Assessing and ensuring a comprehensive system of services for children with special health care needs: a public health approach

The US Department of Health and Human Services called for comprehensive systems of services for children with special health care needs in its Healthy People 2000 and 2010 health care objectives for the nation. We report on the proportion of children with special health care needs receiving care in high-quality systems of services measured by attainment of 6 essential system elements, or quality indicators, generated from a survey of 40,723 families of children with special health care needs in 2005 to 2006. Only 17.7% of children with special health care needs received services in a high-quality service system that met all 6 quality indicators in 2005-2006. Therefore, much more work lies ahead to meet the national Healthy People objective for these children.     

Indian public health standards (IPHS) for community health centres

The health care system in India has expanded considerably over the last few decades but the quality of the services is not up to the mark due to various reasons. Hence standards are being introduced in order to improve the quality of services. A task group under the chairmanship of Director General of Health Services, Government of India was constituted to recommend the standards to be called as Indian Public Health Standards. IPHS are a set of standards envisaged to improve the quality of health care delivery in the country under the National Rural Health Mission.     

Citizenship, community participation, and health as seen by health care professionals: a case study in public health services

This paper deals with the subject of citizenship and people's participation in the health area through an analysis of ideas pertaining to a specific group: health care professionals working in Basic Health Care Clinics in the 3.1 Programmatic Area of the City of Rio de Janeiro (Brazil). The article analyzes their views on the subject and presents them in light of health-related legislation in the Brazilian constitution. It also analyzes the professionals' role vis-à-vis users in raising community awareness that health care is one of their basic rights. Field data from qualitative social research methodology showed a significant heterogeneity in the professionals' conceptions, dividing them into two groups: those belonging to teaching institutions and those working in institutions providing health care. This analysis shows the strategic role that day-to-day relationships between professionals and the community can play in the social change process and the establishment of social rights. It also discusses the viability of this process in view of the discovery of the subjective involvement of the health professionals who promote this process.     

Access to specialty care and medical services in community health centers

Although community health centers (CHCs) provide primary health services to the medically underserved and poor, limited access to off-site specialty services may lead to poorer outcomes among underinsured CHC patients. This study evaluates access to specialty health services for patients receiving care in CHCs, using a survey of medical directors of all federally qualified CHCs in the United States in 2004. Respondents reported that uninsured patients had greater difficulty obtaining access to off-site specialty services, including referrals and diagnostic testing, than did patients with Medicaid, Medicare, or private insurance.     

Application of primary health care standards to a developing community health group: a rural case history

Abstract: The development of community health groups in rural settings involving private general practitioners and other health care workers has been relatively rare. This case history examines the activities of such a group and the views of its participants over a 12-month period. It considers whether the principles of primary care and the relevant Community Health Accreditation and Standards Program criteria can be applied in such a setting. The centre was able to meet most of the primary care criteria; however, some other important elements that could be helpful to further developments emerged in the research process. These included the sensitivity of a rural community to an individual case or patient focus in a case conference setting and the high level of acceptance of population or healthy-community goals. Other key issues included the strengui (in terms of advocacy for healdi service provision) of an intersectoral group in a rural setting. Positive benefits were perceived to accrue from the increased professional and intersectoral communication. The role of the private general practitioner was focal, but the participants did not believe this necessarily had to be a leadership role. The initiation of such a conference and its leadership could be undertaken by any interested and appropriately skilled member. Organisation, administration, continuity and cost are important practical issues which need to be examined in early stages of development and taken into account in evaluation.     

山东省社区卫生机构基本药物实施现况调查

目的:了解基本药物制度在社区卫生服务机构实施的现状.方法:采用问卷调查和访谈相结合的方法,对山东省43所社区卫生服务机构基本药物推行情况进行调查.结果:实施基本药物制度有效降低了药费,但是存在目录内药品利用率不高、财政补偿不能及时到位、药品采购周期过长、宣传培训力度有待加强等问题.结论:基本药物制度在社区卫生机构实施状况良好,但仍暴露出一些问题,建议继续完善基本药物制度以及出台相关配套政策.     

北京市农村社区卫生服务中心基本公共卫生服务人力和成本现状调查

目的：了解北京市农村地区社区卫生服务中心的基本公共卫生服务人力资源和服务成本情况,为推进基本公共卫生服务均等化提供政策依据。方法：自行设计调查问卷和调查表,选择北京市昌平区、通州区、怀柔区和密云县作为调查地区。根据经济发展水平高、中、低,以整群抽样法抽取12个社区卫生服务中心、108位基本公共卫生服务人员进行调查。结果：在基本公共卫生服务人员中,年轻女性、防保人员和低职称人员占的比例较大;农村地区为预防接种和健康教育等项目分配的人员较多,为妇女保健和生殖健康等项目分配的人员较少;设置健康教育专栏、现场疫点处理等项目的单位成本较高;近郊地区为每个项目分配的工作人员数大多高于远郊地区,而每个项目的单位成本则大多低于远郊地区。结论：北京市农村地区基本公共卫生服务队伍的人力资源建设有待加强;各项基本公共卫生服务所需的成本差异较大,应结合实际需求情况和资源现状进行政策和财政上的调整。     

