香港特别行政区医院体制改革

香港特别行政区的卫生筹资及服务主要由政府提供。但通过改革，政府管理的职能已从直接提供医院服务，逐渐转到对医疗质量的监管，具体的立公医院管理工作则由医院管理局负责。医院管理局管理香港所有公立医院、诊所的财务预算分配、医疗服务质量，并将公立医院分成8个网络，网络内医院互相合作，以提高资源的利用率。香港医院通过加强继续教育、临床工作审核、整体护理、落实临床诊疗常规，同行评议等措施，来提高医院服务质量。     

A paying health promotion clinic: combining client services and student learning

Major societal changes over the past two decades have created the need for competent health care professionals able to provide high quality health care in a rapidly changing, highly technical society. To meet this goal, the University of Northern Colorado College of Health and Human Services prepares graduates in a unique multidisciplinary health promotion clinic. Department chairs along with clinic and faculty coordinators manage student-learning and client-service activities in this 9,000-square-foot, on-campus clinic. Income is generated through third-party payments and client fees from programs in nursing, nutrition, communication disorders, human rehabilitative services, and community health. Problems encountered in developing this clinic included staffing, physician consultation, fee assessment, faculty hesitancy, and health care competition. Positive outcomes were a more autonomous professional identity for students, clinic practice and research opportunities for faculty, and health promotion care for selected client groups.     

新冠肺炎疫情下儿童保健门诊家长心理体验及需求的定性研究

目的 通过现象学研究,探索新冠肺炎疫情背景下儿童保健门诊家长心理体验及需求.方法 采用半结构式深度访谈法和观察法,对17名儿童保健门诊的家长进行质性访谈,借助Nvivo 8软件,应用Colaizzi分析法和合众法对访谈收集到的资料进行整理与分析.结果 新冠肺炎疫情背景下儿童保健门诊家长心理体验及需求共提炼出4个主题:对...     

Mothers' attitudes to a child health clinic in a deprivedarea of Nottingham

Ninety children aged between one and two years registered at a child health clinic in a deprived area of Nottingham were classified according to their frequency of clinic attendance. The mothers of 71 of these children were interviewed in their own homes. There was no evidence that poor clinic attendance was due to confusion about the role of preventive child health services. On the contrary, mothers understood clearly the different purposes of child health clinics and other services. The main reason for poor clinic attendance appeared to be that poor attenders did not believe the functions of the clinic to be useful, important or relevant and preferred to use alternative sources of help or advice. Perceived negative features of the clinic or health visitor acted as a deterrent for an important minority of poor attenders. Children whose health visitors were not based at the clinic were less likely to attend. It is concluded that mothers' reasons for poor clinic attendance are not irrational but are based on attitudes which make their behaviour comprehensible, and which need to be taken into account by the health services.     

The continuing care guidelines and primary and community health services

The confirmation of NHS responsibilities for continuing health care has important implications for primary and community health services. In early 1996, during the period of consultation on draft local policies and eligibility criteria, exploratory interviews were carried out with general practitioners (GPs), community nursing managers, primary care development officers and social services purchasers in three health authority areas. The interviews indicated that few GPs had responded to local consultation and were only slowly becoming aware of the implications for the provision and purchasing of primary and community health services. Moreover, local continuing care policies had apparently not addressed two issues which GPs and community nursing staff indicated were currently highly problematic: their responsibilities in relation to independent sector residential and nursing home patients; and the consequences for primary health and community nursing services of hospital discharge decisions. The need for purchasers and commissioners of health services, whether health authorities or GPs, to begin collecting information on patients' potential needs for continuing care services was widely recognised as an urgent priority.     

Health Services Utilization and Special Education: Development of a School Nurse Activity Tool

Increasing competition exists for resources to support health services for children receiving special education. Consequently, management tools to document services when claiming these resources need to be developed. The purposes of this study were to develop a time study instrument based on nursing activities in the school, compare nursing time provided to special education children and their nondisabled peers in general education settings, compare nursing process activities in traditional settings and in special education settings, and elicit feedback from nurses to improve the validity and reliability of the time study process. Eighteen nurses representing rural, urban, and suburban schools completed a time study for two weeks, quantifying services provided in the health room. Nurses recorded student educational status, special education category or not, nursing process activity, and the time utilized per student contact. Results indicated 48.2% of school nursing time was attributed to services for special education students during the study period. Most nursing process activities for both settings were in assessment of problems and in direct services. Findings indicate the instrument can provide objective documentation of special education health services, providing a base for claiming important resources for school health services.     

Mental health services in Sydney nursing homes

Abstract: Senior nursing staff of the 58 nursing homes in one health area of Sydney were interviewed concerning mental health services and staff education. One or more psychiatrically trained staff were employed in 45 per cent of the nursing homes. Most nursing homes received services from a psychiatrist or another mental health professional, but the average time per month provided by them to see residents was less than one hour in 18 (31 per cent), one to two hours in 16 (28 per cent), and three hours or more in only 11 (19 per cent). Forty-four (76 per cent) wanted more mental health services to be provided, especially for advice on management of disturbed behaviour. A substantial number of the nursing homes (at least 28 per cent) provided no ongoing education to their staff about dementia or other psychiatric problems. There is good reason to encourage greater use of mental health professionals in Sydney nursing homes; enhanced funding of area psychiatric services for elderly people is desirable to allow these services to be more readily available.     

