Depressed Older Patients’ Need for and Expectations of Improved Health Services—An Evaluative Approach to the Chronic Care Model

Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons’ need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person’s daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

Longitudinal Care Evaluation in Child Healthcare

Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative character and quantitative approach, conducted with parents/caregivers of 186 children, younger than two years old, patients of primary health care services in the city of Santa Cruz/RN, Brazil. For data collection, the instrument Primary Care Assessment Tools (PCA Tools) was used, and the results of the questions dealing with longitudinal attribute were evaluated. The data were stored and processed in Statistical Package for Social Sciences (SPSS). The study was approved by the Research Ethics Committee of the Health Sciences School of Trairí, under number 348896. Results: The mean age of children in months was 8.21;84.4% (n = 157) were assisted by the same doctor/nurse every time;in 81.7% (n = 152) of cases the doctor/nurse know the full medical history of the child;73.7% (n = 137) answered that the professional know their child more as a person than just as someone with a health problem;48.9% (n = 91) stated that the doctor/nurse do not know their family very well;86.6% (n = 161) reported finding the doctor/nurse understands what is saying or questioning;96.2 (n = 179) of respondents said the doctor/nurse answers the questions so that they understand;96.2% (n = 179) of the interviewed said they feel comfortable telling the concerns or problems of their child to the doctor/nurse;66.7% (n = 124) claimed that they would not change the service/doctor/nurse to another health service. Conclusion: It is concluded that the attribute was well rated by the mothers of children seen in primary health care services and that they can establish good communication and relationship with the health professionals who treat their children.

Outcome of treatment seeking rural gamblers attending a nurse-led cognitive-behaviour therapy service:A pilot study

Objectives:Little is known about the differences between urban and rural gamblers in Australia,in terms of comorbidity and treatment outcome.Health disparities exist between urban and rural areas in terms of accessibility,availability,and acceptability of treatment programs for problem gamblers.However,evidence supporting cognitivebehaviour therapy as the main treatment for problem gamblers is strong.This pilot study aimed to assess the outcome of a Cognitive-Behavioural Therapy(CBT)treatment program offered to urban and rural treatment-seeking gamblers.Methods:People who presented for treatment at a nurse-led Cognitive-Behavioural Therapy(CBT)gambling treatment service were invited to take part in this study.A standardised clinical assessment and treatment service was provided to all participants.A series of validated questionnaires were given to all participants at(a)assessment,(b)discharge,(c)at a one-month,and(d)at a 3-month follow-up visit.Results:Differences emerged between urban and rural treatment-seeking gamblers.While overall treatment outcomes were much the same at three months after treatment,rural gamblers appeared to respond more rapidly and to have sustained improvements over time.Conclusion:This study suggests that rural problem gamblers experience different levels of co-morbid anxiety and depression from their urban counterparts,but once in treatment appear to respond quicker.ACBT approach was found to be effective in treating rural gamblers and outcomes were maintained.Ensuring better availability and access to such treatment in rural areas is important.Nurses are in a position as the majority health professional in rural areas to provide such help.

Participatory approach to design social accountability interventions to improve maternal health services:a case study from the Democratic Republic of the Congo

Background:Social accountability(SA)comprises a set of mechanisms aiming to,on the one hand,enable users to raise their concerns about the health services provided to them(voice),and to hold health providers(HPs)accountable for actions and decisions related to the health service provision.On the other hand,they aim to facilitate HPs to take into account users’needs and expectations in providing care.This article describes the development of a SA intervention that aims to improve health services responsiveness in two health zones in the Democratic Republic of the Congo.Methods:Beneficiaries including men,women,community health workers(CHWs),representatives of the health sector and local authorities were purposively selected and involved in an advisory process using the Dialogue Model in the two health zones:(1)Eight focus group discussions(FGDs)were organized separately during consultation aimed at sharing and discussing results from the situation analysis,and collecting suggestions for improvement,(2)Representatives of participants in previous FGDs were involved in dialogue meetings for prioritizing and integrating suggestions from FGDs,and(3)the integrated suggestions were discussed by research partners and set as intervention components.All the processes were audio-taped,transcribed and analysed using inductive content analysis.Results:Overall there were 121 participants involved in the process,51 were female.They provided 48 suggestions.Their suggestions were integrated into six intervention components during dialogue meetings:(1)use CHWs and a health committee for collecting and transmitting community concerns about health services,(2)build the capacity of the community in terms of knowledge and information,(3)involve community leaders through dialogue meetings,(4)improve the attitude of HPs towards voice and the management of voice at health facility level,(5)involve the health service supervisors in community participation and;(6)use other existing interventions.These components were then articulated into three intervention components during programming to:create a formal voice system,introduce dialogue meetings improving enforceability and answerability,and enhance the health providers’responsiveness.Conclusions:The use of the Dialogue Model,a participatory process,allowed beneficiaries to be involved with other community stakeholders having different perspectives and types of knowledge in an advisory process and to articulate their suggestions on a combination of SA intervention components,specific for the two health zones contexts.

