河北省康复医疗资源调查报告

目的:对河北省现有的康复医疗资源现状进行调研,为卫生行政部门制定相关政策提供依据。方法:采用调查表的方式调研,各医疗机构在完成《河北省康复医疗资源调查表》后通过电子邮件上报数据至河北省卫计委医政医管处。结果:本研究共调查了河北省开展了康复医疗服务的168个医疗机构的康复资源配置情况,其中152家(90.5%)设有康复医学科,99家(58.9%)设有康复病床,各康复专业设置包括运动治疗、作业治疗、言语治疗、矫形器制备、康复评定、针灸推拿及理疗等,共有康复医师1124人,康复治疗师819人,康复护士767人。结论:河北省医疗机构开设康复医学病区尚不足,康复医学专业从业人员数量及质量均落后于发达国家及国内一线城市平均水平且各地区康复医学专业服务发展不平衡。     

上海市康复医疗资源调查报告

目的:上海对本地区现有的康复医疗资源现状进行调研,为卫生行政部门启动康复医疗服务体系的试点工作提供科学循证的决策依据.方法:采用问卷和实地走访的方式调研,各单位在完成《上海市康复医疗资源调查表》填写后需加盖单位公章确认.结果:上海市共有463家医疗机构,其中180家(38.88％)设有康复医学科,31家(6.7％)设有康复病床,康复医师585人,康复治疗师754人.康复医师具有研究生及以上学历者占26.32％,康复治疗师具有研究生及以上学历者占3.71％.结论:目前上海康复从业人员数量和专业质量都未达到卫生部对康复医学科设置的基本标准,尤其康复人才匮乏凸显.多种形式多种渠道,规范培养康复人员非常紧迫.     

福建省厦门市康复医疗资源调查报告

目的：了解厦门市各所综合医院康复科的建立情况和康复服务现状。方法：采用《厦门市康复医疗资源调查表》问卷调查福建省厦门市设有康复医学科的12家大型医疗机构。结果：福建省厦门市设有康复医学科的12家医疗机构中,共设有康复病床285张,共有用房面积10930．00m^2,设备投入总额1449．10万元;康复医师共100人,康复治疗师24人;康复医师具有研究生及以上学历者占32．00％,康复治疗师具有本科以上学历者占95．83％。结论：目前厦门市各医院对康复科的投入远远不足,从业人员数量和专业水平都未达到卫生部对康复医学科设置的基本标准。康复人才尤其匮乏,急迫需要多种形式多种渠道,规范培养,引进优秀康复人才。     

深圳市康复医疗资源配置现状调查

目的:调查深圳市康复医疗资源配置现状,为学科管理与规划提供数据资料.方法:采用问卷法对深圳市康复医学的学科架构、人力资源和物力资源进行调查,分析医疗资源配置中存在的问题.结果:共有55家开设康复科的医疗机构参与,三级、二级、一级、未定级医院的构成比为5.5∶1.67∶1∶1.参与调查的2321名医务人员中,医生、护士、...     

江苏省基层康复医疗资源现状与区域对比分析

目的:明确江苏省基层康复医疗资源现状及区域间发展差异,为医疗卫生政策制定提供依据.方法:各基层医疗卫生机构采用"全国康复医疗资源调查系统"网络平台填报问卷,并通过系统打印纸质版数据盖章后报江苏省康复医学会与江苏省卫生健康委员会.结果:本研究共调查了江苏省内666所基层医疗卫生机构,共有395所(占59.31％)设置有康...     

