社区健康教育在全科医疗实践工作中的探索

全科医疗被世界卫生组织称为"最经济""最适宜"的医疗卫生保健服务模式。与专科医生比之,全科医生更贴近社区,尤其是为社区重点人群(儿童、妇女、老年人、慢性病患者)提供医疗保健服务。作为社区人群的守护者,全科医生是三级预防的践行者,其中最重要的环节是健康教育。全科医生是进行社区健康教育的主要实施者,根据不同对象的特点开展实用性和操作性较强的健康教育工作从而推进社区卫生服务的发展,起到保障居民身心健康的核心作用。本文以案例剖析的方式,介绍了社区健康教育在全科医疗实践中的特点、与循证保健的关系以及创新模式,探索全科医生在开展社区健康教育医疗实践中的有效作用。     

社区口腔健康促进模式构建和发展策略探讨

社区卫生服务是由全科医生为主体的卫生组织或机构所从事的一种社区定向服务[1]。社区卫生服务应以整个社区人群为对象,以预防为主,加强整个社区的健康保健。目的是把服务模式从医疗为主转变为以保护和促进社区健康为主;把服务对象从以患者为主体扩大为以社区全体人群为主体;把服务内容从以治疗为主扩展为预防、治疗、保健、康复、健康教育和计划生育指导等多个方面。这种服务目的、服务对象、服务内容的转变,无疑会给社区居民的健康带来     

全科医生是发展社区卫生服务的关键

全科医生是发展社区卫生服务的关键主要是由于社区卫生服务中的预防、保健、医疗、康复、健康促进和计划生育6项具体内容以及全科医生的性质和特点所决定的。全科医生是社区卫生服务团队的骨干力量，他们研究的是社区常见健康问题，全科医生是实现社区导向的基层医疗的主体，全科医生具有预防保健工作的优势，在健康促进工作中具有独特地位，是社区康复的重要组成人员，全科医生对控制医疗费用的上涨有积极的作用。     

中医全科医生在社区卫生服务中的重要性

随着我国城市化进程的不断加快,我国的社区建设呈现出如火如荼的发展态势,社区建设逐渐走向专业化与一体化,对于社区建设的部分,我国发展部门主张全面建设,健康卫生服务与之兼顾,但是随着社区老人与儿童的增多,卫生服务的种类也必须增加,保证我国社区卫生服务的有效性,其中中医全科医生是健全我国基层的卫生健康体系的重要角色,为我国未来的社区建设打下了基础与理论保证。本文通过阐述我国社区建设中社区卫生服务的发展现状,探究中医全科医生在我国社区卫生服务中的重要性与重要意义,探究优化我国中医全科医生在社区卫生服务的具体措施与策略。     

浅论全科医生在实施社区健康教育方面的优势

全科医生随着医学模式的转变而逐步被人们认识和接受，并且随社区卫生服务的深人发展，被认识和接受的程度愈来愈深。全科医生是社区卫生服务的主要承担者，而社区卫生服务是集预防、医疗、保健、康复、健康教育、计划生育六位一体的综合性服务。所以全科医生与社区健康教育之间存在着必然的联系，而且全科医生在实施社区健康教育方面有很大的优势。     

社区卫生服务机构医务人员从业培训状况调查及分析

目的通过对社区卫生服务机构医务人员的调查,探讨社区医疗全科医学教育的合理方案和模式。方法采用调查问卷方式,对广州市越秀区部分社区医疗医务人员进行调查,包括基本信息、工作状况、培训教育状况等。结果社区卫生服务机构医务人员构成以大学本科、大专学历为主,职称构成以初级为主。对工作满意程度一般的占44.4%,认为工作压力很大的占44.1%。进行全科医生规范培训前有61.9%的人员没有获得过进修机会。大部分人愿意参加全科医生规范培训,并认为业务水平有一定程度提高。结论全科医生规范培训是提高社区卫生服务机构医务人员业务和服务水平有效途径。对于存在一些问题,需要加强政府管理,加以改善。     

社区卫生服务

《中共中央、国务院关于卫生改革与发展的决定》中指出 :“改革城市卫生服务体系 ,积极发展社区卫生服务 ,逐步形成功能合理、方便群众的卫生服务网络。”加快发展全科医学 ,培养全科医生 ,推行全科医疗服务模式是社区卫生服务顺利实施的主要保证。1　社区和社区卫生服务概念卫生部等十部委在《关于发展城市社区卫生服务的若干意见》中对社区卫生服务的概念是 :“社区卫生服务是社区建设的重要组成部分 ,是在政府领导、社区参与、上级卫生机构指导下 ,以基层卫生机构为主体 ,全科医生为骨干 ,合理使用社区资源和适宜技术 ,以人的健康为中心…     

现阶段我国全科医生培养模式探讨

全科医生的培训是我国现阶段社区卫生服务发展的当务之急。本文对目前国内几种全科医生培养模式进行了分析，探讨适宜我国国情和教育现状的全科医生培养模式，以促进我国全科医学教育和社区卫生服务的健康、稳定发展。     