基于SERVQUAL模型的基层医疗卫生服务质量评价研究

目的:在县域医共体的建设背景下,评价社区卫生服务中心服务质量及影响因素,提出基层医疗卫生服务质量改善对策。方法:运用SERVQUAL模型,从社区卫生服务中心服务质量的有形性、可靠性、响应性、信任性、移情性方面,形成问卷条目;通过多因素二分类logistic回归探索筛查服务质量差距的影响因素;借助IPA象限图呈现居民对社区卫生服务中心的SERVQUAL模型各维度服务质量重要性的分布情况。结果:问卷各项条目的服务质量差距均为负值,服务保证性和移情性维度的服务质量差距得分最高,分别为-0.47±0.59分和-0.47±0.65分;服务有形性维度的服务质量差距得分最低,为-0.40±0.55分。年龄、收入情况和慢病年限是服务质量差距的影响因素。结论:当前基层医疗卫生服务质量与居民的期望之间存在一定差距,基层医疗卫生服务机构应重视对低年龄、高收入和慢病病程较长的居民的服务需求。

“岗课赛证”融通下的高职智慧健康养老服务与管理专业人才培养模式研究与实践

当前,我国养老服务产业进入新蓝海,为高职养老服务类专业提供了广阔的发展空间,但与用人需求相对应的是,高职智慧健康养老服务与管理专业发展还存在供需不匹配、岗课不对接、留存不理想、认同不到位等问题,通过推进“岗课赛证”综合育人改革,进一步优化顶层设计、深化产教融合、强化以赛促学、推行以证代评、健全体制机制,可为养老服务产业培养和输送大批高素质复合型技术技能人才。

中医药特色的医养结合养老健康模式应用效果评价

目的评价中医药特色的医养结合养老健康模式的应用效果。方法选择2023年1月—2024年1月入住眉山市中医医院龚村养护中心接受养老服务的102例老年人为研究对象,实施中医药特色医养结合养老健康模式。采用SF-36生存质量评分表评估实施前后生活质量,评价养老服务满意度。结果实施后老年人生活质量评分高于实施前,差异有统计学意义(P<0.05)。实施后养老服务满意度较实施前提高,差异有统计学意义(P<0.05)。结论在医养结合背景下开展中医药健康养老服务模式,能提高老年人的生活质量,提升养老服务满意度。

基于SWOT-CLPV模型的“互联网+护理服务”分析

目的:为积极应对人口老龄化并推动“互联网+护理服务”的发展提供参考。方法:采用SWOT-CLPV模型,深入分析服务发展内部优势和劣势、外部机会和威胁,以及所产生的杠杆效应、抑制因素、脆弱性和潜在问题。结果:医护人才资源及其有效激励不足、服务风险管理机制缺乏,资金投入不足与社会参与度低、用户健康信息壁垒等原因阻碍了“互联网+护理服务”的发展。结论:应完善多元化筹资方式、构建多元化护理人才培养渠道、服务标准化与流程规范化、服务管理与信息整合的优化路径。

