A Study on the Quality of Life of Elderly Nurses in Two Selected Elderly Care Institutions in Shandong Province

Objective: To comprehensively understand the impact of the quality of life of elderly nurses in two selected elderly care institutions in Zibo city, Shandong province, and to provide a scientific basis for improving the professional quality of life of elderly nurses. Methods: The convenient sampling method was used to investigate the professional quality of life (proQOL) questionnaire Version 5 and the self-designed demographic data of 82 elderly nurses working in two elderly care institutions. Result: From this score, it can be seen that the occupational burnout problem of elderly nursing staff in the two nursing homes is the most significant, with empathy and secondary trauma emergency at a moderate level. After controlling the demographic variables, the working hours and monthly income level had a significant impact on nurses’ job burnout. Conclusion: Due to the particularity and high intensity of elderly nurses’ work, their physical and mental health faces many challenges, which affect their quality of life. At present, efforts will be made to reduce work pressure, increase wages and benefits, and thereby improve the quality of life.

Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

Health and Medical Care for the Elderly

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Medical School Students’ Knowledge of Pain and Palliative Care: An Observational Study

Background: Pain and palliative care are a reality in daily routines of medical treatment. However, the theoretical-practical curricula of traditional medical school course still unsatisfactorily contemplate pain management, as well as the palliative care approach. Objective: To assess the knowledge of medical students about pain and palliative care, as well as to identify their perception of teaching these topics during hospitalization. Methods: A cross-sectional observational study, with a descriptive and exploratory approach, data collection for which was carried out between August and November 2020. The target population was medical students, who responded to an online survey of a quantitative, anonymous and follow-up nature. The survey study variables concerned knowledge about pain management and palliative care. Results: An expressive majority of academics showed difficulty in understanding the pathophysiology of pain related to prescribing drugs for pain management purposes, and all of them believe that it is necessary to acquire more knowledge about pain treatment. In parallel, only 9.3% report having received sufficient information regarding palliative care during medical school. Conclusion: The results suggest a certain lack of knowledge and insecurity among medical school students with respect to pain management and care for patients receiving palliative care. The didactical approach to this theme is still deficient in the medical curriculum and requires immediate improvement and new proposals that address the training of these professionals in a more specific and effective way.

Thoughts on the Innovative Design of the Integrated Service Mode of Pharmacies and Elderly Care Centers

Objective To evaluate the service model that integrates medical treatment and elderly care to provide a reference for the development of pharmacies and elderly care centers.Methods Through the literature investigation and case analysis,the domestic integrated medical treatment and elderly care service model was analyzed,and new ideas for the integration of pharmacies and elderly care centers were provided.Results and Conclusion The integrated service model of pharmacies and elderly care centers is designed and the integration mode of pharmacies,hospitals and elderly care centers is proposed by analyzing their advantages.The“pharmacy+elderly care”mode and the“pharmacy+medical treatment+elderly care”mode that integrates pharmacies,hospitals,and elderly care centers are put forward to predict its new development opportunities in the future.

The thinking about Shanghai Development “medical pension combined” type of long-term care insurance system

The aging development in Shanghai shows speed, high degree of aging, the number of elderly people living alone increased and other trends, the contradiction between degree of aging and care become more prominent. However, the prevalence of current pension model has a pension without medical care, health care and pension separate and other issues, so the development of ＂medical support combined with pension＂ long-term care insurance system is imperative. Based on the study to explore parts of the country which operate basic pension model of＂medical pension combination＂, we analyze the necessity and feasibility of the implementation of Shanghai ＂medical support combined with pension ＂ long-term care insurance system, by summing up experiences and lessons, put forward some of the recommendations for the development in Shanghai ＂medical support combined with pension＂ type of long-term care system.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Challenges and Solutions for Rural Mutual-Support Elderly Care:A Perspective of Embeddedness Theory

In rural China,the trend of population aging and family hollowing is becoming increasingly severe.Traditional elderly care methods are no longer adequate to meet the growing demand for elderly care,leading to the emergence of mutual-support elderly care as a new approach to elderly care.Mutual support has gained widespread practice and has become a vital component of the rural elderly service system.However,rural mutual-support elderly care encounters development bottlenecks,including local cultural resilience,disembedding of social relationships,gaps in policies and regulations,and multiple coordination challenges.Embeddedness theory emphasizes the need for social behavior to be embedded in the network of social connections,providing a valuable theoretical framework for mutual-support elderly care.Drawing on embeddedness theory,this paper investigates the accessibility of mutual-support elderly care in rural areas by examining cognitive embeddedness,relational embeddedness,systemic embeddedness,and structural embeddedness.By addressing the development bottlenecks of mutual-support elderly care in rural China,this paper aims to propose ideas for achieving high-quality development in rural mutual-support elderly care.

