Immigrants’ Satisfaction from the National Health System in Greece: In the Quest of the Contributing Factors

Immigrants deserve special attention as they constitute a very sensitive social group, facing an increasing risk of social exclusion. The access of immigrants to health services is one of the most important factors, which contributes to their integration into the society of induction. The purpose of this study is to track and assess the immigrants’ satisfaction from the health services provided by the Greek National Health System (NHS). The satisfaction level assessment is examined in conjunction with demographic and socio-economic characteristics of the study participants, as well as with the characteristics that are related to their personal experience with the National Health System in Greece. The research was conducted from March 2012 to May 2013. The sample of the research comprises of 126 “first-generation” immigrants on legal permit of residence in Greece, who lived in the prefecture of Attica. It is panel study based on “snowball sampling” and the statistical analysis was conducted with the use of the Stata (ver. 11), while the statistical analysis used probit estimation techniques. The demographic and social variables—particularly the variables of gender, “understanding the Greek language”, “education”, “participation in the community of origin” and “insurance”—the variables of “health” and specifically “long-term diseases” and the variable of “trust” are found to be highly related with immigrants’ satisfaction degree from the Greek health system. Our research concludes that health is a fundamental, human right and immigrants’ access to health services is essential not only for their instant and effective treatment of their health problems and the improvement of their lives but also for ensuring the public health in Greece. In order to properly incorporate immigrants in Greece in particular, the health policy decision-makers have to pay attention to the contributing factors.

Public satisfaction with the quality of First Health Facility Services in Indonesia: Does sociodemographic matter?

Objective:To investigate individual characteristics related to satisfaction with the quality of First Health Facility Services(FHFS)in Indonesia.Methods:This cross-sectional study analyzes national representation data.Meanwhile,the study involved 9846 representative respondents in 2019.Respondent’s satisfaction with FHFS based on the five dimensions of service quality(SERVQUAL)is a dependent variable.Independent variables consist of sex,marital status,age,education,employment,insurance ownership,and economics.The study used multivariate logistic regression to explain the relationship between individual characteristics and FSHS quality.Results:77.3%Respondents were satisfied with FHFS,with the highest order of satisfaction dimensions being assurance(59.4%),empathy(57.3%),reliability(53.6%),responsiveness(52.7%),and then tangibility(49.1%).Multivariate logistic analysis showed that divorce was 1.48 more likely than never-married to be satisfied(95%CI 1.17-1.87).Employees were 0.77 less likely than the unemployed to get satisfied(95%CI 0.70-0.86).Respondents with higher education was 0.82 less likely than those with primary education to be satisfied(95%CI 0.67-0.99).Meanwhile,respondents who had government-run insurance were 1.61 more likely than uninsured to be satisfied(95%CI 1.42-1.80).Moreover,the rich were 0.82 less likely than the poor to get satisfied(95%CI 0.73-0.92).Conclusions:Community satisfaction with FHFS is generally high,though some areas could be improved.Demographic factors are still strongly related to satisfaction ratings.The government can assess the quality of services in accordance with standards and disseminate information about service standards for primary facilities to all levels of society,ensuring that service satisfaction is rated as good by all groups.

Challenges of a negative work load and implications on morale,productivity and quality of service delivered in NHS laboratories in England

The National Health Service(NHS)is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom.There are several challenges militating against the effective laboratory service delivery in the NHS in England.Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients.They provide the"engine room"of modern medicine with 70%of diagnosis based on the laboratory results generated by them.This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England.Laboratory service delivery in the NHS in England faces numerous daunting challenges;staffing levels in the last few years have become dangerously low,less remunerated,relatively less experienced and predominantly band 5's,multidisciplinary rather than specialty based,associated with working more unsocial hours without adequate recovery time,de-banding of staff,high staff turnaround,profit and cost driven rather than quality.These factors has resulted in burn out,low morale,high sickness absences,increased error rate,poor team spirit,diminished productivity and suboptimal laboratory service delivery.There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix,ensuring adequate remuneralion of laboratory staff,implementing evidenced-based specialty oriented service,determining the root cause/s for the high staff turnover and implementing corrective action,identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

The impact of a computerized care records service (CRS) on doctors’ work patterns in urological outpatient clinics