妇幼保健体系子宫颈癌医防一体化管理与技术服务专家共识

子宫颈癌可防可控却仍严重威胁女性健康。人乳头瘤病毒(HPV)疫苗接种、子宫颈癌筛查和早诊早治的综合干预策略是实现全球消除子宫颈癌战略目标的重要路径。目前我国已建立比较完善的妇幼保健体系,承担人群子宫颈癌防控技术服务与管理的重要职能。在妇幼保健体系内建立子宫颈癌医防一体化服务管理模式与协同机制,整合健康教育、疫苗接种、筛查、诊断与治疗、随访管理,对提高防治服务可及性,加速消除子宫颈癌的目标实现具有重要的公共卫生意义。本共识在对我国妇幼保健体系充分调研和专家研讨基础上,系统梳理妇幼保健体系在子宫颈癌防控工作中的作用、服务模式和瓶颈因素,提出构建妇幼保健机构内医防服务一体化和妇幼保健机构间医防服务全流程闭环的双路径模式,以及实现医防一体化模式的关键要素和建设原则,为推动我国妇幼保健体系子宫颈癌防治服务向连续、整合、系统转型提供指导建议。

癌症生存者整合型照护模式的概念框架、特征及对我国的启示

癌症是世界性的重大公共卫生问题。癌症发病率的持续升高以及生存时间的不断延长导致癌症生存者数量持续攀升。癌症生存者面临着身体、心理和社会照护方面的复杂挑战,其照护服务也需要跨领域、跨部门、跨学科的有效协同与整合,建立癌症生存者整合型照护模式已经成为各国应对癌症生存者照护挑战的重要策略。然而目前我国癌症生存者照护领域的发展还相对滞后。本文梳理和总结了当前代表性的癌症生存者整合型照护模式的概念框架、特征、应用以及在我国的实践进展,结合我国卫生服务体系状况,从建立共识、试点探索、人才建设、强化基层、政策支持五个方面提出相关建议,以期为我国设计与实施癌症生存者整合型照护策略提供参考和借鉴。

基于公办与民办差异视角的养老机构医养结合服务质量评价研究

背景近几年,关于我国医养结合服务模式、影响因素等的研究报道较多,但关于养老机构医养结合服务质量的研究报道较少,且缺乏对不同类型养老机构医养结合服务质量差异的比较研究。目的评价公办与民办养老机构医养结合服务质量。方法2020年10月—2021年9月,采用分层随机抽样方法在内蒙古自治区包头市、陕西省西安市、湖北省宜昌市、浙江省绍兴市共4个地区进行问卷调查,共选取25家养老机构老年人1106名。通过SERVQUAL模型构建包含可靠性、及时性、保障性、规范性、移情性5个维度和15项二级指标的医养结合服务质量评价指标体系,结合熵权法与模糊综合评价法分别计算公办、民办养老机构医养结合服务质量评分并进行比较。结果公办、民办养老机构老年人对医养结合服务质量满意度综合评价值分别为41.66、38.82分,其中公办养老机构15项二级指标评分均在40.00分以上,民办养老机构13项二级指标评分在40.00分以下。结论公办与民办养老机构老年人对医养结合服务质量满意度综合评价结果存在一定差异,其中规范性、移情性维度评分差异较大,可靠性、及时性、保障性维度评分差异较小,这为发现不同维度下医养结合服务存在的问题、促进养老机构医养结合服务高质量提供了参考。