准确把握新时代我国公共卫生体系建设的概念及内涵

党的二十大报告强调人才是第一资源,并对全面推进健康中国建设、健全公共卫生体系提出了明确要求。“健康中国”战略提出实现“以健康为中心”,加强疾病预防和健康促进,使医疗和预防有效融合。群医学是运用、融合当代医学及相关学科的知识、技术、艺术和学术,作为公共卫生的医学基础,实现人群整体与长远健康效益最大化的一门医学学科。群医学人才队伍建设符合人才强国战略,群医学实践与健康中国建设趋向一致。本文分析探讨了群医学人才队伍建设的必要性与现实性,并通过总结和借鉴国外群医学人才培养的相关经验与实践,提出了我国群医学人才队伍建设的思考。     

Women, health and development, with special reference to Indian women

That women often receive inadequate health care is increasinglybeing recognized. On the whole women in developing countriesare exposed to the same illnesses as men, although they alsohave special health needs: they are likely to carry a heavierworkload than men, and to spend many years in pregnancy andlactation. Despite these difficulties, the low status of womenin many societies often results in their receiving an inadequatediet-putting further strain on their health-and having lessaccess to health care. In response to the inequality and discriminationfaced by women, the United Nations proclaimed 1975–85to be the Decade for Women. This created a new awareness ofthe problems, but the effects have yet to be felt in the livesof most women. This paper uses the example of Indian women to highlight someof the problems addressed during the Decade for Women, and tochart some recent developments. Women in India have a particularlylow status and tend to have many pregnancies, often too closelyspaced. Despite high levels of malnutrition, diarrhoea and infectionamong women, they use health services less than men, even whenthey are available. This is not because women's need is less,but because they do not recognize their need or cannot overcomesocial and cultural barriers. The paper draws on experiencegained in a programme to extend and develop health care deliveryin the Indian State of Orissa to suggest policies which needparticular attention if the health of women is to improve.     

Assessing rural community resources for health care: the use of health services catchment area economic marketing studies

A relatively simple method for estimating the ability of rural communities to support health provider personnel services, the utilization of this tool is described and illustrated. Special aspects of the approach include: (1) its application on a systematic basis to an entire state, utilizing identified economic marketing areas and local determination of data; (2) the use of the finished product, or study, as a focus for community discussion and decision making; (3) its use as a recruitment device for physicians as well as communities; and (4) its use for long term state health and educational planning. Within this broad approach, the specific figures and conclusions are less important than the interpretation, application and use of the method.     

Characteristics of ambulatory care patients and services: a comparison of community health centers and physicians' offices

The overall aim was to determine whether health care delivery for vulnerable populations served by community health centers (CHCs) was comparable to care for mainstream Americans primarily seen in physicians' offices (POs). Data came from the 2006 National Ambulatory Medical Care Survey. Patient visits occurring in CHCs were largely from younger, uninsured or Medicaid-insured, minority populations, while POs catered mainly to older, Medicare- or privately-insured, White patients. Communities served by CHCs were more often in low-income, low-education, urban regions. A greater proportion of visits to CHCs were from diabetic, obese, and depressed patients; CHCs also offered more evening/weekend visits and provided more health education during visits, but spent less time per visit than POs and had more difficulty referring patients to specialists. Results affirmed the significant role of CHCs as safety-net providers for vulnerable populations, and indicated that CHCs provide adequate care compared with POs although there remains room for improvement.     

Private sector health care organizations and essential public health services: potential effects on the practice of local public health.

This article focuses on the activities of eight private health care organizations undertaking public health and prevention activities. Few activities were motivated by or integrated into the business or operating strategy of the organizations and poor integration with the business strategy puts the long-term future of these activities in jeopardy. The lack of integrated activity can be attributed to: slow pace of managed care implementation; low penetrance of full-risk capitated reimbursement; and fragmented, competitive health care markets. Purchaser pressure, quality assurance requirements, community benefit standards, and government mandates are among the levers available to encourage such activities by the private sector.     

Health care for children: perspectives for community health services

The study aims at analysing the community health nursing practice in the care of children and to point out the perspectives for the coming millennium. The study was conducted by review of the literature. It provides a brief synthesis of the current social context and a short historic reflection about health practices with children and community health nursing practice. It is observed that the practice of nursing is conducted according to the official Health Assistance Program for Children. Despite its goals, however, the program has not been efficient. In this way it will be valued the multiprofessional work in the accompaniment of the growth and development, domiciliary visit, and "groups of mothers" in which the nurse will be a co-participant of the staff, with the great contribution that health professionals with preventions and promotions background frequently offer.     

Applying HEDIS clinical measures to community health centers: a feasibility study

Since participation in managed care is critical for community health centers' (CHCs) survival, centers must demonstrate their good performance to purchasers (e.g., state Medicaid agencies) and health plans. Such measures also can contribute to quality improvement. Ideally, the effort would use measures and methods widely recognized in the managed care industry, logically the Health Plan Employer Data and Information Set (HEDIS). This article summarizes a feasibility study of applying HEDIS clinical measures to CHCs as providers. It finds that, with concerted, well-directed efforts, it will be possible to use clinical HEDIS measures in health centers.