健康教育在妇女保健中的作用探究

  目的  分析京沪两地识别妇女保健需要权威程度的变迁情况及其与孕产妇死亡率的关系,并验证识别妇女保健公众需要权威程度量化评价的可行性。  方法  从研究机构、专业机构和政府3个层面出发,收集2000 — 2017年京沪两地发布的所有妇女保健敏感指标公开信息,运用描述性方法等分析两地发布妇女保健需要信息的变迁情况,并运用Spearman相关、单因素回归等分析识别权威程度与孕产妇死亡率的关系。  结果  上海政府等机构共同发布妇女健康敏感指标信息情况略优于北京,共同发布信息的问题数占比由2000年的30.0 %提升至2017年的40.0 %,北京则由2000年的0 %提升至2017年的30.0 %,其中育龄期保健类型上海三类机构共同发布信息的问题占比保持在40.0 %水平,北京最高为20.0 %,孕产期保健类型京沪共同发布情况2017年均为50.0 %,但上海在2000年已发布问题占比已为25.0 %;最终识别妇女健康需要的权威程度北京由40.5 %提升至63.1 %,上海由59.9 %提升至69.9 %。两地识别权威程度与孕产妇死亡率均存在负相关,其中上海的相关程度高于北京,相关系数为 – 0.710,北京为 – 0.484,京沪识别妇女健康需要权威程度与孕产妇死亡率均存在负影响关系,方程解释程度为37.2 %和47.1 %。  结论  适宜的妇保体系应加强政府等主要部门对健康需要的识别,上海识别妇女保健权威程度提升对健康结果作用略高于北京,专业机构应加强对妇女保健信息的识别与发布,促进妇女健康水平的提高。     

Effects of perceived autonomy support and basic need satisfaction on quality of life in hemodialysis patients

Purpose

Despite a growing understanding of health-related quality of life (HRQOL) and its determinants in hemodialysis (HD) patients, little is known about the effects and interrelationships concerning the perception of autonomy support and basic need satisfaction of HD patients on their HRQOL. Based on self-determination theory (SDT), this study examines whether HD patients’ perceived autonomy support from health care practitioners (physicians and nurses) relates to the satisfaction of HD patients’ basic needs and in turn influences their HRQOL.

Methods

A questionnaire was administered to 250 Taiwanese HD patients recruited from multiclinical centers and regional hospitals in northern Taiwan. Structural equation modeling (SEM) analysis was conducted to examine the causal relationships between patient perceptions of autonomy support and HRQOL through basic need satisfaction.

Results

The empirical results of SEM indicated that the HD patients’ perceived autonomy support increased the satisfaction of their basic needs (autonomy, competency, and relatedness), as expected. The higher degree of basic need satisfaction led to higher HRQOL, as measured by physical and mental component scores.

Conclusion

Autonomy support from physicians and nurses contributes to improving HD patients’ HRQOL through basic need satisfaction. This indicates that staff caring for patients with severe chronic diseases should offer considerable support for patient autonomy.

     

Experience of racism and associations with unmet need and healthcare satisfaction: the 2011/12 adult New Zealand Health Survey

Objective: Racism may affect health through differential access to, and quality of, healthcare. This study examined associations between experience of racism and unmet need and satisfaction with healthcare. Methods: Cross‐sectional analysis of the 2011/12 adult New Zealand Health Survey (n=12,596) was undertaken. Logistic regression was used to examine associations between experience of racism (by a health professional and other experiences of racism [ever]) and unmet need for a general practitioner and satisfaction with a usual medical centre in the past year. Results: Experience of racism by a health professional and other forms of racism were higher among Māori, Pacific and Asian groups compared to European/Other. Both racism measures were associated with higher unmet need (health professional racism adjusted OR 3.52, 95%CI 2.42–5.11; other racism OR 2.21, 95%CI 1.78–2.75) and lower satisfaction with a usual medical centre (health professional racism adjusted OR 0.25, 95%CI 0.15–0.34; other racism OR 0.60, 95%CI 0.45–0.79). Conclusions: Racism may act as a barrier to, and influence the quality of, healthcare. Implications for public health: Addressing racism as a public health issue and major driver of inequities in healthcare and health outcomes is required within the health sector and wider society.     

Optimizing primary care telephone access and patient satisfaction

Telephone medicine is often preferred by patients to meet primary care needs and may be associated with high patient satisfaction. This article presents findings about incoming patient calls to primary care for medically based reasons during office hours and reports factors independently associated with telephone encounter satisfaction, considering patient characteristics, call reasons, and staff responsiveness, for a national cohort of primary care users. Interviews were conducted with patients from 18 nationwide primary care clinics during the fall of 2009. Calling for an urgent medical issue was associated with dissatisfaction. Odds of call satisfaction were greater when patients thought staff was friendly (10×), call answer was timely (5×), and needed medical information was provided (7×). These findings can be used for interventions to optimize telephone access and patient satisfaction which is beneficial because satisfactory telephone encounters reduce primary care use and satisfied patients are more likely to be engaged in their health care.     