网络模式在社区老年慢性病健康管理中的应用

随着我国人口老龄化进程的加快,老年慢性病的发病和死亡率呈上升趋势,老年医疗服务已经成为我国公共卫生面临的最紧迫的问题。作为医疗基层的社区卫生服务站应加强慢性病建设,推行社区老年慢性病健康管理工作,解决社会老年的医疗卫生问题。本文根据老年人群特点,运用社区医疗服务的特有优势,探讨信息网络化管理,为新形势下构建老年慢性病健康管理的有效模式提供依据和借鉴。     

基于健康管理的全科医疗服务模式初探

健康管理旨在调动个人或群体的积极性,有效利用有限资源来获得最大的健康效益。如何建立健全全科医生制度,健康管理理念将为全科医疗服务模式提供新的思路。全科医生是居民健康的守护者,全科医学是基础医疗的新曙光,健康管理可以为全科医生工作提供新的切入点。通过建立健全规范化的全科医师培训制度,建立基于社区的全科医疗服务体系,以健康管理作为全科医学工作的切入点等方法,发展基于健康管理的全科医学服务模式。从"治病"到"治未病"的医疗模式转变,健康管理和全科医学将为我国初级医疗保健提供新的动力源泉。     

福建省人口老龄化趋势与社区卫生服务探讨

文章分析了福建省老年人口系数的变化,人口类型从年轻型转变为老年型,人口老龄化对福建省各类死因死亡率的景, 地人口老龄化应大力发展社区卫生服务,要针对老年人特点,开展社区医疗卫生服务,老年的社区卫生服务问题应纳入社区的规划中,与社区服务相结合,医疗康复、家庭病床是老年社区卫生服务的主要形式,同时要发展社区卫生服务,必须加快全科医生的培养。     

南京市社区卫生服务实践与体会

南京市开展社区卫生服务具有做法是转变传统观念,适应群众需求;加强组织领导,搞好规划建设;利用卫生资源、建立服务网络;开展全科医务人员培训,探索双向转诊,完善社区服务。作者认为,当前社区服务还存在亟待解决的问题。建议：争取国家和政府的支持;制定开展社区卫生服务的相关配套政策;建立相应的合理补偿机制;加强全科医学人才的培养;规划社区卫生服务管理。     

True believers? Characteristics of general practitioners in Victorian community health centres

Abstract: General practitioners have been part of multidisciplinary services in Victorian Community Health Centres (CHCs) for 20 years. This model institutionalises a high degree of integration between general practitioners and other primary care and community service personnel. Of 51 eligible full-time general practitioners in Victorian CHCs, 46 were interviewed, using a structured questionnaire. General practitioners in CHCs were younger less experienced and more likely to be female than other general practitioners. Nearly three-quarters were salaried. The philosophy of practice and the conditions of employment were the commonest reasons for entering CHC practice. Teamwork and the conditions of employment were felt to be the biggest advantages of CHC practice, while difficulties with management and the perceived loss of professional ownership and control were the commonest disadvantages. None reported interference from the CHC management in their clinical practice. Nearly a quarter of full-time CHC general practitioners do not undertake any formal community health promotion activities. Forty-five per cent of respondents intended to leave their CHC within the next five years. Universal health insurance has diminished the impact of CHC general practice. The philosophy of CHCs and the salaried nature of the employment continues to attract general practitioners. High staff turnover is a feature of CHC general practice, in part related to young doctors making an initial, but not long-term commitment to CHC practice. However, the loss of professional control and management difficulties should be addressed, as these may contribute to the high turnover.     

社区卫生服务开展首诊制的影响因素及对策研究

目的:了解社区医生、医疗保险工作人员及居民对社区卫生服务机构开展首诊制的意愿及影响因素。方法:2006年4月,对江苏省南京、苏州、镇江、盐城、泰州5个市,1 141名居民、192名社区医务人员和148名医疗保险工作人员进行问卷调查。结果:居民自感病轻时,53.1%的居民会选择去社区卫生服务机构首诊。吸引居民去社区首诊的原因主要是,就近方便(75.6%)、医疗费用低(49.5%)、服务态度好(37.6%)。不愿意去社区首诊的原因主要是,不放心医疗水平(48.0%)和社区卫生服务机构设备差(27.5%)。结论:社区卫生服机构开展首诊制需加强自身建设,并同时应建立相应的政策支持。     

芬兰与浦东新区社区卫生服务的比较

对芬兰与上海浦东新区两地社区卫生保健体系的基本情况、内部协作与人才培养进行介绍和阐述,并抽取其中的重要参数进行比较,经分析提出可在两点上借鉴芬兰简便高效的运作模式:(1)医、护、防职能分工优化整合,紧密协作;(2)全科医师培养和进修多管齐下,多方协作,以充分保障全科医师的素质与能力,发展与提升,充分激发其职业热忱和为民服务的高度责任心,做好社区卫生保健工作。     

Cooperation or conflict over child health surveillance? Views of key actors.

