Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective:This study aimed to understand the affordability,accessibility,and quality of maternal and child health services for postpartum mothers,and their impact on satisfaction.Methods:The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire.A survey was conducted among 289 mothers aged 20–49 in Feicheng City.Results:Regarding accessibility,most respondents(133)reported that travel time to healthcare services exceeded 60 minutes,while 99 respondents indicated a travel time of 16–30 minutes.The issue of affordability was highlighted,with 86.85%of participants perceiving maternal healthcare services as costly,indicating a significant financial burden.More than 50%of respondents were satisfied with two specific dimensions(P<0.05)regarding the quality of maternal healthcare services.Conclusion:The study found that accessibility,affordability,and quality significantly affect mothers’satisfaction with maternal health services.Future research should focus on developing more suitable service pathways for rural mothers.

Maternal complications and the utilisation of maternal health care services with special reference to West Bengal, India

The study aims to examine maternal complications in the eastern states of India. Further, an attempt is also made to understand the socioeconomic factors that determine the utilization of health care services during maternity in the state of West Bengal. The data used for the study are District Level Household Survey (DLHS) 2007-08, which reveals wide regional variations in maternal complications in India. But the state of West Bengal depicts a unique picture. It has the dubious distinction of achieving low fertility and mortality with high maternal complications. The utilisation of health care services in West Bengal was never near completion. Full utilisation of ANC which is essential for safe motherhood is just above national average. A large number of deliveries still take place out of the institution and are unsafe. Analysis reveals that higher age at motherhood increases the probability of utilising maternal health care services. Social groups, years of schooling, wealth index and place of residence also show significant relationship. The findings of the study provide an insight that efforts should be made to create awareness among socially and economically disadvantaged groups of the society about the benefits of utilisation of health care services. Further it also addresses the issue of creating awareness about MDG’s.

Utilization and Felt Need of Oral Health Care Services among Women in Chennai-Descriptive Cross-Sectional Study

Introduction： Oral health is window to overall health. There is a greatest burden of oral diseases on the underprivileged group. In developing countries like India the affordability to oral health care services is very limited thereby leading to poor oral wellness ＆ millions suffer intractable toothache and poor quality of living and end up with few dentition. Objective： To assess the utilization level of oral health services among women in Chennai. Material and methods： A cross-sectional questionnaire survey was conducted among 200 women in Teynampet Zone in Chennai District, Tamil Nadu. The women were chosen by simple random sampling and were interviewed using the semi-stzuctured questionnaire to assess their utilization level during the period of June to July 2016. The data were analyzed by SPSS Version 22. Result： Descriptive statistics and multivariate analysis--MANOVA were used to analyze the utilization level. Majority of the respondents were in the age group of 30-35years, most of the respondents had oral problem and almost everyone had visited dentist at least once within 3 years. Multivariate analysis--MANOVA also showed that the utilization levels were directly influenced by accessibility, availability and affordability and showed statistical significance （p value 〈 0.05） and also from MANOVA analysis it showed that the respondents who had poor oral hygiene did not utilize oral health care services as the affordability was a problem although accessibility and availability was adequate. Conclusion： Our fmdings suggest that people who had oral problem had visited dentist in previous 3 years and most of the people who visited dentist had a good oral hygiene. Cost of the treatment affected the dental visits. They believed that visiting the dentist is necessary only for pain relief.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

The Role of Health Inequality in the Maternal Health Services Provided by Public Institutions in Mexico

This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.

Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

A family nurse-led intervention for reducing health services’utilization in individuals with chronic diseases:The ADVICE pilot study

Objectives:Intensive health services'utilization is common in older individuals affected by chronic diseases.This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services'use(readmissions and/or emergency service access)among older people affected by chronic conditions.Methods:This is a non-randomized before-after pilot study.A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months.Standard home care was provided during the first four months'period(months 1-4),followed by the educational intervention until the end of the study(months 5-8).The intervention,based on the teach-back method,consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment,potential complications,medication adherence,and health behaviours.Rates of health services'use were collected immediately before(T0),and after the interventions(T1).Differences in utilization rates were examined by the McNemar's test.Potential factors associated with the risk of health services'use were explored with a Cox proportional hazard regression model.Results:The sample(n=78)was predominantly female(n=50,64.1%),and had a mean age of 76.2(SD=4.8)years.Diabetes mellitus was the most frequent disease(n=27,34.6%).McNemar's test indicated a significant reduction in health services'use at T1(McNemar χ^(2)==28.03,P<0.001).Cox regressions indicated that time and patient education,as well as their interaction,were the only variables positively associated with the probability of health services'use.Conclusion:A teach-back intervention led by a family nurse practitioner has the potential to reduce health services'use in older patients with chronic diseases.