Objective: Government targets to reduce waiting times are putting enormous pressures on outpatient services. The implementation of an electronic care records service (CRS) at our hospital in 2008 has led to widespread press coverage of ensuing chaos in clinical administration. We wanted to know how this new electronic system impacted on our working patterns in outpatient clinics and – more specifically – on the time actually spent with the patients. Material & methods: This study was performed 4 and 12 months after implementation of CRS to assess its impact on the time distribution in clinic. Senior doctors were monitored with a stop clock during consultations. Timings for pre- and post-consultation administration, and the actual consultation with the patient were recorded. A total of 170 consultations were evaluated in this way. Results: The key findings were that the total time needed to spend on a urological outpatient of 16 minutes remains unchanged from the pre-CRS era, but a majority (57%) of this time is spent in administration on the computer without the patient involved. Conclusion: No more than 15 patients should be seen in a 4 hour outpatient clinic per doctor. This recommendation drawn up by BAUS before CRS remains still valid. Patient administration related to the consultation that has previously been done by administrative aides is now to be done by the doctors on the computer in the same consultation session. Intended to streamline patient pathways, this does reduce the quality interaction-time between doctor and patients significantly.

我国基层中医药服务现状及发展路径探讨

背景我国对基层中医药卫生服务的关注度持续提升,但是目前基层中医药卫生服务体系仍存在问题,制约了我国中医药事业的发展。目的分析我国基层中医药卫生服务体系现状,探索持续提升基层中医药服务能力的策略。方法于2022年12月,检索《中国卫生健康统计年鉴》《全国中医药统计编摘》及国家疾病预防控制局和国家心血管病中心官方网站获取数据,从卫生投入、服务产出、健康需要3个层面构建指标体系,结合秩和比法和WHO卫生系统绩效模块框架对基层中医药服务现状进行综合评价。结果卫生投入方面:2017—2021年,除乡镇卫生院外,其他能够提供中医药服务的基层医疗卫生机构数量均有所增加;社区卫生服务中心(站)、乡镇卫生院、门诊部中医类临床科室床位数呈现上升趋势,但门诊部中医类临床科室床位数占门诊部总床位数的比例有所下降;社区卫生服务中心(站)、乡镇卫生院、诊所中医类执业(助理)医师占比明显上升,而村卫生室的中医类执业(助理)医师占比保持稳定,门诊部的中医类执业(助理)医师占比逐年递减;近5年,基层医疗卫生机构财政投入的绝对数值稳步提高,而中医机构财政拨款波动减少。服务产出方面:尽管各类机构中医诊疗人次占机构总诊疗人次的比例按照一定增幅稳步增长(除中医类门诊部外),但仅村卫生室的中医诊疗量占比始终保持在30.0%以上;除乡镇卫生院外,其他基层医疗卫生机构的中医类执业(助理)医师人均担负年诊疗人次总体上呈下降趋势。根据综合评价结果,2017、2018、2021年处于资源分配适宜状态,而2019、2020年处于资源分配不均衡状态。结论目前,我国基层中医药卫生服务体系建设得到有效落实,但在有序推进的过程中也存在一些不足。基层中医药资源不足、服务与利用不均衡、中医药优势未充分发挥、人才培养机制不健全、财政投入少等问题制约中医药事业的发展。为推动基层医疗卫生机构持续提高中医药卫生服务能力,需要夯实政府职能,进一步弘扬中医药文化,建立激励机制以优化人才培养模式,加强中医药服务与医保政策紧密结合,建设以“信息一体化”为支撑的中医医联体。

Effectiveness of the Service Mapping Method in Re-designing the Bariatric Surgery Clinical Pathway of a Public Hospital

Background： Nowadays obesity is the world＇s common disease. Bariatric surgery is the only therapy that providessignificant cost savings within Public Health Service, but the lack of diagnostic paths universally accepted causes enormous waste ofresources and disruptions. Service Mapping is the ideal methodology to describe work＇s organization and to plan a new service model.Methods： The Service Mapping has been used to represent the actual state of the bariatric surgery service and starting from the criticalaspects found, we have developed a desirable state of the service. Results： Experience-based design has given centrality to thebeneficiary, making the bariatric service sensitive to patient＇s needs and expectations. The micro-organization of work has improvedprofessionals＇ integration, avoiding the creation of new operational entities or additional costs. The service has been simplified both forclinicians and hospital managers. The strategic repositioning of the dietician and general practitioner＇s recognition within the bariatricpath allowed us to achieve better clinical outcomes. Conclusions： Service Mapping has highlighted clinicians＇ difficulties in providingthe service, emphasizing the importance of the beneficiary. The iconic representation is a powerful explicit framework, fundamental formanagement purposes, to understand the role of every subject involved in the service, to rationalize work＇s organization, and integratehealthcare activities.