基于PCAT的签约服务模式下社区儿童健康服务质量研究

背景基层医疗卫生机构以其综合、连续、协调、便捷和经济的特点,扮演着儿童常见病、多发病诊疗、计划免疫以及儿童健康管理的重要角色,为儿童健康服务奠定坚实基础。开展家庭医生签约管理下的儿童保健服务,对于提升儿童健康服务质量至关重要。然而,我国基层机构在儿童健康服务能力方面存在地区差异,因此,准确评价基层儿童健康服务质量,有助于及时发现问题,推动基层儿童健康服务向更高水平发展。目的了解签约儿童家长对社区儿童健康服务质量的评价情况,分析质量问题,提出优化策略,为进一步提升社区儿童健康服务质量、推进儿童签约服务高质量发展提供决策参考。方法以成都市某区为案例地区,2022年采用方便抽样,抽取该区3家社区卫生服务中心为样本机构,采用初级卫生保健服务质量评价工具(PCAT)中文版,对样本机构签约儿童家长进行社区儿童健康服务质量在线问卷调查。结果共完成3631名签约儿童家长调查。样本机构社区儿童健康服务质量PCAT中文版总得分为(58.72±13.43)分。社区儿童健康服务质量PCAT得分相对较高的维度为“持续性”“社区首诊(服务可及性和服务使用)”以及“服务综合性(服务提供)”,而“以家庭为中心”“综合性(可用服务)”和“协调性(转诊)”等维度得分相对较低。不同户籍、文化程度、平均年收入、有无熟悉的医护人员和过去1年在该中心就诊次数的调查对象PCAT中文版总得分比较,差异有统计学意义(P<0.05);多元线性回归分析结果显示,调查对象的户籍所在地,母亲的文化程度、家庭平均月收入、有无熟悉的医护人员和过去1年在该中心就诊次数均是PCAT总得分的影响因素(P<0.05)。结论案例地区签约服务模式下社区儿童健康服务质量水平有较大提升空间,应重点加强社区儿童健康服务综合性(可用服务)和服务协调性(转诊),推动以儿童及家庭为中心理念落实,关注非本地户籍儿童健康服务工作。

家庭医生制度下医护团队模式干预在社区高血压疾病管理中的应用效果

目的:探讨家庭医生制度下医护团队模式干预对社区高血压疾病管理的应用效果。方法:选取2021年1月—2022年1月湖北中医药高等专科学校附属三板桥医院收治的高血压患者126例作为研究对象,依据随机数字表法分为两组,各63例。对照组实施常规干预,观察组实施家庭医生制度下医护团队模式干预。比较两组血压、依从性及高血压知识知晓率。结果:干预6个月后,两组收缩压、舒张压低于干预前,且观察组低于对照组,差异有统计学意义(P<0.05);两组治疗依从性、护理依从性、自我管理依从性、预防行为依从性评分高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05);两组预防知识、危害、危险因素、高血压诊断知晓率高于干预前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:家庭医生制度下医护团队干预模式在社区高血压疾病管理中的应用效果较好,可有效控制患者血压水平,提升患者依从性及高血压知识知晓率。

守护儿童青少年心理健康常青——心理健康素养下加拿大的心理健康教育与服务实践

心理健康问题已成为当前加拿大儿童青少年面临的主要健康问题,为守护儿童青少年心理健康,加拿大在国家、地方和学校层面采取了一系列行动。加拿大制定了一系列针对精神卫生以及自杀预防的国家战略框架,为社会心理健康服务提供资金支持和医疗保障,推动开展基于社区的心理健康计划与服务项目。学校以培养学生心理健康素养为基点,在课程中渗透心理健康教育,并推行以学校为基础的综合护理路径模式。由此,形成了守护儿童青少年心理健康的加拿大做法。

“互联网+延续上门护理服务”对母婴健康与产妇自护能力的影响

目的探讨“互联网+延续上门护理服务”对母婴健康与产妇自护能力的影响。方法选取2022年2月至2023年2月于本院产科分娩的80名产妇作为研究对象,以随机数字表法将其分为对照组和观察组,各40例。对照组给予常规护理,观察组在对照组基础上给予“互联网+延续上门护理服务”护理。比较两组的护理效果。结果观察组的乳房肿胀、母乳喂养情况优于对照组(P<0.05)。观察组产妇及新生儿的并发症总发生率均低于对照组(P<0.05)。护理后,两组的自我管理能力测定量表(ESCA)各维度评分均升高,爱丁堡产后抑郁量表(EPDS)评分均降低,且观察组优于对照组(P<0.05)。结论“互联网+延续上门护理服务”可改善产妇的心理状态,提升其自护能力,减轻乳房肿胀程度,保障母婴健康。