基于Anderson模型社区老年人医养结合服务的利用水平及影响因素研究

目的探究基于卫生服务利用的Anderson模型,了解社区居家老年人目前医养结合服务利用水平及影响因素,旨在推进优化服务体系建设。方法对上海市浦东新区某街道内长护险服务覆盖的居家养老老年人进行问卷调查并分析,调查内容包括倾向特征、促进资源和需要三个层面的影响因素和医养结合服务利用水平现状。结果调查共收到问卷2348份,有效问卷2302份,问卷有效回收率为98.04%。不同长护险评估等级的老年人中年龄段(年龄段占比)、文化程度、疾病数量、需要帮助程度,差异均有统计学意义(P<0.05)。27项生活护理服务中,利用率排名前六的项目依次为指/趾甲护理、手/足部清洁、沐浴、梳理/洗发、温水擦浴、头面部清洁;15项常用医疗护理服务方面,目前“未利用任意一项”的占比为61.86%。多元线性回归模型提示,倾向因素中的年龄对生活照护服务、整体医养结合服务利用均有正向影响(P<0.05),文化程度对生活照护服务、整体医养结合服务利用均有负面影响(P<0.05);促使因素中的医保类别、生活来源、照护费用对各服务利用均无影响(P>0.05);需要因素中的需要帮助程度、疾病数量、长护险等级对生活照护服务、医疗护理照护服务、整体医养结合服务利用均有正向影响(P<0.05)。结论长护险制度协调了居家养老的老年人的服务需求与服务供给,各项服务的利用水平仍有待进一步提升,服务模式有待优化。

智慧医疗情境下四方主体隐私行为的交互机理及演化趋势研究

[目的/意义]本文针对智慧医疗情境下隐私行为研究在博弈主体、模型参数等方面的不足,探寻患者、医疗机构、智慧医疗平台和政府四方主体之间的隐私行为交互机理与演化趋势。[方法/过程]基于演化博弈理论,构建患者、医疗机构、智慧医疗平台和政府四方博弈模型。根据不同参数调节下各方行为策略的收益、成本、损失等计算收益矩阵,求解主体的演化稳定策略,并考虑不同因素对主体行为策略及系统稳定状态的影响。[结果/结论]患者的隐私披露行为与披露隐私后获得的服务收益密切相关,医疗机构的隐私保护投入成本和隐私泄露概率对其隐私保护行为有显著影响,智慧医疗平台的政府奖惩、罚款收益和投入成本是影响其严格管理行为的关键因素,政府的监管行为与奖惩机制等因素密切相关。通过应用本文模型和方法,可以动态调整隐私保护机制,明确各方职责,推动智慧医疗可持续健康发展。

福利多元主义视角下医养结合协同治理研究——以广州市A医院托管养老机构为例

目的研究医养结合的协同治理模式,以促进医疗机构参与医养结合服务,提供对策建议。方法基于福利多元主义的视角,结合广州市A医院托管养老机构的实践经验,探讨政府、市场、社区和家庭等不同福利主体在医养结合服务体系中的作用。结果医养结合面临政府在场地、医保等方面保障力度不足的问题,市场上社会资本参与医养结合的活力不足,医养结合机构与社区组织之间的联动不强,以及老年人家庭对医养结合服务的负担较重等问题。结论政府应完善顶层制度设计,市场需优化医养结合服务供给,社区应发挥平台的枢纽作用,家庭则要营造尊老爱老的良好氛围。