基于“相对价值”量化标准的基层医疗卫生服务机构内部绩效考核模式

目的：探索建立基于“相对价值”量化标准的基层医疗卫生服务机构内部绩效考核模式。方法：以河南郑州市某县为例，采用研讨会以及访谈等方法，逐一确定案例地区各基层医疗卫生服务项目“相对价值”的量化标准（以“当量值”计）；在量化标准基础上，构建基层医疗卫生服务机构内部绩效考核指标体系和实施路径。结果：共建立城乡5大类180个基层医疗卫生服务项目“相对价值”的量化标准，其中社区医疗服务项目52个、社区护理服务项目16个、社区药剂项目5个、社区辅助检查服务项目23个和社区公共卫生服务项目84个。城乡5大类项目当量值平均为3.99/4.11、1.49/1.77、0.5/0.5、0.96/0.96，2.21/2.58个标准服务当量。结论：基于“相对价值”量化标准，基层医疗卫生服务机构内部绩效考核指标体系简化为“岗位工作当量值总数”X“岗位工作质量效果系数”。     

Specialized Family Planning Clinics in the United States: Why Women Choose Them and Their Role in Meeting Women's Health Care Needs

BackgroundPublicly funded family planning clinics provide contraceptive care to millions of poor and low-income women every year. To inform the design of services that will best meet the contraceptive and reproductive health needs of women, we conducted a targeted survey of family planning clinic clients, asking women about services received in the past year and about their reasons for visiting a specialized family planning clinic.MethodsWe surveyed 2,094 women receiving services from 22 family planning clinics in 13 states; all sites included in the survey were clinics that specialize in contraceptive and reproductive health services and were located in communities with comprehensive primary care providers.ResultsSix in 10 (59%) respondents had made a health care visit to another provider in the past year, but chose the family planning clinic for contraceptive care. Four in 10 (41%) respondents relied on the family planning clinic as their only recent source for health care. The four most common reasons for choosing a specialized family planning clinic, reported by at least 80% of respondents, were respectful staff, confidential care, free or low-cost services, and staff who are knowledgeable about women's health.ConclusionsSpecialized family planning clinics play an important role as part of the health care safety net in the United States. Collaborations between such clinics and comprehensive primary care providers, such as federally qualified health centers, may be one model for ensuring women on-going access to the full range of care they need.     

Women’s Preferences for the Location of Abortion Services: A Pilot Study in Two Chicago Clinics

Between July and December 2006, 209 women at a university-based primary care center and a freestanding abortion clinic completed a verbally administered questionnaire in which they were asked their preference for the location of early abortion services. Sixty women seeking primary care services at the university-based clinic and 149 women seeking first-trimester abortion services at an abortion clinic completed the questionnaire. Sixty-seven percent (67%) of women surveyed at the university-based primary care facility and 69% at the abortion clinic indicated a preference for abortion services from their regular health care provider. A statistically significant association (P = 0.002) was found between comfort speaking with a regular health care provider about pregnancy prevention and preference for the provision of abortion services from a regular health care provider. Women may feel more comfortable undergoing an early abortion procedure with a provider with whom they have an established relationship. The integration of early abortion services into primary care practice may increase continuity of care among women seeking an abortion.     

不同依托单位的医养结合机构健康养老服务提供现状与困境

目的了解不同依托单位的医养结合型健康养老服务提供现状、成果以及遇到的各种困难,为建设医养结合型健康养老服务提供借鉴依据。方法 2019年1月对江苏省24家依托于不同单位的医养结合机构提供的健康养老服务内容与现状、遇到的困境、医护服务人员缺失程度和各主体在服务过程中作用缺失程度进行调查分析。结果 83.33%的医养结合机构为半自理老人、失能老人提供健康养老服务,八成机构提供个性化健康管理服务(83.33%)和重大疾病转诊服务(79.17%),仅有50.00%的机构考虑帮助老人实现心愿;70.83%的机构认为政策保障力度不足、制度障碍是开展医养结合服务遇到的最大难点;83.33%的机构认为医生和护士资源最为缺乏。结论应注重老年人精神需求,重视专业人才培养,建立医养结合政策体系,提高医疗资源供给力度;完善长期医疗护理保险制度,促进医养结合多方主体协同。     

Does making clinic-based reproductive health services more youth-friendly increase service use by adolescents? Evidence from Lusaka, Zambia.