Interpretations of Key Points of National Nursing Developmental Project from 2016 to 2020

National Nursing Developmental Project from 2016 to 2020 w as printed and published by General Office of National Health and Family Planning Commission to further accelerate the development of medical nursing so as to meet the healthy requirements of the masses.This paper aimed to interpret the key points of the project from the aspects of excellent achievements in medical nursing development during the 12thFive-Year Plan,opportunities and challenges in nursing development during the 13thFive-Year Plan,guiding thought and primary principles,as w ell as the developmental targets,the primary assignments,the key projects and the supporting measures in the 13thFive-Year Plan,so as to provide the latest important information for nurses and patients w ith special requirements,and to improve nurses’professional nursing quality and capacity in medical nursing profession.

运动转诊服务纳入医疗卫生优先事项的卫生经济学分析

当前,运动转诊服务获得了世界卫生组织推荐,正成为全球公共卫生优先事项。中国体医融合服务尚未获得政策优先级,可能受制于卫生经济学证据不足。文章系统梳理了身体活动不足的全球疾病负担研究,得知:(1)患病率。2010—2018年中国身体活动不足患病率上升7.93%;(2)健康负担。1990—2019年中国可归因于身体活动不足的死亡人数增长3.24倍、残疾调整寿命年增长2.64倍、健康寿命损失年增长2.89倍、寿命损失年增长2.58倍,过去近30年健康负担持续增长;(3)经济负担。2020—2030年,身体活动不足将引起4 517.01万例12种常见非传染性疾病,导致医疗卫生和医疗保健总成本达到36 694.53亿元;(4)宏观经济收益。2020—2050年解决身体活动不足将为中国带来的累积经济收益41 473.48~150 124.07亿元。这些数据为中国运动转诊服务纳入医疗卫生优先事项提供卫生经济学证据,但提升政策优先级还需:(1)进行独立的中国身体活动不足的疾病负担测算,为医疗卫生政策提供可靠证据;(2)将运动转诊作为中国非传染性疾病治理的优先政策;(3)建立运动转诊机制,并将运动转诊服务纳入医疗卫生服务目录。

海南省居民对国家基本公共卫生服务项目知晓率与满意度网络调查分析

[目的]了解海南省居民对国家基本公共卫生服务项目的知晓率和满意度情况。[方法]采用方便抽样方法,对海南省31507名居民进行网络问卷调查,运用卡方检验、二分类Logistic回归和Spearman相关分析进行统计分析。[结果]海南居民对基本公共卫生服务项目的总体知晓率为85.8%,知晓率的主要影响因素为性别、民族、居住地区、年龄、文化程度、职业、人群类型和家庭平均月收入。居民总体满意度为93.8%,满意度的主要影响因素为年龄、文化程度、居住地区和职业。知晓率与满意度之间呈正相关(r s=0.330,P<0.001)。[结论]海南省居民对国家基本公共卫生服务项目知晓率和满意度较高,应进一步加大宣传力度,提高服务质量,进而提高居民的获得感。