基于Andersen模型的“医养结合“型机构养老需求的影响因素研究

目的了解老年人对“医养结合”型机构养老需求的现状及其影响因素,为构建多层级、持续性“医养结合”长期照护服务体系提供循证依据。方法采用多阶段抽样方法,抽取厦门市6个区,16个街道/镇,44个社区,3260名60周岁及以上老年人进行面对面问卷调查。基于Andersen理论模型,采用卡方检验分析人群分布差异,采用二元logistic回归分析方法从倾向性因素、使能因素、需要因素等方面分析老年人对“医养结合”型机构养老需求的影响因素。结果大多数老年人选择传统的居家养老(82.01%),仅有12.89%的老年人表示希望入住“医养结合”型养老机构。倾向性因素中,年龄越大、文化水平越高、居住在农村的老年人更倾向于选择医养结合养老模式,OR值均大于1(P<0.05);使能因素中,在婚、主要由配偶照护、经济状况越好的老年人倾向于医养结合式养老,OR值均大于1(P<0.01);需要因素中,老年人自理情况越差越倾向于入住“医养结合”型养老机构(P<0.01)。使能因素对模型的贡献度最大,对医养结合养老需求的影响最大。结论厦门市老年人对于“医养结合”机构养老模式的需求高于一般的机构养老需求。“医养结合”型机构养老需求受年龄、文化程度、居住地、收入、照护情况和自理能力等因素影响,其中使能因素影响最大。

上海市家庭病床服务供给现状调查研究

目的:分析上海市家庭病床服务的供给现状和存在的问题,为家庭病床服务高质量发展提供参考。方法:采用定性、定量相结合的研究方法,选取上海市城郊4个行政区的91家社区卫生服务机构,分析其2021年家庭病床服务床位、人力资源、服务项目相关情况。同时对44名家庭病床服务的供方和需方相关人员进行访谈,对10名专家进行咨询,分析上海市家庭病床开展现状和存在的问题。结果:上海市家庭病床服务网络较为完善,呈稳中向好态势。但服务中存在药物配送渠道不畅通、设备配置较基础、城郊人力资源配置不均、缺乏针对性的绩效考核制度、诊疗操作不规范、市场化发展不成规模等问题。结论:上海市家庭病床服务需加强人力、物力、信息系统建设,激发医护人员提供服务的动力,并给予社会办医疗机构更多政策支持,以鼓励其提供家庭病床服务。

以调理脾胃为中心治疗声敏感的疗效观察

【目的】观察以调理脾胃为中心治疗声敏感的临床疗效,并探讨影响疗效的相关因素。【方法】以2018年1月至2023年12月期间广州中医药大学第一附属医院耳鼻咽喉头颈外科门诊收治的符合声敏感诊断标准且资料完整的以调理脾胃为中心治疗的患者作为研究对象,对转归不明确的患者进行电话、网络等追踪随访,以治疗前后的声敏感严重程度评估指标(IAHS)得分变化情况作为疗效评估参考指标,以痊愈率和有效率作为疗效分析指标进行统计分析,评价以调理脾胃为中心的中医治养结合方式治疗声敏感的疗效,同时采用多因素二元Logistic回归分析探讨影响声敏感疗效的相关因素。【结果】共收集符合标准的声敏感患者298例,其中痊愈151例(50.67%),显效22例(7.38%),有效75例(25.17%),无效50例(16.78%),总有效率为83.22%(248/298)。单因素分析结果显示:治疗后生活方式评分、生活方式调整幅度、声敏感严重程度、病程、是否伴耳鸣、是否伴听力下降、是否伴眩晕、年龄等8个因素对疗效有影响,差异均有统计学意义(P <0.05或P <0.01),而性别、职业、受教育程度、噪音接触史与疗效无关(P> 0.05)。多因素二元Logistic回归分析结果显示:治疗后生活方式评分、生活方式调整幅度、声敏感严重程度、是否伴眩晕、病程5个因素与声敏感痊愈率具有明显相关性(P <0.05或P <0.01),治疗后生活方式评分、声敏感严重程度、生活方式调整幅度、年龄4个因素与声敏感有效率具有明显相关性(P <0.05或P <0.01)。【结论】以调理脾胃为中心的中医治养结合方式对声敏感的疗效较好,其中生活方式、声敏感严重程度、病程、年龄、是否伴眩晕是影响疗效的相关因素,值得进一步深入研究。