老年病康复医疗

人口老龄化是社会发展的必然结果,也是社会进步的象征之一。由于老年人在其生理、心理和社会特征等方面的特殊性,具有患病种类多、患病时间长和功能障碍率高、致残率高等特点,因此人口老龄化必然带来特殊的老年保健和医疗护理问题。为减少老年人功能障碍和致残率,改     

英国康复医疗体系现状的概况与借鉴

1 简介 在2008年启动的北京市科委重大项目"社区常见疾病医疗康复技术研究及示范"课题的支持下,笔者于2008年4月14～18日访问了英国伦敦大学(University College London)的国际健康发展部(Department of International Health and Rehabil-itation Development),与来自康复各方面的专家同行们进行了广泛交流,包括Sheila Wirz教授对英国康复现状的介绍和对ICF的回顾及其对康复观念和社会兼容性的影响;     

华西医院地震伤员康复医疗的应急体系

本文介绍华西医院建立灾后医疗应急体系的具体作法，即建立和完善地震伤员信息资料体系、制订医疗康复的攻坚策略、成立了“康复医学科抗震救灾治疗小组”，拟订灾后康复的实施方案等。截至2008年7月2日8∶00AM，全院在院地震伤员数1７２例，涉及的科室共有24个，其中100例地震伤员需要进行康复治疗。通过对住院地震伤员信息资料的掌握，利于对目前因地震造成的伤残总数、分类及康复治疗需求等进行总体评估，为组织协调及专业指导方案的制订提供理论依据，使康复治疗师及康复医师能够：①明确伤员身体结构、功能损伤与受限的部位及程度；②明确伤员个体活动受限的程度和预后；③明确伤员参与能力（包括职业、社会交往、休闲娱乐、生存质量、社区活动等）受限的程度和预后。通过实行学科交叉工作，使伤员得到了更好的康复指导和治疗，避免或减少骨折伤员愈后残疾的发生。通过建立四级医疗卫生网络，能合理利用有限的医疗卫生资源，应用现代康复治疗技术，以地震伤员为中心，分工合作，为地震伤员提供全面康复服务。     

福建省康复医疗资源现状调查与发展探讨

目的:了解福建省各级各类医疗机构康复医疗资源情况,掌握福建省康复医疗资源分布,推动福建省康复医学发展。方法:采用调查问卷的形式,了解全省医院康复医学科设置、床位、医疗服务能力、从业人员、科研等情况。结果:全省506所各级各类医院中设置康复医学科的有211所(41.7%),有独立设置病床的有174所(34.4%),全省各级各类医院共有床位103765张,康复床位仅有3996张(3.9%)。532所社区卫生服务中心和880所乡镇卫生院中具备康复医疗服务能力的不足30%。结论:福建省康复医学在学科发展、服务能力、人才等方面存在不足,且分布和发展不均衡,基层医疗机构康复医疗服务能力薄弱。     

康复医疗价值观

长久以来 ,医疗价值都以治愈为标志 ,以挽救生命、去除病因、逆转病理和病理生理为主要目标。为此将病情转归分类为 :治愈、好转、不变和恶化。这在传染病为主要疾病谱的年代无疑是合理的。但是历史的车轮在不停地滚动 ,医疗价值的基本理念也不断地升华。如今多数疾病的转归已经不可能简单地以治愈为结局。大多数疾病的发病原因与环境、心理、行为、遗传、衰老等有关 ,其病因并非可以轻易去除 ,其病理和病理生理改变也并非可以彻底逆转。我国医疗体制改革的目的是尽可能提高医疗的投入/产出比 ,或者说医疗服务的性能价格比。而在评估性能价…     

上海地区人口老龄化及其医疗、保健和康复需求问题的调查与分析

目的探讨上海地区人口老龄化及其医疗、保健和康复问题.方法利用上海统计局逐年发布资料,对上海地区的老龄结构以及发展趋势和上海某小区常见老年病发病率、老年人口医疗、保健和康复有关数据进行分析.结果和结论老龄人口医疗、保健和康复的需求是增加的.     

The system for medical rehabilitation in Croatia

Purpose.?To describe the framework for medical rehabilitation in Croatia and to discuss its influence on the practice of the specialty.

Methods.?Collection, analysis and interpretation of data pertaining to the need for medical rehabilitation in the country and to its elements of structure, process and outcome of care.

Results.?The practice of medical rehabilitation in Croatia has evolved without strategic planning on the national level and therefore without a designed system. This lack in the present framework causes shortcomings in all three elements of rehabilitation care and impedes the advancement of the specialty.

