居民就医选择与基层医疗机构的竞争性分析

目的探索影响城乡居民选择基层医疗机构就诊的影响因素,并为基层医疗机构发展提出建议。方法采用Logistic回归对中国健康与营养调查2009年截面数据进行分析。结果疾病严重程度、医疗保险状况、有无工作以及户籍是影响居民选择基层医疗机构就诊的关键因素。结论应当针对这些方面对目前政策做出调整以增强基层医疗机构竞争力。     

广东省基层适宜卫生技术使用现状及筛选评价探讨

通过对广东省不同经济发展水平地区的基层医疗机构进行调查,了解其治疗常见病、多发病的卫生技术使用情况,探讨技术使用环境与卫生技术使用之间的关系,为开展适宜卫生技术遴选、推广和评估提供科学依据.     

新时期农村初级卫生保健事业发展的思考

21世纪的新一轮农村初级卫生保健取得了新进展。在新时期推进农村初级卫生保健意义重大。要正确认识现阶段农村初级卫生保健面临的新问题和挑战。农村初级卫生保健重点要抓好农村卫生服务体系建设、人才队伍建设和新型农村合作医疗制度建设,要立足于建立长效机制促进农村初级卫生保健工作任务的落实。     

澳大利亚初级卫生保健与全科医疗绩效考核概述

澳大利亚初级卫生保健的绩效考核主要围绕全科医疗,社区卫生、牙科服务、精神卫生、健康促进和疾病早期干预等进行。从对整个初级卫生保健的绩效考核看,相关的指标很多,但散见于不同的研究和项目中,未成体系。但针对全科医疗的绩效考核,澳大利亚全科医疗皇家学院（RACGP）进行了系统、深入的研究。RACGP从20世纪90年代起就致力于全科医疗质量标准的研发,经过不断修订,至今已发布了3个版本。RACGP的全科医疗标准以医疗服务质量和安全为导向,一级指标包括诊所服务、病人权利与需求、安全、质量改善和教育及执业管理和环境因素。这一标准对全科医生明确服务内容和标准、改善服务质量等发挥了积极作用,并成为新西兰、爱尔兰等国用于制定本国全科医疗质量标准的基础。     

国家卫生系统绩效测量与统计指标的概念框架

卫生系统绩效评价是2000年世界卫生组织提出的先进的卫生系统绩效评价方法,建立绩效测量与统计指标的概念框架是完善国家卫生服务系统功能的基础.定义衡量目标实现进度的关键绩效指标（KPI）,并建立KPI测量标准和标尺是得出绩效评分和位次的主要步骤.本研究根据国家卫生信息标准基础框架——国家卫生信息数据模型,对模型中的超级实体“卫生业务”中的“绩效目标”子实体做了扩展,兼顾国际可比性和我国的实用性,提出了由8个KPI组成的国家卫生系统绩效测量指标集,并阐述了指标的内容、测量标准及其意义,同时还简要讨论了数据元的标准化、指标标尺的制定等有关问题.     

初级卫生保健的内涵及其在我国的发展回顾

由世界卫生组织及其成员国于1978年《阿拉木图宣言》提出的“初级卫生保健”,是指最基本的、人人都能得到的、体现社会平等权利的、人民群众和政府都能负担得起的卫生保健服务。初级卫生保健所反映的核心价值观是社会公平,所信奉的理论是“健康乃人类的基本权利”,所追求的目标是“人人享有健康”,所采用的技术是适宜技术。中国初级卫生保健实践始于建国之初,20世纪50年代初确定的“面向工农兵、预防为主、团结中西医、卫生工作与群众运动相结合”四大方针,已包含了初级卫生保健的基本思想和内容。建国后的前30年取得的成就为国际上形成初级卫生保健策略奠定了实证基础,随后20年是我国初级卫生保健发展阶段,政府承诺实现2000年人人享有卫生保健的目标,但取得的健康效果有限。21世纪以来,政府仍然把初级卫生保健作为农村卫生的中心任务,但是可持续性问题还没有解决。     

Integrating the Use of Patient‐Reported Outcomes for Both Clinical Practice and Performance Measurement: Views of Experts from 3 Countries

Context

Patient-reported outcomes (PROs) can play an important role in patient-centered health care by focusing on the patient''s health goals guiding therapeutic decisions. When aggregated, PROs also can be used for other purposes, including comparative effectiveness research, practice improvement, assessment of the performance of clinicians and organizations, and as a metric for value-based payments. The feasibility of integrating the use of PROs for these various purposes on a wide scale has not yet been demonstrated. Our study was conducted to inform policymakers of prudent next steps for implementing PROs in clinical practice and performance measurement programs in order to maximize their impact on the quality of health care.

Methods

We conducted a qualitative study, interviewing 58 experts and leaders from 37 organizations (response rate: 88%) in the United States, England, and the Netherlands. Respondents included clinical practitioners (n = 30), measure developers (n = 11), and leaders of performance measurement programs (n = 17). We used a qualitative content analysis to assess current strategies for applying PROs in clinical practice and performance measurement and to identify barriers to and facilitators of further implementation.

Findings

The use of PROs in clinical practice and for performance measurement has developed both separately and in parallel. Experts across the stakeholder spectrum support the collection of PRO data in an integrated manner that would enable using the data for these distinct purposes. We identified 2 main concerns about the feasibility for integrated use of PRO data: the complexity of establishing routine data collection and the tension among stakeholders when using PRO data for different purposes. These contrasting stakeholder views suggested varying interests among clinicians, measure developers, and purchasers of care.