PURPOSE: To report the findings of a study that evaluated the impact of three youth-friendly service (YFS) projects in Lusaka, Zambia. In 1994, the Lusaka District Health Management Team (LDHMT) identified adolescents as a priority underserved population with regard to reproductive health information and services. As part of its long-term goal to improve the health and well-being of Lusaka youth, the LDHMT, in collaboration with CARE, UNICEF/Zambia Family Life Movement, and John Snow International, implemented three separate YFS projects to increase service use among adolescents. METHODS: Service statistics from 10 clinics (8 "treatment clinics" and 2 "non-YFS clinics") were used to measure adolescent service use. Qualitative and quantitative data were collected to measure the degree of "youth-friendliness" at the clinics and the level of community acceptance of providing reproductive health services to youth. Specific indicators of youth-friendliness were developed that measured the attitudes of the clinic staff toward giving services to youth, whether clinic staff honored privacy and confidentiality, whether boys and young men were welcomed, whether the clinic policies supported providing services for youth, whether clinic staff promoted its services to youth in surrounding community, and whether youth, themselves, perceived that they would be welcomed and have their needs met at the clinics. Similarly, indicators of community acceptance were developed that measured whether parents and other adults supported the provision of reproductive health services to youth. RESULTS AND CONCLUSIONS: Although the projects appear to have improved the clinic experience for adolescent clients and to have increased service use levels at some clinics, the findings suggest that community acceptance of reproductive health services for youth may have a larger impact on the health-seeking behaviors of adolescents.     

临床护理路径在阑尾炎手术患者护理中的应用

选取172例急性阑尾炎手术患者,随机分为试验组和对照组,分析临床护理路径对阑尾炎手术患者的护理效果。结果显示,通过引入护理路径,形成主动护理与主动参与相结合的护理工作模式,由于服务流程的优化,患者住院天数缩短,医疗费用降低,满意度明显提高。     

Mental health services in Perth nursing homes

Directors of nursing (DONs) in 42 nursing homes in Perth were asked for information concerning mental health services provided for their residents. A questionnaire similar to those used by other researchers in Sydney and in Ontario was utilised to enable meaningful comparisons among the three studies. According to the DONs' perceptions, the mean proportion of residents in Perth nursing homes with psychiatric and/or behavioural problems was between 50% and 75%. The mental health services provided to nursing homes were significantly less than that desired by the DONs. Other variables assessed in this study included the number of transfers per year because of psychiatric problems; the number of staff with psychiatric qualifications; the provision of psychiatric training for staff; the most frequently occurring psychiatric problems in residents and the most valued mental health services provided to nursing homes. Results were comparable to those of the Sydney and Ontario studies. This study suggests that there is a significant psychiatric population in Perth nursing homes that, like those in Sydney and Ontario are seriously neglected regarding appropriate professional psychiatric care. Existing psychogeriatric community assessment teams could provide more of these services if adequately staffed and resourced.     

Mental health services for nursing home residents: What will it cost?

The Nursing Home Reform Act of 1987 requires nursing homes to provide basic mental health services for all residents and to give active mental health treatment, a set of specialized mental health services, to those residents who are admitted with a serious mental illness. This article examines the potential size of the nursing home population who will require mental health services, its demographic composition, and the facilities in which these individuals reside using the Institutional Population Component of the National Medical Expenditure Survey. Estimates of the potential costs of providing monthly psychotherapy and pharmacological management to this population in nursing homes indicate that the mandate will have significant financial effects on nursing facilities. Conclusions about how the requirements for maintaining the mental and psychosocial well-being of nursing home residents may affect the future of nursing home care and mental health care are considered.     

Involvement of workers from municipal outpatient services in Uberaba, Minas Gerais State, Brazil, in the reorganization of services under the Unified National Health System

This study was conducted in two specialized municipal outpatient clinics in the city of Uberaba, Minas Gerais State, Brazil. The study analyzes the involvement of professionals in their work and the reorganization of health services from their perspective, considering the participatory management recommended by the Unified National Health System (SUS). The study included nine workers with or without specific health training, all involved in health sector activities. Participants were selected according to profession or job (groups: dentistry, infrastructure, medicine, social work, psychology, coordination, nursing, pharmacy, and biochemistry), with one participant per "category" for each clinic. The content was submitted to structural narrative analysis. Three analytical categories were identified: management, involvement in work, and involvement in the SUS proposals. The study was not intended to generalize results on health workers' involvement, but it does highlight the importance of understanding the interaction between the management model and the reorganization of services as recommended under the SUS.     

Inequity in occupational health services for government hospital workers in South Africa

South Africa's inequitable public health system is mainly delivered by provincial health departments, and exemplifies the potential and problems of occupational health services in middle-income countries. The occupational health services for 153 265 employees in all of South Africa's 370 provincial hospitals were described and compared. Information was obtained from 303 (82%) hospitals, using a self-completed questionnaire and telephone interviews. Thirty-two per cent of hospitals had an occupational health clinic, but 61% of employees worked in hospitals with a clinic. Occupational health clinics were more likely to be present in larger hospitals, and were strongly associated with provision of primary care and chronic disease services to workers. Thirty-nine per cent of hospitals had a safety officer, 41% had access to an industrial hygienist or environmental health officer, and 80% had health and safety committees, as required by law. While occupational health services were more likely in larger hospitals, workforce size did not explain the marked differences between provinces. The study shows that substantial occupational health services exist, but that important gaps persist, even in wealthier provinces and especially in provinces without coherent occupational health policies.