Conclusion.?Medical rehabilitation in Croatia needs a national strategic plan for a three-level system that incorporates inpatient, outpatient and community-based rehabilitation.     

The system for medical rehabilitation in Croatia

Purpose. To describe the framework for medical rehabilitation in Croatia and to discuss its influence on the practice of the specialty.

Methods. Collection, analysis and interpretation of data pertaining to the need for medical rehabilitation in the country and to its elements of structure, process and outcome of care.

Results. The practice of medical rehabilitation in Croatia has evolved without strategic planning on the national level and therefore without a designed system. This lack in the present framework causes shortcomings in all three elements of rehabilitation care and impedes the advancement of the specialty.

Conclusion. Medical rehabilitation in Croatia needs a national strategic plan for a three-level system that incorporates inpatient, outpatient and community-based rehabilitation.     

Durable medical equipment reuse and recycling: uncovering hidden opportunities for reducing medical waste

Abstract

Purpose: The purpose of this study was to investigate hospital practices for the management of unwanted durable medical equipment (DME) and to understand how health care providers conceived of their role in preventing DME waste. In order to fully identify opportunities for DME waste prevention, we began this study at the point where health care providers prescribed patients DME.

Methods: We conducted a basic interpretive qualitative study in a large regional health care system in the United States employing semi-structured interviews and a focus group. Study informants included clinicians, physicians and others involved in prescribing patients DME as well as those who played a role in environmentally sustainable health care. Informants were targeted at the patient and health care systems levels. Data were analysed using conventional qualitative content analysis.

Results: Analysis of data revealed some of the hospitals were implementing sustainability practices to reduce their output of DME waste such as breaking down unwanted DME into its core components for recycling. In addition, one hospital was operating a DME reuse programme for low-income uninsured and underinsured patients. While a concern for the environment seems to have been embedded in the day-to-day operations of these hospitals, we found that health care providers were not educating patients on options for DME reuse and recycling.

Conclusion: These findings may point to a disconnect between practices to prevent DME waste at a health care systems level and clinical decision-making for patient care and merits additional investigation.

• Implications for rehabilitation

• DME reuse and recycling is likely to have environmental as well as economic and social benefits.

• The management of DME waste should include rehabilitation providers.

• Rehabilitation providers should be trained in environmentally sustainable health care practices.

• Rehabilitation providers should educate patients on how to sustainably manage their unwanted DME.

     

An explanatory model of medical practice variation: a physician resource demand perspective

Practice style variation, or variation in the manner in which physicians treat patients with a similar disease condition, has been the focus of attention for many years. The research agenda is further intensified by the unrealistic assumption that by reducing variation, quality will be improved, costs will be reduced, or both. There is a wealth of literature that identifies differences in health care use of many kinds, in apparently similar communities. Attempts have been made by many scholars to identify the determinants of variation in terms of differences in the population characteristics (e.g. age, sex, insurance, etc.) and geographical characteristics (e.g. distance to provider, number of physicians, number of hospital beds, etc.). When significant differences in use rates prevail after controlling for differences in population characteristics, it is often attributed to 'uncertainty', or the fact that there is no consensus on what constitutes the optimum treatment process. It is suggested by this literature that the greatest variation can be found in the circumstances where there is the most 'uncertainty'. In this work, a physician resource demand model is proposed in which it is suggested that, during the diagnosis and treatment process, physicians demand resources consistent with the clinical needs of the patients, modified by the intervening forces under which they practice. These intervening forces, or constraints, are categorized as patient agency constraints, organizational constraints and environmental constraints, which are characterized as 'induced variation'. It is suggested that when all of the variables that constitute these constraints are identified, the remaining variance represents 'innate variance', or practice style differences. It is further suggested that the more completely this model is specified, the more likely area differences will be attenuated and the smaller will be the residual variance.     

