发挥临床医生优势 开展临床预防服务

随着疾病谱的变化，人类不得不考虑慢性病可能盛行的现实。由于目前对慢性非传染性疾病尚不能根治，病情往往迁延不愈，使家庭和社会承受着沉重的经济负担。据1998年统计，我国卫生总费用中一半以上由个人卫生支出构成。而非传染性疾病(如肿瘤、糖尿病等)造成的经济损失亦占全部疾病之首。影响这类疾病的因素中，心理、文化和社会因素占30％，人类自身行为影响占据50％。因此，人类开始要求生物、心理、社会全方位的医疗服务。根据慢性病病因复杂且有个体化特点，临床医生的使命不仅是治疗疾病，还应转向从“身体上、心理上、社会上”使患者力促成为一个健康的人。据此，开展临床预防服务可带来良好的成本一效果和成本一效益，减轻家庭和社会经济负担，使人类寿命得以延长。据报道，刚刚过去的一个世纪中，美国临床服务使     

骨质疏松的预防与健康管理

健康管理是一种对个人及人群的健康危险因素进行全面管理的过程，是对健康危险因素的检查监测（发现健康问题）→评价（认识健康问题）→干预（解决健康问题）→再监测→再评价→再干预。其中健康评价是关键，健康干预是手段，健康促进是目的，健康管理循环的不断运行使管理对象走上健康之路，不能形成有效的健康循环就不能成为健康管理。     

基本预防保健有偿服务与无偿服务的探讨

随着人们的物质生活水平的提高，对科学知识的需求不断增长，尤其对自然与生命和健康关系的认识已发展到一个新的历史阶段，这一被人们所广泛重视的自然科学规律无时无刻的冲击和检验着整个医疗领域里的工作。世界卫生组织提出“健康”概念，早已更新了人们的观念，对“健康”的概念有更深层次的理解，人们强烈的意识到保持机体内、外环境的平衡，人的生理、心理适应能力更与社会环境相适应，强化了人们对健康意义的理解意识。     

预防保健工作参与社会卫生服务的思考

1 原因分析1.1 各级政府和卫生主管部门对社区卫生服务的功能认识上还有一定的距离,片面认为社区卫生服务就是全科医疗服务,而实际上社区卫生服务应包括基本医疗服务、公共卫生服务、特需医疗服务三部分主要内容,而其中的公共卫生服务应该是核心,是重中之重。因此,政府和有关部门预防保健机构参与社区卫生服务的要求不高、措施不硬、力度不大,更是缺少必要的考核和奖惩办法。     

农村卫生机构提供基本预防保健服务的意愿研究

基本预防保健服务是农村卫生工作的重点,它对防治急慢性传染病的爆发与流行,强化地方公共卫生管理,推动农村爱国卫生运动深入开展,保护人民身体健康,促进地方经济发展有着十分重要的作用.研究农村卫生机构提供基本预防保健服务的意愿,提高村诊所提供基本预防保健服务的意识,研究结果表明:增加村诊所的财物总额以提高经济活力,对村诊所提供的基本预防保健服务以适量的补偿,加大村诊所医疗卫生服务竞争的力度,是提高基本预防保健服务意愿的关键.同时公有诊所和公占优混合所有诊所提供基本预防保健服务意愿程度高于私有诊所,寻找激励私有性质的村诊所负责人提供基本预防保健服务意愿十分必要.     

农村基层防保服务落实难点分析

本文通过对农村居民的问卷调查，了解农村居民对防保服务的认知及实际利用情况，并与防保服务供方的判断进行比较，以探讨基层防保工作难以落实到位的主要原因。结果显示农村居民的防保意识较强。对于防保服务的认知水平较高，但其支付意愿相对较低。造成该现象的原因主要是由于我省经济比较落后。农村居民的支付能力还相对有限。且基层防保机构并没有按照居民的实际需要提供足够的防保服务，使得农村居民对其的可利用度受到很大程度的限制。     

计算机在预防保健与医院感染管理信息系统中的应用研究

目的为建立一个功能齐全的预防保健与医院感染管理信息系统,替代原始的手工传染病、医院感染等疾病填报、传递、整理、登记、统计、分析、查询、反馈的整个过程. 方法在医院信息系统平台上,构建医院预防保健与医院感染管理信息系统,采用C/S构架,后台采用SQL SERVER 2000企业版大型数据库,前端应用程序使用PowerBuilder7编程,将突发公共卫生事件、传染病疫情和医院感染管理信息数据采集的应用软件,集成到医院管理系统的各个工作站上,构建涉及医院任何部门的报告、监控网络. 结果该系统能对医院各部门发现的突发公共卫生事件、传染病病例、医院感染病例等进行校核、整理、上报、统计、分析、浏览、查询、反馈,形成图文并茂的监测图表. 结论该软件是一个医院医疗质量控制系统,能够对突发公共卫生事件、传染病疫情和医院感染进行实时监控、提高工作效率.     