Conclusions

Data collection approaches that support the use of PROs in health care are underdeveloped, need better integration with clinical care, and must be tailored to the characteristics of the health care system. Enabling the sustainable use of PROs will require a shared vision of clinical professionals, purchasers, and patients, with a prudent selection of the steps in implementing PROs that will maximize their impact on the quality of health care.     

农村基层医疗卫生机构绩效管理探索——以甘肃省会宁县为例

甘肃省会宁县结合世界银行贷款,英国政府赠款中国农村卫生发展项目（简称卫生XI项目）,以推行乡村卫生机构绩效考核为突破口,以提高乡村卫生机构服务质量为核心,对全县所有乡村卫生机构实施了绩效考核和质量评价,并将考评结果应用于绩效支付等管理中,有效地改善了乡村卫生机构的服务质量与水平。对此项工作进行了总结,并重点探讨了实施过程及实施效果。     

What Palliative Patients and their Carers Need at Home and what a Primary Health Care Team can Offer – First Pilot Study in Slovenia

IntroductionSpending one’s last days and dying at home is a common wish of people with a life-limiting illness. Home-based palliative care is essentially organised at the primary level to meet the needs of palliative patients and their carers. The aim of this study was to identify the characteristics of home-based palliative care, focusing on those who identify palliative patients, what their needs are and how this affects their length of life and site of death.MethodsThis retrospective cohort study analysed routinely collected notes of patients enrolled in home-based palliative care between 2015 and 2021. Palliative care was provided by a primary health care team in a predominantly rural area.ResultsThis study included 107 palliative patients, aged 71±11.4 years, 94% of whom had cancer. They were enrolled in palliative care by their primary care team or by hospital staff. The enrolment by hospital staff (3%) resulted in significantly shorter survival (p=0.008). Patients lived an average of 66 days, and 65% of patients died at home. Home-based palliative care was found to respond to both basic and complex palliative medical needs, but was weaker in addressing socio-economic, psychological or spiritual issues.ConclusionThis exemplary primary-level palliative team provided home-based palliative care that has improved over the years in terms of all the observed quality indicators: early enrolment, the proportion of patients dying at home and the ability to address needs. Specialised mobile palliative teams, hospitals and other palliative care settings complement home-based palliative care.     

The Efficacy of Interventions to Reduce Adolescent Childbearing in Low‐ and Middle‐Income Countries: A Systematic Review

This study reviews the scope and quality of existing literature regarding the interventions to reduce adolescent childbearing in low‐ and middle‐income countries and compiles findings concerning their effectiveness. A total of 737 studies published between 2000 and 2011 were reviewed; 19 were identified as meeting eligibility criteria. Studies were included that: evaluated program effects on adolescents and young people, either as the primary target population or as a subset of a broader target group; evaluated an intervention intended to reduce adolescent fertility or generate improvements on a related outcome; and reported childbearing‐related outcomes. Evidence indicates that a variety of interventions may be successful at reducing fertility, including school‐based programs, health counseling, and cash transfers. An overview of evaluation efforts to date is provided, and potential best practices are highlighted. Conclusions are that funding for adolescent fertility initiatives should be directed toward programs for which a sound evidence base exists, such as cash transfers or other interventions that encourage school enrollment, and that programs of unknown effectiveness should be conducted in tandem with rigorous evaluation.     

Community Health Workers’ Provision of Family Planning Services in Low‐ and Middle‐Income Countries: A Systematic Review of Effectiveness

This systematic review evaluates the strength of the evidence that community health workers’ (CHW) provision of family planning (FP) services in low‐ and middle‐income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre‐test/post‐test studies met inclusion criteria. A total of 56 studies were included. Of those studies with relevant data, approximately 93 percent indicated that CHW FP programs effectively increased the use of modern contraception, while 83 percent reported an improvement in knowledge and attitudes concerning contraceptives. Based on these findings, strong evidence exists for promoting CHW programs to improve access to FP services. We recommend a set of best practice guidelines that researchers and program managers can use to report on CHW FP programs to facilitate the translation of research to practice across a wide range of settings.     

Annals Journal Club: Health Care Assistants in Primary Care Depression Management: Role Perception,Burdening Factors,and Disease Conception

PURPOSE In primary care, the involvement of health care assistants (HCAs) in clinical depression management is an innovative approach. Little is known, however, about how HCAs experience their new tasks. We wanted to describe the perceptions and experiences of HCAs who provided case management to patients with depression in small primary care practices.METHODS This qualitative study was nested in the Primary Care Monitoring for Depressive Patients Trial on case management in Germany. We used a semi-structured instrument to interview 26 HCAs and undertook content analysis. We focussed on 3 key aspects: role perception, burdening factors, and disease conception.RESULTS Most HCAs said their new role provided them with personal and professional enrichment, and they were interested in improving patient-communication skills. They saw their major function as interacting with the patient and considered support for the family physician to be of less importance. Even so, some saw their role as a communication facilitator between family physician and patient. Burdening factors implementing the new tasks were the increased workload, the work environment, and difficulties interacting with depressed patients. HCAs’ disease conception of depression was heterogeneous. After 1 year HCAs believed they were sufficiently familiar with their duties as case managers in depression management.CONCLUSION HCAs were willing to extend their professional responsibilities from administrative work to more patient-centred work. Even if HCAs perform only monitoring tasks within the case management concept, the resulting workload is a limiting factor.