工伤康复患者医学应对方式和心理状况的相关性

摘要 目的：探讨工伤康复患者医学应对方式与心理状况的相关关系。 方法：应用医学应对问卷（MCMQ）和90项症状清单（SCL-90）对738例工伤康复患者进行测评。 结果：不同受伤类型工伤康复患者的应对方式存在显著差异。未婚组和已婚组在屈服和回避的得分上存在显著差异。不同性别患者在面对和屈服的得分上存在显著差异。屈服与SCL-90各因子存在显著的相关。屈服应对方式是对工伤患者心理健康状况较好的预测指标。 结论：工伤康复患者的医学应对方式和心理健康状况密切相关,工伤康复患者的心理状况及其医学应对方式对疾病的发展及预后有很大影响, 医护人员应通过心理干预改变工伤康复患者的不良应对方式, 改善他们的心理状况, 以提高其生存质量和治疗效果。     

康复体育政策架构、优先领域及其核心内容：基于WHO康复政策内容分析

目的 运用世界卫生组织(WHO)健康服务6大构成要素理论,对康复体育的政策架构、核心内容以及优先领域进行内容分析,从宏观、中观和微观3个层次,探讨康复体育的政策架构、行动战略以及实施方法。方法 依据WHO发布的《健康服务体系中的康复》和《健康服务体系中的康复：行动指南》,结合其配套使用工具等政策文件,运用内容分析方法,探讨康复体育服务体系的政策架构以及行动战略、核心内容与优先发展领域。结果 康复体育是现代康复的组成部分,依据《国际功能、残疾与健康分类》的功能、残疾和健康理论,秉持以人为本的理念,采取措施满足残疾人康复体育服务需求,整合于健康服务连续体之中,促进实现全民健康覆盖的可持续发展目标。康复体育服务发展涉及领导力和治理、筹资、人力资源、服务提供、设备/技术/设施和监测评估与信息系统6大领域。在康复体育法规、政策与治理领域,国家为发展康复体育制定法律法规、政策文件、行动指南等,提升政府领导力与治理;拓宽康复体育筹资渠道并优化经费分配方案;完善康复体育人才培养体系,将康复体育专业人员匹配到三级卫生健康服务机构中,确保有康复体育需求的功能障碍者能够在不同层级的健康体系中获得高质量的康复...     

农村老人健康状况和医疗保健的调查分析

目的:了解农村老人健康及其医疗保健现状。方法:对295位农村老人进行问卷调查,内容包括老人所患疾病、就医现状和保健常识等。结果:在农村老人中慢性疾病的患病率达100％,其中患4种以上疾病的占69.8％,老人对自身健康的满意度只有28.1％,对医疗保健的满意度只有22.7％。结论:改善农村卫生环境、建立新型农村合作医疗制度、合理控制医疗卫生费用、培养农村医疗保健专业队伍、开展敬老活动、协调家庭关系和健康宣教等活动,有助于提高农村老人的健康水平和生活质量。     

因素型患者分类系统在眼科护理人力资源配置中的应用

目的 构建因素型眼科患者分类系统，探讨其在眼科护理人力资源配置方面可行性及作用。方法 本文依据RMT-PCS原始量表与哈尔滨医科大学第一临床医学院眼科实际护理诉求相结合，构建因素型眼科患者分类量表，此量表的四部分为中心制定67个护理及相关项目，运用整数时数分割法将眼科患者分为四种类型患者进行分析。结果 一类与二类患者占比数量较大，依次为44.88%、49.77%，一类患者在出院病区占比49.48%，手术病区占比46.75%，二类患者在眼底病病区占比50.87%，术后病区，占比48.63%；三类与四类患者集中在创伤绿色通道病区和眼底病病区。眼科5个病区的一类、二类、三类及四类患者每日平均护理时数依次为（1.76±0.67）h、（2.79±0.53）h、（5.97±1.05）h、（12.14±1.34）h。护士配备系数依次为0.34、0.51、1.16、2.18。 结论 因素型眼科患者分类系统为不同患者归类提供量化指标依据，护理配备系数应用对护理管理操作带来科学化依据，对护理人力资源的分配起到指导作用，值得广泛推广。