Women's satisfaction with pregnancy follow-up. Differences among healthcare levels

OBJECTIVES: To determine women's satisfaction with pregnancy follow-up and to evaluate possible differences among healthcare levels. METHODS: Cross-sectional study in women who had given birth in the University Hospital of Salamanca (Spain) between November 2002 and April 2003. Satisfaction was measured by a self-completed questionnaire after delivery. The questionnaire contained 28 items, with five optional answers (1, not satisfied; 5, highly satisfied), distributed in four dimensions: accessibility, equipment, organization of the consultation, and professional competence. Social demographic and healthcare-related variables were also included. Student's t-test, variance analysis, Pearson's correlation coefficient and logistic regression were used to study the association between these variables and satisfaction. RESULTS: A total of 27.1% of pregnancies were followed-up in primary care. The mean global satisfaction was 3.92 (95% CI, 3.88-3.97), and satisfaction was higher in women followed-up in primary care than those followed-up in specialized care. All dimensions obtained a global satisfaction of more than 3; "accessibility" received the worst score and "professional competence" the highest. The factors significantly associated with satisfaction were age, educational level, the presence of risk factors and complications, and the possibility of choosing the physician. CONCLUSIONS: General satisfaction was good. Because satisfaction was higher in women followed-up in primary care than in those followed-up in specialized care, pregnancy follow-up at this level of healthcare should be supported.     

Nursing and justice as a basic human need

This paper explores the idea that justice is a basic human need akin to those famously depicted in Maslow's hierarchy of human needs and, as such, warrants recognition as a core element in representative ideas about nursing. Early nurse theorists positioned the principles and practice of nursing as having their origins in ‘universal human needs’. The principle of deriving nursing care from human needs was thought to provide a guide not only for promoting health, but for preventing disease and illness. The nursing profession has had a longstanding commitment to social justice as a core professional value and ideal, obligating nurses to address the social conditions that undermine people's health. The idea of justice as a universal human need per se and its possible relationship to people's health outcomes has, however, not been considered. One reason for this is that justice in nursing discourse has more commonly been associated with law and ethics, and the legal and ethical responsibilities of nurses in relation to individualized patient care and, more recently, changing systems of care to improve health and health outcomes. Although this association is not incorrect, it is incomplete. A key aim of this paper is to redress this oversight and to encourage a broader conceptualization of justice as necessary for human survival, health and development, not merely as a professional value, or legal or ethical principle for guiding human conduct.     

Selected factors determining outsourcing of basic operations in healthcare entities in Poland

BackgroundIn light of insufficient financial resources allocated to the functioning of the health care system in Poland, healthcare entities undertake several restructuring measures aimed at cost reduction, improvement of effectiveness and optimisation of operations. One of the elements of this restructuring is outsourcing.ObjectiveThe objective of the study is to determine the significance of selected factors determining the outsourcing of basic operations in healthcare entities in Poland.MethodsThe research tool was the authors’ questionnaire. The study was conducted at healthcare entities using the CAWI method in 2018. The outsourcing of laboratory diagnostics, diagnostic imaging and medical personnel was examined.ResultsOut of 750 healthcare entities, 241 outsource medical personnel, 484 outsource laboratory diagnostics, 445 outsource imaging diagnostics. The use of outsourcing primarily results from the excessively high cost of maintaining own employees, the desire to gain access to the top-quality knowledge and technology as well as the need for financial savings.ConclusionsThe scale of outsourcing of medical personnel may be greater than it results from the obtained study results. Excessively high costs of maintaining own employees as the most important reason for using outsourcing is a consequence of high personnel costs occurring in the case of establishing cooperation on the basis of an employment relationship.     

Certificate of need and the cost of competition in home healthcare markets

ABSTRACT

We used 2010–16 Medicare Cost Reports for 10,737 freestanding home health agencies (HHAs) to examine the impact of home health (HH) and nursing home (NH) certificate-of-need (CON) laws on HHA caseload, total and per-patient variable costs. After adjusting for other HHA characteristics, total costs were higher in states with only HH CON laws ($2,975,698), only NH CON laws ($1,768,097), and both types of laws ($3,511,277), compared with no CON laws ($1,538,536). Higher costs were driven by caseloads, as CON reduced per-patient costs. Additional research is needed to distinguish whether this is due to skimping on quality vs. economies of scale.