卫生服务示范区的评估。