医疗保健生态学模型在卫生服务研究中的应用现状及启示:一项概况性评价

背景近十年来,随着医疗保健生态学模型(ecology of medical care model)应用价值的突显,该模型得到了学者们的高度关注。医疗保健生态学理论模型构建的差异与变化在一定程度上可以反映医疗模式的转变,为了解我国人群健康需求和卫生服务利用情况提供证据基础。目的对运用医疗保健生态学模型的研究进行整合和对比,以描述使用医疗保健生态学模型建立的研究现状、对比研究方法和主要发现。方法于2022年6月,在PubMed、Ovid Medline、Web of Science、EmBase、中国生物医学文献服务系统、中国知网、万方数据知识服务平台中根据关键词、不限制语种开展检索,检索时限为1961-2022年。在Joanna Briggs Institute(JBI)概况性评价方法学手册的指导下,对文献进行筛选、信息提取,并开展描述性分析。结果共纳入符合要求的文献28篇,其中22篇(78.6%)发表于2010年以后。多数研究运用医疗保健生态学模型重点关注人群的健康需求、医疗资源利用模式,聚焦就医行为模式、疾病转诊等问题。在研究人群方面,多数研究覆盖全年龄段人群(11篇,39.3%),针对特定人群开展的研究有7篇(25.0%)。有4项研究在中国开展,均针对城市地区。相较于发达国家(地区),发展中国家(地区)研究中较少关注患者自我寻求帮助(非处方药、按摩等)情况,已有的医疗保健生态学模型反映出发展中国家(地区)具有较低的患者自报有健康问题(症状)比例,但具有更高的医院门诊就诊和急诊就诊比例。结论医疗保健生态学模型及其研究方法在过去20年间不断演进,仍然是帮助研究者和政策制定者了解医疗保健需求和医疗资源供需关系的重要工具。目前,中国对医疗保健生态学框架的应用程度不高,未来可更多地运用该模型反映卫生服务不平等和健康需求未被满足情况,并可开展群医学等领域的研究,为提高我国人群健康资源合理分配提供证据基础。

北京市妇幼保健机构互联网诊疗服务影响因素的质性研究

目的针对北京市妇幼保健机构互联网诊疗服务存在问题,提出针对性建议,为促进妇幼保健机构“互联网+”医疗服务发展提供参考。方法对来自北京市10家公立妇幼保健机构的58名职能部门管理人员进行半结构化访谈与焦点小组访谈,采用Colaizzi七步法对访谈内容进行分析。结果妇幼保健机构开展互联网诊疗服务受到制度要求、组织管理、患者特征三方面因素影响。结论妇幼保健机构开展互联网诊疗服务需加大政策支持和财政投入,加强医疗服务质量控制,规范互联网诊疗流程,提高医生线上诊疗服务能力,拓展线上服务内容,培养患者线上就医意识等。

基于PEST-SWOT分析模型的省级妇幼保健机构科技创新发展策略

目的探讨省级妇幼保健机构科技创新发展的内外部因素并提出有效策略。方法采用PEST-SWOT分析模型从政治、经济、社会和技术四个宏观环境角度对某省级妇幼保健机构科技创新发展的优势、劣势、机会、威胁进行全面分析。结果某省级妇幼保健机构科技创新发展在政策支持、科研管理制度、科研经费投入、学科特色等方面具有优势和机会,但是在人才队伍、信息化水平、行业竞争等方面存在一定的威胁和劣势。结论妇幼保健机构科技创新发展受内部、外部多方面影响,需要牢牢把握机遇,从医教研协同、学科布局、人才队伍、信息化建设等方面全面促进科技创新发展。

基于政策工具的我国中医药养生保健服务政策文本分析

目的分析中医药养生保健服务政策工具使用情况,为后续政策的调整和优化提供参考。方法基于Rothwell和Zegveld对政策工具分类的方法,结合卫生系统宏观模型构建中医药养生保健服务政策分析框架,政策工具分类维度为X维度,卫生系统宏观模型维度为Y维度,运用Nvivo对2013-2022年国家公开发布的50份中医药养生保健服务政策进行量化分析。结果X维度共142个文本编码,Y维度共154个文本编码,环境型、供给型、需求型政策工具分别占50.00%、38.73%、11.27%;内、外部子模指标分别占47.40%、52.60%。在三大政策工具中,策略性措施、法规管制和示范项目等政策子工具使用频率较多;在卫生系统宏观模型维度,监管系统、社会系统和政治系统子工具使用率较高。结论中医药养生保健服务政策以环境型为主导,需求型应用相对不足,系统内、外部子模指标分布仍需调整。建议政府有关部门加强市场引导、加大政策扶持、加快高层次人才培养,综合运用政策工具促进中医药养生保健服务发展。