老年人多元化需求与社区医疗服务体系的建构

<正>社区医疗范围是指一般的医疗保健,即病人在转诊到医院或专科前的一些医务治疗,为社区居民提供整合、便利的医疗保健服务。社区医疗服务是指社区卫生服务管理中心的医护人员在患者有需求的情况下可以提供的入户诊疗,为居民提供医疗、保健、心理咨询等服务。徐刚等〔1〕认为老年人的潜在医疗需求很大,因此应积极开展社区卫生服务,把为老年人提供连续、综合的卫生保健服务列为社区卫生服务的重点,形成从单一医疗向集医疗、预防、保健、康复、健康促进、健康教育为一     

社区老年人居家养老服务需求调查

目的了解社区老年人居家养老服务需求现状。方法采用随机整群抽样方法,在唐山市497个开展居家养老服务的社区中抽取2个社区,对社区内60岁以上的老年人,采用一般情况调查表、健康状况调查表及老年人居家养老服务项目需求量表进行问卷调查。结果 724例调查对象中,男性、文化程度高、独居、月收入多、身体健康状况差、原工作单位为政府机关的老年人对居家养老服务的需求较高(P0.05);老年人对社区居家养老服务有需求者占89.4%,其中老年人对医疗预防保健服务的需求占81.8%,对日常生活照料服务的需求占44.3%。对文化教育服务及精神慰藉服务的需求分别占39.8%、34.8%。结论社区老年人对居家养老服务的需求较高,特别对于医疗预防保健服务的需求最迫切。     

社区卫生服务健康档案管理和应用

社区卫生服务健康档案在医疗保健服务中十分重要,是社区、家庭和居民健康状况的系统化文件和资料库.通过建立个人、家庭和社区健康档案,能够了解和掌握社区居民的健康状况、社区家庭卫生问题和卫生资源.利用社区与家庭资源,包括卫生机构、卫生人力、福利慈善机构、家属及其它可动员的社会资源等,可以为本社区居民提供医疗保健、精神支持和经济上的协助.因此,在实践中逐步建立和完善社区卫生服务的健康档案是十分必要的.     

基于体育健身视角的甘肃省平凉市居民健康需求调查

目的 调查甘肃省平凉市居民体育健身现状,分析存在问题及原因,为满足居民健康需求提供有益的策略与措施.方法 自行设计调查问卷,采用分层抽样方法,于2020年10月-2021年2月随机抽取平凉市3个县(市、区)的居民开展问卷调查.结果 共调查363人,其中69.42％的居民经常参加体育健身,健身项目以跑步为主、占77.78％,仅11.51％的居民去商业健身中心锻炼,41.05％的居民每年体育健身投入低于200元,96.97％的居民主要通过网络获取体育健身信息;66.67％的居民愿意参加社区或单位举办的体育比赛,跑步项目参与人数最多、占71.90％;51.52％的居民需要专业体育健身指导,希望学习拳操类技能的人数最多、占51.51％,80.99％的居民希望高校免费开放体育场地,49.04％的居民希望高校开展体质健康测试和评估.结论 平凉市居民人均体育健身投入比重较低,健身方式和获取健身信息途径较为单一;应采取增收带动体育产业消费,借助"互联网+"宣传体育健身,加大政府对体育健身公益性服务的投入、发展高端体育产业、实施高校体育资源社会共享项目等措施,满足平凉市居民健身健康需求.     

沈阳市老年居民对社区中医药健康养老服务使用现状调查研究

目的 了解沈阳市老年居民对社区中医药健康养老服务使用情况及诉求。方法 在沈阳市随机向60岁及其以上的老年居民发放201份调查问卷。结果 共回收到201份有效问卷,问卷中的年龄、文化程度、职业、医保、宣传教育情况、有无慢病、家属从事行业等项目均具有统计学意义(P<0.05)。有78.1%的老年居民充分了解后愿意使用社区中医药健康养老服务。老年居民社区中医药健康养老服务需求依次为中药饮片、中药拔罐、中医膳食指导等。结论 沈阳市老年居民的中医药健康养老服务使用程度有待提高,大多数老年居民了解后有意愿参加,需求倾向性明显,未来可通过加大中医药健康养老服务宣传教育,完善相关配套政策与基础设施建设,有针对性地提高老年居民对中医药健康养老服务的使用程度。     