2021-2023年云南省重点人群对国家基本公共卫生服务知晓率和满意度的调查研究

[目的]了解2021-2023年云南省65岁及以上老年人、高血压和糖尿病三类重点人群对国家基本公共卫生服务项目的知晓率和满意度,为进一步提高服务质量,提升居民的获得感以及更好地开展个体化健康教育工作提供参考。[方法]采取随机抽样的方法,选取云南省16个州(市)重点人群进行现场问卷调查,采用描述性分析、Kruskal-Wallis非参数检验对调查数据进行分析。[结果]2021-2023年,云南省重点人群对国家基本公共卫生服务项目的总体知晓率为72.69%,其中居民健康档案管理知晓率最高(95.38%)。重点人群对基本公共卫生服务总体满意度为74.04%,其中医患关系满意度最高(87.50%)。重点人群首诊选择村卫生室的占61.25%,乡镇卫生院占50.87%。[结论]云南省重点人群对国家基本公共卫生服务项目的知晓率和满意度相对较低,知晓率呈逐年上升趋势。建议加强针对老年人和慢性病等重点人群的教育和健康促进工作,提高基层医务人员的专业能力和服务水平,从而有效提高居民的获得感。

国家公园生态系统健康测度模型构建及黄山实证研究

国家公园是中国生态文明建设的重要制度实践,其生态系统健康的科学评估是国家公园分区管理、空间管制、生态保护的基础。国家公园生态系统具有特殊性和复合性,区别于城市、流域、湿地等生态系统,亟需建立一套适合国家公园生态系统的生态系统健康测度模型。基于国家公园生态系统的特殊性和生态系统健康概念的多维性,探讨了现有模型存在的问题和不足,从生态系统与人类活动交互的视角,建立了“VSR”(生态活力Vigor、服务能力Service、抗干扰力Resilience)国家公园生态系统健康测度模型。此外,将“VSR”模型应用到黄山国家公园生态系统健康的测度中,可视化了黄山国家公园生态系统健康的时空过程和格局,通过随机森林回归模型和增强回归树模型验证了“VSR”模型的有效性和稳定性。“VSR”国家公园生态系统健康测度模型有效量化了国家公园生态系统健康的时空差异性和时空动态性,为国家公园空间管制、生态保护等目标实施提供了科学支撑。

新时代全民健身志愿服务的实践探索与制度创新

全民健身志愿服务承载着“全民健身”与“志愿服务”的双重属性,支撑健身运动普及与志愿精神传承,助力全民健身活动创新与体育制度治理,增强全民族健康水平与体育文化交流。研究发现,目前我国全民健身志愿服务正发挥着日益精进的作用,不论从志愿服务开展的内容、形式、组织还是志愿者参与度来看都取得了长足的发展,但是也面临着法律保障有待加强、激励政策亟待完善、政府机构间协同乏力、志愿者培养与管理制度尚待改进等问题,难以满足新时代人民群众日益增长的健身志愿服务需要。因此,提出健全法律保障、建立科学的激励手段、完善政府部门协同合作、建立长效化培养与管理机制等建议,以此创新我国新时代全民健身志愿服务发展思路。

加强公共卫生服务体系建设的逻辑进路——以淮安市为例

重大公共卫生事件不仅严重挑战公共卫生服务体系,而且也关系着人民生命健康和国家安全。健全的公共卫生服务体系需要全生命周期的逻辑协同。健全防控体系、强化预警和监测能力、完善重大疫情救治体系、健全公共卫生服务辅助与保障体系是当前健全公共卫生服务体系的现实路径。

数字赋能全民健身与全民健康深度融合的逻辑机理、关键问题与实践进路

运用文献资料、逻辑分析等研究方法,以数字赋能为手段,以更高水平发展为目标,在阐述全民健身与全民健康深度融合内涵的基础上,探骊数字赋能全民健身与全民健康深度融合的逻辑机理、关键问题与实践进路。研究认为:理念认知与服务意识亟须进一步提升、政策法规与制度标准亟须进一步完善、技术应用与数据靶控亟须进一步加强、场景创新与场景应用亟须进一步拓展等关键问题。进而提出理念融合:助力提升数字赋能的参与主体服务效能;政策融合:持续完善数字赋能的各项制度内容;技术融合:继续加强数字赋能的数据共享与安全机制;场景融合:不断拓展数字赋能的场景创新元素等实践进路。

借鉴英国医疗服务体系破解我国实施双向转诊制度难题

本文分析了我国医疗服务体系中双向转诊制度实施的三大难题:患者首选大医院,对社区卫生服务中心的诊疗能力存在质疑;各级医院受经济利益驱动,不愿主动转出病患;政府投入不够,相关配套政策尚不完善。通过借鉴英国国民医疗服务体系中双向转诊制度的实施要点,提出对我国双向转诊制度顺畅实施的政策建议:完善医保制度,拉开价格差距,体现社区医疗价格优势;加大政府投入,改善社区卫生服务中心的物力和人力资源;建立高效的计算机医疗服务网络,方便患者就诊转诊;建立城市医疗集团,从根本上消除趋利的阻碍。