中医药服务参与医养结合机构的困境与出路

随着中医药文化传播和健康老龄化观念普及,中医药逐渐开展医养结合发展模式研究。目前,中医药与养老产业融合尚不紧密,本文通过走访调查、政策分析、文献梳理等方法,揭示中医药参与医养行业实践现状及存在问题,探索具有中医药特色的医养结合模式。

医养结合模式在中老年脑卒中后遗症患者居家照护中的价值

目的:探究医养结合模式在中老年脑卒中后遗症患者居家照护管理中的应用价值。方法:选取2023年7月—2024年6月佛山市禅城区人民医院就诊的脑卒中后遗症患者80例为研究对象,随机分为观察组(接受医养结合居家护理模式)和对照组(接受常规居家护理模式),各40例。对比两组生存质量与居家护理满意度。结果:干预前,两组活动能力、自理能力、社会角色、个人情绪评分比较,无统计学差异(P>0.05);干预后,两组活动能力、自理能力、社会角色、个人情绪评分升高,观察组高于对照组(P<0.05)。观察组居家护理总满意度高于对照组(P=0.0284)。结论:医养结合模式在中老年脑卒中后遗症患者居家照护管理中的应用价值较高,可改善患者生存质量,提高其居家护理满意度。

养老机构慢病患者合理用药知信行状况调查及影响因素分析

目的了解养老机构慢病患者合理用药知信行现状,为养老机构慢病患者合理用药提供参考。方法采用问卷调查法,2023年7—10月对西安市3家医养结合型养老机构的慢病患者进行调查,采用独立样本t检验和单因素方差分析检验合理用药知信行水平在一般人口学资料间的差异,采用多元线性回归分析影响合理用药知信行水平的因素。结果回收有效问卷298份。老年慢病患者用药知信行测评问卷总分为(28.77±13.66)分,用药知识、用药信念和用药行为维度得分分别为(16.65±10.54)分、(3.42±2.14)分、(8.69±3.33)分,得分率分别为46.3%、48.9%、72.4%。多元线性回归分析结果显示,学历、退休前职业、自理能力是用药知识的影响因素,是否申报慢病门诊和自理能力是用药信念的影响因素,退休前职业和自理能力是用药行为的影响因素。结论西安市养老机构慢病患者合理用药知信行水平还有待提高,养老机构应针对性采取相关措施加强合理用药宣教,提升慢病患者合理用药水平。

老龄化视域下中医药医养结合养老模式实施路径探究——以沧州市智慧社区为例

文章运用SWOT分析方法、AHP层次法,以嵌入理论、马斯洛需求层次理论为理论基础,对沧州市中医药医养结合养老服务模式应用现状进行研究,并提出针对性建议,为沧州市及国内医养结合工作的进一步开展提供有益借鉴。

医养结合的延续性护理在老年慢性病患者中的应用效果

目的:观察医养结合的延续性护理在老年慢性病患者中的应用效果。方法:选取2022年1月至2023年1月该院收治的150例老年慢性病患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各75例。对照组实施常规护理,观察组实施医养结合的延续性护理。比较两组护理前后疾病认知评分、孤独程度[加利福尼亚大学洛杉矶分校(UCLA)孤独量表]评分、自我管理能力[成年人健康自我管理能力测评量表(AHSMSRS)]评分、生命质量[生活质量综合评定问卷(GQOLI-74)]评分。结果:护理后,两组疾病认知能力评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);两组UCLA孤独量表评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);两组自我管理行为、自我管理认知、自我管理环境等各项AHSMSRS评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);两组躯体功能、心理功能、社会功能、物质生活等各项GQOLI-74评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:医养结合的延续性护理应用于老年慢性病患者可提高疾病认知能力、自我管理能力和生命质量评分,以及降低孤独程度评分的效果优于常规护理效果。

北京市老年人医养结合的难点与对策:机构的视角

中国老年群体在全国人口中的比例越来越大,如何通过医养结合真正做到老有所养、病有所医,是当前亟须解决的重要难题。以北京市为例,分析了北京市医养结合的发展形势,通过对北京三种主要的医养结合模式进行实地调研,从组织机构的视角总结不同模式面临的困难和挑战,建议进一步统筹协调京津冀医养结合政策,加快长期照护险落地,加强养老人才队伍的专业化建设,强化对养老机构的标准化建设和监管,大力发展科技养老、智慧养老。