城市中老年回族居民常见慢性疾病调查与社区医疗保健

城市社区医疗预防保健服务是完善社区服务功能的一项重要工作,我市已基本建成社区卫生服务体系的框架.为了更好地探讨社区医疗保健运作的方法和服务内容,我院社区卫生服务中心于2000年7月至9月对辖区内2490名30岁以上的回族居民进行了高血压、冠心病、脑血管疾病、慢性支气管炎、糖尿病等常见慢性疾病的调查.     

农村高龄老人社区卫生服务需求调查

目的 探讨农村高龄老人社区卫生服务需求状况及影响因素.方法 采用入户问卷调查方式对如皋市搬经镇谢甸村和加力村129例80岁以上农村高龄老人进行调查.结果 7.8%的老人愿意建立社区健康档案;10.2%的老人愿意医务人员上门提供医疗服务;7.9%的老人愿意在生病出院后在家中继续接受医疗康复服务;6.3%的老人愿意接受健康教育;1.6%的老人选择热线电话健康咨询服务;0.8%的老人愿意接受居家护理服务;0.8%的老人愿意定期进行体检;91.5%的老人选择在养老院养老.结论 农村社区卫生服务出现了"低知晓率,低利用率"的原因之一是宣传不够社区卫生服务未深入人心,原因之二为医疗保险制度不健全.     

老年人群医疗卫生服务需求及利用

目的 了解江西省老年人卫生服务需求和利用现况及其影响因素,为我省制定老年人医疗保健措施、卫生服务管理与决策提供科学依据.方法 通过问卷形式对我省11个地市38个县60岁及以上人群的健康及医疗卫生服务需求与利用状况进行了抽样调查分析.结果 共抽查2 932人.慢病患病率33.0%,城市高于农村;就诊大都选择在诊所、卫生室、社区卫生服务站等机构;两周患病率15.5%,就诊率9.7%,未就诊率20.6%,主要是经济困难和自感病轻;年住院率7.8%,城市高于农村,需住未住院率为51.4% ,主要原因经济困难和自认没必要;老年失能以听力和视力障碍为主;近期体检率城市高于农村, 63.2%的老年人希望每年接受一次,69.1%希望上门服务,46%希望发展家庭病床;老人对医护技术与服务态度满意率低,且73.1%的人自费医疗,并普遍感到医疗费用偏贵.性别、收入、去最近医疗点时间、医保制度、医疗费、对医疗技术和服务态度满意度为影响老年人医疗卫生服务需求和利用主要因素.结论 老年人卫生服务需求率高,利用率低.改善其经济状况、降低医疗费、完善医疗服务系统、提高医技水平与服务态度、健全医保制度、合理布局医疗点、发展城市社区卫生服务、完善新农合和医疗救助制度,提高村卫生室和卫生院技术和服务能力是解决老年人医疗保健问题的有效途径.     

宁波市西草马路社区卫生现状及居民卫生服务需求调查与分析

全科医学是实现 WHO提出的“2 0 0 0年人人享有卫生保健”宏伟目标的有效措施。 2 0世纪 80年代“全科医学”概念引入中国 ,立即引起广大医务工作者的重视和响应 [1]。浙江省是我国最早开展全科医疗试点的地区之一 [2 ]。经过近 2 0年的发展 ,浙江省宁波市全科医疗服务也已取得一定的成效。为了配合宁波市建立社区居民健康档案 ,我们于 2 0 0 1年 7月对江北区西草马路社区进行了为期 3周的调查研究。西草马路社区下辖东槐、中槐、浮王、新义、范家边 5个居委会 ,有家庭 4 971户 ,总人口 16 0 5 1人。其中 6 0岁以上老年人 16 6 5人 ,占 10…     