OBJECTIVE--To describe the views of general practitioners, health visitors, and clinical medical officers on child health surveillance, recent changes, perceptions of each other's roles, and attitudes to audit. DESIGN--Postal questionnaire survey. SETTING--Three health districts in North West Thames health region. SUBJECTS--All 602 general practitioners, 272 health visitors, and 42 clinical medical officers in these districts. MAIN MEASURES--Attitudes to and perceptions of child health surveillance and audit. Questionnaires were completed by 440 general practitioners (response rate 73%), 164 health visitors (60%), and 39 clinical medical officers (93%). RESULTS--Attitudes to child health surveillance were less positive among general practitioners than health visitors or clinical medical officers. Few respondents agreed that child health surveillance was a cost effective use of general practitioners' time (general practitioners 28%, 113/407; health visitors 28%, 40/145; clinical medical officers 39%, 15/39) and most thought that health visitors should carry out more of the doctors' examinations (68%, 262/387; 65%, 89/136; 66%, 25/38). General practitioners thought that clinical medical officers were less supportive than other relevant groups of their doing more child health surveillance. Most (72%, 105/146) health visitors thought that the 1990 contract had reduced parental choice of where to attend for child health surveillance. General practitioners were less enthusiastic than health visitors about most forms of clinical audit. CONCLUSIONS--Despite reservations about the impact of recent changes all groups were willing to explore innovative ways of delivering child health surveillance. IMPLICATIONS--There is scope for health visitors to increase their responsibilities and for more varied relationships between general practitioners and community child health doctors.     

上海市社区卫生服务工作的最新进展

[目的 ]　探讨上海市社区卫生服务的总体模式 ,为今后的发展提供可持续发展的思路。 [方法 ]　对上海市社区卫生服务在组织管理、服务方式、服务内容、运行机制、经费筹资机制、人才培养、科学管理和研究等方面进行了理论和实践的探讨。 [结果 ]　上海市的社区卫生服务已初步形成了具有中国特色、上海特点、时代特征的模式格局。 [结论 ]　上海市社区卫生服务为中国城区社区卫生服务的开展和发展提供了有益的经验。     

Primary health care and general practice--a comparison between Australia and Malaysia

The Australian and Malaysian systems of general practice were examined and compared. The issues of similarity and difference identified are discussed in this paper. Quality clinical practice and the importance of compulsory vocational training prior to entry into general practice and continuing professional development is one important area. A move towards preventive health care and chronic disease management was observed in both countries. Practice incentive programmes to support such initiatives as improved rates of immunisation and cervical smear testing and the implementation of information technology and information management systems need careful implementation. The Medicare system used in Australia may not be appropriate for general practitioners in Malaysia and, if used, a pharmaceutical benefit scheme would also need to be established. In both countries the corporatisation of medical practice is causing concern for the medical profession. Rural and aboriginal health issues remain important in both countries. Graduate medical student entry is an attractive option but workforce requirements mean that medical education will need individual tailoring for each country. Incorporating nurses into primary health care may provide benefits such as cost savings. The integration model of community centres in Malaysia involving doctors, nurses and allied health professionals, such as physiotherapists, in a single location deserves further examination.     

Connecting for health literacy: health information partners

This article describes a community-based health information partnership to address health literacy and health information inequalities in marginalized communities. Public health, medical, literacy, and library practitioners promote health literacy through outreach, training, and professional development activities in community settings. They create learning environments for people to develop the necessary knowledge and skills to better understand health information and health policy so they can make decisions concerning personal and community health. Outreach activities focus on visits to neighborhood health centers, health fairs, health exhibits at union meetings and conferences; training programs involve hands-on, peer-led computer classes for people living with HIV and for the general public; and professional development programs connect librarians, health providers, public health workers, and literacy teachers in joint planning and learning. Several learners currently participate in and lead community health education programs and HIV advocacy. The coalition's strength develops from strongly shared objectives, an absence of territoriality, and a core active leadership group.     

深圳市宝安区社区全科医生精神卫生知识调查

目的调查深圳市宝安区社区全科医生对精神卫生知识的掌握情况。方法通过分层抽样,在宝安区的社区健康服务中心选取全科医生作为调查对象,以典型的焦虑症、抑郁症和精神分裂症个案作为案例描述,调查其对常见精神障碍的认识和相关知识的掌握情况。结果共回收有效问卷134份,深圳市宝安区社区全科医生对焦虑症、抑郁症、精神分裂症三种精神障碍的平均正确识别率为74.6%。对于非重性精神疾病中焦虑症和抑郁症,分别有85.1%和54.5%的全科医生建议咨询心理医生;而对于精神分裂症,79.1%全科医生建议看精神科医生。工作中遇到精神障碍患者,绝大多数(95.6%)会选择转诊转介专科机构,但其中只有71.4%人明确知道市级或区级精神卫生机构。结论有必要在社区全科医生中加大关于精神卫生知识的培训和宣传,提升其对常见精神障碍的识别、转诊、转介能力。