我国结核病防治主要成就回眸及亟待解决的问题与建议

结核病是我国乃至全球关注的重大公共卫生问题。本文作者回顾和总结了我国结核病防治工作主要进展和成效,系统梳理了当前我国结核病防控存在的问题和挑战,特别是多部门合作、人畜共患和中医药防治结核病等领域存在的短板,提出了我国下一步结核病防治工作的对策和建议。

老龄化社会下英国健康服务体系的改革及经验

英国是最早进入老龄化的发达国家之一,应对老龄化有较为丰富的经验。本文主要从英国的健康服务体系、健康筹资及支付模式、老年健康服务模式及整合服务模式探索案例对英国应对老龄化的健康服务体系进行介绍。从英国经验启示来看,我国应建立统一的资源配置规则,加强全科医生、初级保健和公共卫生建设,建立以数据、分析工具为支持的决策体系,以应对老龄化带来的健康服务体系的挑战。

西部民族地区某高校大学生卫生服务需要和利用现况调查

目的:对西部民族地区某高校大学生卫生服务需要和利用进行分析研究。方法:采用分层随机整群抽样方法,抽取627名在校大学生进行卫生服务状况调查。结果:西部民族地区高校大学生两周患病率为22.01%,高于全国平均水平。不同性别(χ2=1.770,P=0.183)、城乡(χ2=2.377,P=0.123)、家庭经济状况(χ2=3.685,P=0.450)之间患病率差异无统计学意义。两周就诊率为8.45%,应就诊未就诊比例为61.3%,高于全国总体水平;调查前1a内大学生住院率为1.91%,应住院未住院比例为58.62%。校医院是大学生首选的医疗机构。logis-tic多因素分析结果显示,年龄、城乡、年级、月生活费用、是否参加医疗保险是影响大学生卫生服务利用的主要因素,其OR及95%CI分别是1.111(1.024～1.206)、0.468(0.383～0.571)、1.246(1.042～1.490)、1.280(1.091～1.501)、0.705(0.588～0.845)。结论:西部民族地区大学生卫生服务需要高于全国平均水平,但各种卫生服务的利用程度偏低。经济因素是影响大学生卫生服务利用的主要因素。

1998～2003年中国母乳喂养与婴儿过渡期食物添加状况分析

[目的]从第三次国家卫生服务调查资料中了解我国婴儿喂养现状,从而发现问题、提出建议。[方法]利用第三次国家卫生服务调查的资料,对婴儿喂养情况进行描述性分析。[结果]1998-2003年间我国产妇早开奶率为19％-26％,且在县(区)级以上医院或妇幼保健院住院分娩的产妇早开奶情况并不好于不在上述医院住院分娩的产妇;城乡的母乳喂养情况较好;农村地区儿童辅食添加存在问题,普遍存在辅食添加过晚的现象,而四类农村地区存在过早添加辅食现象,在四类农村,有约50％的婴儿在4个月内添加了辅食。[结论]近年我国儿童母乳喂养率高,但产妇早开奶情况无明显改善;在农村地区,儿童辅食添加过早和过晚现象同时存在。

我国体卫融合发展的历史脉络和现实困境及其疏解策略

采用文献资料、逻辑演绎等方法,通过量化不同年份政策数量和力度来剖析我国体卫融合发展的时变规律,将其划分为体医结合、体医融合及体卫融合3个阶段;分析体卫融合的社区模式、医院模式和体质监测中心模式,管窥体卫融合发展过程中存在的顶层设计不完善、保障措施不到位、创新驱动发展不足、资源共享不充分等困境,提出要站在人类卫生健康共同体的高度,完善顶层设计,把握体卫融合发展方向;措施落实到位,保障体卫融合健康发展;创新驱动发展,赋能体卫融合提质增效;共享体卫资源,实现健康治理效能最大化,保障体卫融合健康可持续发展,助力健康中国和体育强国建设。