社区老年人居家养老服务需求及影响因素

目的了解老年人对居家养老服务的需求及影响老年人居家养老服务需求的因素。方法采用整群抽样方法,在唐山市路南、路北区35个开展居家养老服务的社区中抽取2个社区,对社区内60岁以上的老年人724名应用老年人一般情况调查表、居家养老服务需求调查表进行调查。结果老年人对医疗预防保健服务的需求占首位,在具体项目的需求中对上门输液、打扫室内卫生、文化活动的需求分别占60.6%、39.5%、16.9%,对居家养老服务的需求受性别、年龄、收入等因素的影响。结论在今后的居家养老服务项目中,应增加医疗预防保健服务的项目,特别是上门输液、紧急救护等服务;在日常生活照料服务的项目中应关注打扫室内卫生方面的服务;还应关注老年人的精神需求,增加老年人生活的幸福指数。     

Housing for the elderly in Taiwan

Traditionally, the care of elderly persons was the responsibility of families. However, the structure of families is changing, while the number of aged persons, particularly the frail elderly, is rising. The current living arrangements in housing include living in multigenerational dwellings, family dwellings and institutions or collective dwellings. Frail elderly in need of long-term care live in nursing homes. In the future, housing options must have better space standards and must be barrier-free. Elderly residents must have access to support services and health services in the community. There is a growing demand for institutions and nursing homes because of the special care needs of the frail elderly. A Commissioner of the National Council on Ageing Welfare.     

Training generalist physicians

To train more generalist physicians, structural changes must be made along the continuum of medical education. Future generalists require in-depth exposure to primary care practice, with substantive experience in the longitudinal management of patient panels and the opportunity to work with successful generalist role models. Clinical training and course work must incorporate a wide range of skills and disciplines, including areas now under-emphasized, such as epidemiology, health services, and psychosocial medicine. Recommendations for structural changes to increase the generalist focus of medical education include: 1) the development within institutions of central authorities, involving departments of internal medicine, family medicine, and pediatrics, in joint efforts to foster all aspects of generalist training, including recruitment, curriculum development, community linkages, innovative approaches to training, and recognition and support for successful generalist teachers; 2) commitment of a minimum of 50% of clinical training to ambulatory care settings at both medical school and residency levels; 3) required longitudinal care experiences for all medical students and a 20% or greater time commitment to longitudinal care for internal medicine, pediatrics, and family medicine residents; and 4) increased numbers of generalist faculty and enhanced teaching skills among faculty in the outpatient environment, to guarantee increased exposure of medical students and residents to generalist role models.     

Geographic variation in health services use in Nova Scotia

To further our understanding of factors underlying geographic variation in health and the potential role of availability of and access to health services, we sought to quantify the geographic variation in health services use in the province of Nova Scotia. For the period 1996 to 1999 we examined the variation in the use of health services across 64 geographic areas in conjunction with health and socio-economic factors, using multilevel methods and empirical Bayesian estimates based on provincial physician billings and hospital separation records. We revealed moderate geographic variation in the use of family physician services and large variation in specialist and hospital services. In the two urban centres, Metropolitan Halifax and the Cape Breton Regional Municipality, use of specialist services was respectively 26.24% and 15.59% higher than the provincial average, and use of hospital services was respectively 21.55% and 37.67% higher. Geographic areas in which residents had better health were characterized by more use of family physician services and reduced use of specialist and hospital services. These associations seem to support policy strategies that aim to improve health and to reduce health care costs by investing in prevention and primary health care, and they highlight the potential implications of the shortage of family physicians across Canada.     

Latino Children with Asthma: Rates and Risks for Medical Care Utilization

Latino families have been reported to underutilize health care services compared with families from other ethnic backgrounds. As part of a community trial in a low income Latino population designed to decrease environmental tobacco smoke (ETS) exposure in children with asthma in San Diego, we examined unscheduled medical care for asthma. Latino families (N = 193) reported information about medical care use for their children during the past 12 months. About 23% were hospitalized, 45% used the emergency department, and 60% used urgent care services. About 8.5% of families had two or more hospitalizations in 12 months. Most families were insured by Medicaid or had no insurance. Significant risk factors for a child's hospitalization were age (under age six), failure to use a controller medication, and a parental report of the child's health status as being poor. Risk factors for emergency department use were age (under age six) and male gender. These findings indicate that low-income Latino families with young children with asthma lack the medical resources necessary for good asthma control. Quality and monitored health care with optimization of asthma management could reduce costly acute care services.     