Evaluation of the Maternal Health Indicators: An Ecological Study from 2000 to 2014

The aiming of this worksheet is to evaluate and to compare the quantity of prenatal appointment indicators;childbirth by kind of delivery;maternal mortality coefficient and maternal deaths number. It is about an ecological, descriptive and analytical study, made through the appreciation of secondary data related to the maternal mortality in Rio Grande do Norte, from 2000 to 2014. To that, it was used information from SISPACTO to compare real data to the estimated goals. The results show that there was an increase on the number of women who performed seven or more prenatal queries, in turn, there was an increase of alive newborns through cesarean, moreover, it is observed an oscillation on the maternal deaths number by residence during the studied period, achieving superior values to the agreed goals during the last two analyzed years. It is concluded that the maternal health, in Rio Grande do Norte, negative indicators are being presented concerning the maternal mortality, in spite of presenting an improvement on the prenatal access.

The situation of primary care institutions under the background of new medical reform in China

[目的] 分析新医改背景下我国基层医疗卫生机构的发展现状,探讨存在的问题,为进-步完善基层 卫生事业改革发展提供参考.[方法]利用2008 - 2 0 1 2年中国卫生统计年鉴数据,对基层医疗卫生机构基础设 施、人才配置和卫生服务利用状况进行分析.[结果] 2008 - 2 0 1 2年我国基层医疗卫生机构总数量年平均增速 为 1.55%,其中西部地区的机构数量最少、但年平均增速最快,中部地区的数量比西部多比东部少;在三大基 层医疗卫生机构当中,社区卫生服务中心（ 站）、乡镇卫生院和村卫生室机构数量年平均增长率分别为8 . 4 4 %、 -1.3%和 1.6%; 三大基层机构卫生技术人员数量年平均增长率分别为2 0 . 2 5 %、3% 和 5 . 0 2 % ; 三大基层机构 诊疗人次数年平均增长率分别为2 3 . 6 8 %、3. 96% 和 8. 92 %.截至2 0 1 2年 ,社区卫生服务中心卫生技术人员的 学历以大专为主（占40. 9%）,职称以师级/助理为主 （占32. 8%）; 乡镇卫生院卫生技术人员的学历以中专为 主 （占51. 3%）,职称以士级为主（占40. 2%）.[结论]新医改后我国基层医疗卫生机构发展迅速,但资源分 布仍不均衡;基层卫生技术人员数量不断增加,但学历职称层次仍偏低;基层医疗卫生机构卫生服务利用增 加 ,但患者就医仍缺乏有效引导.

The level of patients’ satisfaction and perception on quality of nursing services in the Renal unit, Kenyatta National Hospital Nairobi, Kenya

Introduction: Renal failure is on the increase and patients have to identify with renal services and centres where services for renal replacement therapies are rendered. This calls for health care workers to offer services that are perceived as quality and satisfying in order to meet the biophysical and psychological needs of the patients. Study design: This was a descriptive cross-sectional study undertaken at the Renal unit of Kenyatta National Hospital (KNH). Purpose: The study aimed at determining the level of satisfaction and perception of the quality of nursing services in the Renal unit. Methodology: The study population included all patients who were seeking dialysis services during one month period of data collection. The sample size was 151 following data collection. Data collection tools consisted of semi-structured questionnaires which were administered with the aid of research assistants as well as checklists which were self administered. Data analysis and results: Analysis of data was performed using the statistical package of social sciences (SPSS) version 16. Results of data analysis were presented in form of descriptive statistics which included mean, standard deviation and percentages. Regression analysis, t-test and ANOVA were conducted to determine demographic predictors of patient satisfaction with the nursing services. The results of the study revealed that patients in the Renal unit were generally satisfied with the nursing services. The aggregate mean score for all patients on Likert scale was 71.2 out of 105, with a standard deviation of 16.8. Level of satisfaction was 67.8%. The findings also showed that there was no association between demographic characteristics with the levels of satisfaction with the nursing services. Recommendation: The hospital should keep the patients’ level of satisfaction high and maintain it through the provision of more dialysis machines and hiring more nurses.