临床预防服务概述

在国外,临床预防医学的发展很快。本文主要阐述了《临床预防服务指南》的制定、组织实施和临床预防服务的发展前景。     

临床路径管理对改进医疗质量的作用分析

目的分析临床路径管理对医疗质量的影响。方法将595例实施临床路径管理的7个病种病例作为路径组,将2009年入院采用传统方法治疗的7个病种1284例作为对照组,对两组进行比较。结果7个病种实施临床路径管理后,组平均住院日、平均术前住院日缩短,外科围手术期抗生素使用天数和内科抗生素费用比显著降低,其中6个病种的药占比降低,平均住院费用有下降趋势,患者满意度提高。结论临床路径管理能缩短平均住院日,提高床位周转率,规范抗生素使用,控制医疗费用的增长,提高医疗质量水平。     

德国健康保险与预防性医疗服务

德国社会医疗保险具有悠久的历史,早在1883年俾斯麦执政时就引入了强制性医疗保险并奠定了社会保障的基础。德国的基本法规定了社会医疗保险的团结互助原则,保证了每个参保人拥有相同的医疗保障, 这在法律上体现了公平合理的原则。从上世纪80年代至90 年代,德国经济一直处于高速发展的繁荣期,社会医疗保险     

医疗服务行业的情感管理及对策

我国医疗卫生体制改革提出了要缓解老百姓"看病难、看病贵",医疗机构服务形式要多样化,实现医患双赢的目标.随着医改的深入,研究探讨医疗服务行业医患双方的情感价值,找出医疗服务中使患者评价服务效果不满意、满意、感动的成因日益重要.医疗服务作为高风险、高专业化、高人性化的服务业,应从完善制度、建立工作规范和简化流程着手,建立起获得医患双方理念满意、行为满意、视听满意的运行机制;做好医患沟通交流,加强服务环节和过程管理,使医院的服务等于或高于患者的期望值,从而促进医患和谐,提高医疗服务质量水平,提升患者满意度.     

Clinical Preventive Services for Older Adults: The Interface Between Personal Health Care and Public Health Services

Healthy aging must become a priority objective for both population and personal health services, and will require innovative prevention programming to span those systems. Uptake of essential clinical preventive services is currently suboptimal among adults, owing to a number of system- and office-based care barriers.To achieve maximum health results, prevention must be integrated across community and clinical settings. Many preventive services are portable, deliverable in either clinical or community settings. Capitalizing on that flexibility can improve uptake and health outcomes.Significant reductions in health disparities, mortality, and morbidity, along with decreases in health spending, are achievable through improved collaboration and synergy between population health and personal health systems.BETWEEN 2010 AND 2050, the population of Americans aged 65 years and older is expected to more than double, swelling to nearly 89 million. This “silver tsunami,” composed mostly of Baby Boomers (the first of whom crossed the 65-year line in 2011), will pose serious challenges for our nation’s public health and health care systems, along with state and federal budgets, family finances, and private sector profitability. Healthy aging, too often viewed as a peculiar product of luck or luxury, must become a priority objective for both population and personal health services—and will require innovative prevention programming to span those systems.Chronic illness currently represents an estimated 83% of total US health expenditures and 99% of Medicare spending.1 Increasing rates of costly chronic conditions, many of which are not well managed,2–5 are associated with significant Medicare spending increases.6,7 Each year, more than half of Medicare beneficiaries are treated for 5 or more chronic conditions.6 The average Medicare enrollee sees 2 primary care physicians and 5 specialists working in 4 different practices annually8; those with 5 or more chronic conditions see an average of 14 different physicians a year.9 Care fragmentation results in suboptimal uptake of clinical preventive services (CPS) among US adults3,10: only 33% of women and 40% of men aged 65 years and older are fully up to date with all preventive services recommended for all adults in this age range,11 and less than a quarter of adults aged 50 to 64 years have received all these services.12 Even if adults receive recommended disease screening, a positive finding may not lead to effective treatment: although blood pressure screening in older adults is relatively high, hypertension is controlled in only half of patients.13Preventing chronic diseases and keeping chronically ill older adults healthier are imperatives to drive improvements in health, quality of life, and value in US health spending.14 Population-based primary prevention works to avert disease. It must be reinforced with patient-focused primary prevention and coupled with effective secondary prevention to detect illness as well as tertiary prevention aimed at better managing existing illness and preventing additional disease and disability. To achieve maximum health results, prevention must be integrated across community and clinical settings. Many preventive services are portable—deliverable in either clinical or community settings. Capitalizing on that flexibility can improve uptake and health outcomes.Optimal use of CPS—particularly for cardiovascular conditions—could avert an estimated 50 000 to 100 000 deaths per year among adults younger than 80 years and 25 000 to 40 000 deaths per year among those younger than 65 years.15 Increasing uptake of selected high-value CPS to 90% could produce an additional 1.89 million quality-adjusted life years.16 Outside clinical settings, the Trust for America’s Health has estimated that an investment of $10 per person per year in community-based programs tackling physical inactivity, poor nutrition, and smoking could yield more than $16 billion in medical cost savings annually within 5 years—a return on investment of $5.60 for every $1 spent, without considering the additional gains in worker productivity, reduced absenteeism at work and school, and enhanced quality of life.17 Significant reductions in health disparities, mortality, and morbidity—and attendant decreases in health spending—are achievable through improved collaboration and synergy between population health and personal health systems.18 We discuss essential CPS for older adults, emerging delivery models that encompass health care and community settings to boost uptake, and public health priorities in a changing US health system.