Latino children with asthma: rates and risks for medical care utilization.

Latino families have been reported to underutilize health care services compared with families from other ethnic backgrounds. As part of a community trial in a low income Latino population designed to decrease environmental tobacco smoke (ETS) exposure in children with asthma in San Diego, we examined unscheduled medical care for asthma. Latino families (N = 193) reported information about medical care use for their children during the past 12 months. About 23% were hospitalized, 45% used the emergency department, and 60% used urgent care services. About 8.5% of families had two or more hospitalizations in 12 months. Most families were insured by Medicaid or had no insurance. Significant risk factors for a child's hospitalization were age (under age six), failure to use a controller medication, and a parental report of the child's health status as being poor. Risk factors for emergency department use were age (under age six) and male gender. These findings indicate that low-income Latino families with young children with asthma lack the medical resources necessary for good asthma control. Quality and monitored health care with optimization of asthma management could reduce costly acute care services.     

上海市社区老年人服务利用与需求现况调查

目的　全面了解老年人各种服务利用的现状。方法　对 １ ２０３ 名社区老年人 １３ 项一般性服务项目的利用、自觉需求、服务提供者情况分析。结果　社区老年保健服务的主要内容是交通工具、家访服务、家事服务、社会／娱乐活动、餐饮准备、护理性照护几项。老年人的服务提供者以家人为主。结论　今后社区应适当增加社会／娱乐活动设施和生活照顾、医疗保健服务机构,减轻家庭照顾的负担。此外,社区有必要增加综合评估服务、老年医疗服务及心理健康服务等新的服务内容。     

济宁市社区卫生服务居民满意度调查分析

目的通过对社区卫生服务的满意度的调查,分析居民利用社区服务的影响因素。方法设计调查问卷,深入社区居民家中、公共场所等对家庭成员及社区卫生服务利用情况进行调查。结果济宁市城市居民年龄、文化程度、婚姻状况、职业、医疗保险形式与在社区卫生服务站就诊率无相关性。卫生服务站机构的就诊率高达92.20%;到卫生服务站就诊主要原因是方便;居民对就诊环境、医疗设备、技术水平、服务态度等比较满意。结论济宁市城市社区居民对社区卫生服务满意度高,城市社区卫生服务的发展前景广阔。     

Medical education: meeting the challenge of implementing primary health care in sub-Saharan Africa

Medical education in sub-Saharan Africa must be defined by its health needs and the health care services required. The sociodemographic milieu that determines the disease pattern makes a compelling case for primary health care in the context of community participation and multisector community development as the driver of a plan for medical education, in tandem with clinicians' role in continuity of care. Such ideas have been derived from the experience of planning for undergraduate medical education at the Aga Khan University Medical College, Nairobi, whose curriculum incorporates broad-based general education and liberal arts principles.     

The impact of childhood rheumatic diseases on the family

Much of the burden of providing health care and other services for children with rheumatic diseases falls on the parents, but little is known about the impact of these conditions on the family. A survey of the parents of 138 children revealed that the most important predictors of high family impact were the number of the child's activities of daily living that were limited by illness, the educational attainment of the mother, the child's sex, the mother's perception of the child's health, and the volume of medical care use. Our results provide guidelines for identifying families who are most vulnerable to the stress of having a child with a rheumatic disease.     

Resident outcomes of Medicaid-funded community residential care

PURPOSE: Washington State's initiatives to increase the availability and quality of community residential care presented an opportunity to describe clients entering adult family homes, adult residential care, and assisted living and to identify outcomes of care. DESIGN AND METHODS: We enrolled 349 residents, 243 informal caregivers, and 299 providers in 219 settings. We conducted interviews at enrollment and 12 months later, and we collected data from state databases. RESULTS: The average resident was a 78 year old woman reporting dependence in two of six activities of daily living. Residents in adult family homes demonstrated significantly more disability. Seventy-eight percent of residents survived at the 12-month follow-up. In analyses that controlled for differences at enrollment, residents in the three types of settings were very similar in health outcomes at follow-up. IMPLICATIONS: State policies should reflect the wide range of needs of residents seeking care in these settings. Choices among type of setting can be based on the match of needs to individual preferences.