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。

居家失能老年人照护需要满足状况及影响因素分析

目的了解我国居家失能老年人照护需要满足状况,分析影响因素,以期为建立和完善我国老年人照护服务和保障体系提供参考。方法采用中国健康与养老追踪调查(CHARLS)2020年数据,选取居家失能老年人样本,根据安德森模型设置自变量,描述性统计居家失能老年人照护需要满足状况,运用卡方检验和二元Logistic回归分析未满足照护需要的影响因素。结果共纳入2473名居家失能老年人,其中36.2%的老年人存在照护需要未满足情况,男性、失能程度低、经济状况差、无医疗保险、无配偶、与子女交往少、可选择其他照护资源不足的居家失能老年人更容易出现照护需要未满足的情况。结论建议引导家庭成员积极承担照护老年人的责任,探索以人为本的整合型照护服务,重视男性养老护理员培养,发展灵活多样的照护服务项目,建立完善的社会化照护服务体系,同时可通过发展养老储蓄账户、长期护理保险和商业照护保险等方式来缓解居家失能老年人照护经济压力。

上海金山区朱泾镇2013-2022年孕产妇保健管理的现状分析

目的:分析上海市金山区朱泾镇2013-2022年应用孕产妇保健管理信息系统(简称孕保系统)开展孕产妇保健的状况,为提高孕产期保健管理水平提供依据。方法:采用回顾性研究方法对2013-2022年朱泾镇孕产妇系统保健相关数据进行回顾性分析。结果:2013-2022年朱泾镇孕产妇管理各项指标逐年全面提升。本市户籍孕产妇的孕早期册卡率、产检≥5次率和系统管理率等指标都明显高于同期非本市户籍孕产妇,差异均有统计学意义(93.65%比64.34%、98.19%比89.45%和90.73%比64.61%,均P<0.05)。2013-2022年朱泾镇孕产妇保健质量指标提示高危孕产妇数量逐年增多,检出率由2013年(36.97%)增加至2022年(87.56%);剖宫产率波动在39.13%~48.74%之间。结论:朱泾镇孕产妇系统管理各项指标逐年全面提升,但不同户籍类别的孕产妇健康管理水平存在差距,孕早期保健是影响朱泾镇孕产妇系统管理的主要环节,应进一步加强孕情监测工作,提高了孕产妇产前、产后保健质量,更好的保障母婴健康。

如何推进农村重点疾病人群基本卫生保健模式的改进:以人为本整合型健康管理政策证据简报

背景为了更好地应对我国基本卫生保健服务面临的问题与挑战,中国国家卫生健康委员会与盖茨基金会开展紧密合作,2017—2022年在山西省、湖北省以及河南省部分农村地区开展基本卫生保健项目。项目的总目标是探索基本卫生保健服务的有效模式,助力健康扶贫工作,加强中国国内经验分享,并惠及其他发展中国家。目的总结在以高血压和糖尿病为代表的农村重点疾病人群中开展以人为本整合型健康管理的经验。方法农村基本卫生保健项目资料和数据的收集包含了多个来源,包括医院信息系统数据、统计报表资料、基本公共卫生数据、定性访谈、患者调查、医生问卷调查、病历质量调查等,以描述性统计分析以及前后比较作为主要的评估方法。结果高血压和糖尿病患者规范化管理率保持稳定上升,住院患者次均住院费用下降,患者健康生活行为逐渐上升、患者服药依从性有明显改善。在健康结局方面,患者高血压控制情况明显改善但患者血糖控制情况变化不明显。结论项目地区重点疾病健康管理的服务理念和服务能力明显提升,相关措施已经变成政策在项目地区推广和落地,各类专家是项目推动实施的关键因素,各项措施的可持续性有待保持。

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。

江苏省妇幼健康类医疗服务项目比价研究

目的:了解江苏省妇幼健康类医疗服务项目价格水平,比较和筛选价格不合理的项目,为动态调整医疗服务价格提供参考。方法:构建标化价值模型,测算服务项目价值,根据价格价值差和比值法筛选优先调价项目。结果:共测算江苏省妇幼健康类医疗服务项目72项。31项(43.06%)现行价格低于标化价值且构成比比值低于1(妇科类20项、产科类8项、计划生育类2项、康复类1项),8项(11.11%)高于标化价值且构成比比值高于1(妇科类7项、产科类1项)。筛选建议优先调升价格项目22项,调低价格项目8项。结论:比值法简洁高效。江苏省部分妇幼健康类医疗服务项目价格及比价关系不合理,建议分步分批调整,建立价值数据库,健全价格监测与动态调整机制,将医疗服务价格动态调整与DRG/DIP医保支付方式改革相结合。

重庆市区县级妇幼保健机构孕前保健服务现状调查

目的了解重庆市各区县妇幼保健机构孕前保健服务现状。方法对参加2021年重庆市孕前保健培训班的人员进行问卷调查。内容主要包括个人信息、各区县妇幼保健机构孕前检查开展现状、孕前相关知识知晓情况,共32个问题。按照经济发展、道路交通状况、资源环境承载能力、发展水平接近的原则和地理位置,把重庆市38个行政区县分为主城区组和非主城区组。比较两组孕前检查开展现状及孕前相关知识知晓情况。结果共发放问卷109份,回收有效问卷101份,问卷有效回收率为92.66%。所有医院均开展国家免费孕前优生检查,但风险人群复诊率低。两组孕前专科门诊、心理测评、免费孕前风险人群在本院复诊率、随访形式、多媒体宣传比例比较,差异有统计学意义(P<0.05)。主城区孕前相关知识总分、B部分得分高于非主城区,差异有统计学意义(P<0.05)。结论重庆区县妇幼保健机构孕前保健服务能力需进一步提升。

中医特色服务在县级妇幼保健机构的应用探讨

本研究依托2021年江西省妇幼保健机构绩效考核、江西省妇幼保健机构中医药服务能力调查表和国家卫健委妇幼健康领域中医药工作进展情况调查表等相关数据,系统梳理实施中医药强省战略以来,江西省中医服务在县级妇幼保健机构开展情况及取得的成效。结合相关调查数据,分析江西省在妇幼健康中医药服务体系建设、人才培养、学科建设、服务能力提升等方面的优势和存在的不足,思考中医药服务在江西省县级妇幼保健机构的应用前景、发展方向。

非正式照护对我国失能老人医疗服务利用的影响——基于中国健康与养老追踪调查2018年数据的实证分析

目的分析非正式照护对我国失能老人医疗服务利用的影响,为有效利用医疗资源和不断完善失能老人长期照护服务体系提供参考。方法选择中国健康与养老追踪调查2018年数据共2330名失能老人为研究对象,描述性分析我国失能老人非正式照护及医疗服务利用现状,并采用Logistic回归分析是否接受非正式照护对其医疗服务利用的影响。结果非正式照护是我国失能老人主要的照护模式,占失能老人总人数59.55%。接受非正式照护的失能老人门诊(OR=1.344,P=0.011)及住院(OR=1.528,P<0.001)服务利用概率更高,分别提升了4.2%和9.2%~9.6%。结论失能老人以非正式照护为主,家庭照护负担较重,亟需有效配置长期照护、医疗资源等完善其保障机制。

新医改十年宁夏回族自治区农村居民健康状况与卫生服务利用公平性的进展与成效

背景 医药卫生体制改革是一道世界性难题。2009年,我国启动新一轮医药卫生体制改革,十年来,特别是党的十八大以来,改革为近14亿人带来了实实在在的获得感。这一浓缩了各方利益博弈交锋的十年医改,是我国医疗卫生事业浓墨重彩的一笔,对其改革成效的探讨和实证已然成为学界热议之题。目的 梳理并分析新医改进程中宁夏回族自治区农村居民健康状况与卫生服务利用公平性的数据变迁及其背后所映射的发展成效。方法 选取2009年宁夏回族自治区“农村居民家庭健康询问调查”的基线数据,以及后续2015年及2019年的随访数据。选取自评不健康率、慢性病患病率作为衡量居民健康状况的指标,选取两周就诊率、住院率作为衡量居民卫生服务利用的指标。利用集中指数及其分解法探索新医改十年宁夏回族自治区农村居民健康状况及卫生服务利用公平性。结果 新医改十年间,宁夏回族自治区农村居民的自评不健康率总体下降,慢性病患病率逐年上升,2009、2015、2019年的自评不健康率分别为20.37%(4 107/20 160)、17.75%(3 216/18 114)、19.51%(3 527/18 074),慢性病患病率分别为13.01%(2 623/20 160)、19.45%(3 523/18 114)、26.28%(4 750/18 074);卫生服务利用的变化总体呈上升趋势,2009、2015、2019年的两周就诊率分别为6.43%(1 296/20 160)、5.66%(1 026/18 114)、8.06%(1 457/18 074),住院率分别为8.89%(1 792/20 160)、10.66%(1 931/18 114)、13.23%(2 392/18 074)。健康公平性及卫生服务利用公平性得到一定改善:2009、2015、2019年宁夏回族自治区农村居民自评不健康率的集中指数分别为-0.024 1、-0.095 2、-0.098 0,慢性病患病率的集中指数分别为-0.001 3、-0.081 5、-0.081 0,两周就诊率的集中指数分别为0.068 8、-0.011 3、-0.051 2,住院率的集中指数分别为0.039 0、-0.029 4、-0.061 2。公平性的主要影响因素则从较为单一的经济收入为主导的现象逐步演变为由年龄、经济收入、患慢性病情况、文化程度等多因素多方面互相影响的局面。结论 新医改十年间,宁夏回族自治区农村居民健康水平得到提升,卫生服务利用公平性逐步得到改善,但应进一步关注由于老龄化、社会结构发生变化而产生的医疗改革新问题和不公平现象。