The Intermediary Roles of Public Health Nurses (PHNs) in Utilizing Communication Robots (CRs) in Community Health Care Practice

Robot technology is expected to reduce the burden of medical professionals, a concern in the super-aged society. The aim of this article is to determine the intermediary roles of Public Health Nurses (PHNs) in using Communication Robots (CRs) in Community Health care. It is necessary to consider who will manage, and how to draw lines of responsibility when a problem occurs when using robots in the future. Regarding the mediator or intermediary role of PHNs in the use of CRs, PHNs are expected to be cognizant of varieties of robots for use with persons of diverse ages and health levels, as well as of robot performances. As one of the community healthcare workers who service the elderly living in the community, the role of PHNs as mediators or intermediaries is to pay attention to ethical and moral issues while working with CRs to manage the health of the community. Lack of understanding of the intermediary role might create possible ethico-moral issues in the future. Therefore, it is critical for PHNs to understand their role as intermediaries. In doing so, it is expected that older people at home will be able to live peaceful lives, as well as be physically and mentally healthy.

General medical practice in China:evaluation of urban community health care service functions based on a rough set reduction theory

Objective:This study aims to achieve an empirical evaluation on the functional performances of urban community health care services in fi ve administrative districts of Nanchang city in China.Methods:In order to increase effectiveness,data collected from fi ve administrative districts of Nanchang city were processed to exclude redundant information.Rough set reduction theory was brought in to evaluate the performances of community health care services in these districts through calculating key indices’weighed importance.Results:Comprehensive evaluation showed the score rankings from high to low as Qing-yunpu district,Xihu district,Qingshanhu district,Donghu district,and Wanli district.Conclusion:The objective performance evaluation had actually reflected the general situation(including social-economic status)of community health care services in these administrative districts of Nanchang.Attention and practical works of community health service management were needed to build a more harmonious and uniform community health care service system for residents in these districts of Nanchang.

The Role of Library and Information Science Education in the Development of Community Health Information Services for People Living with HIV/AIDS: Perspectives of Directors and Managers of Public Libraries

This article identifies the role of library and information science (LIS) education in the development of community health information services for people living with HIV/AIDS (PLWHA). Preliminary findings are presented from semi- structured qualitative interviews that were conducted with eleven directors and managers of local branches in the Knox County Public Library (KCPL) System that is located in the East Tennessee region in the United States. Select feedback reported by research participants is summarized in the article about strategies in LIS education that can help local public librarians and others in their efforts to become more responsive information providers to PLWHA. Research findings help better understand the issues and concerns regarding the development of digital and non-digital health information services for PLWHA in local public library institutions.

Spatial Identities of Public Health Service Facilities in Metropolitan Suburban Communities: A Case Study of Shanghai Jinshan District

Both "Healthy China" and "Healthy Shanghai" programs require construction and development of community public health services. Taking Jinshan District in Shanghai as a case study, this paper evaluates the status quo of community health services from the "demand-supply" perspective, and finds a remarkable difference in the needs among different age groups, a big gap between urban and rural areas in the coverage degree of facilities, and different challenges for public service at the "prevention – treatment – health care" stages. It further puts forward several planning strategies involving(1) specific service supply based on different age groups,(2) "15-minute health service cycles" in both urban and rural communities,(3) adjustment of facilities to local conditions, and(4) promoting the quality of health services. Furthermore, it discusses in-depth issues underlying planning policies, such as the innovation of service content, the integration of different plans, and the cultivation of health service needs.

The Management of Mental Health, and Service Networks in Italy

Madness has attracted and frightened for centuries,and talking about this means discussing how this diversity was built and managed in different social contexts and historical periods.Not all societies have had,and still have,the same relationship with madness.It is only with the affirmation of the Modern State,and of Capitalism,that the idea of“normality”indispensable to be able to conceive diversity as something dangerously distant and different from the norm takes over.In our post-modern society,people with mental illness in Italy can resort to specialists and social-health services.But the heterogeneous answers given after the approval of law 180 appear to be increasingly diversified.In this research,much attention will be paid to how the social and health services,located in different areas of Italy(Messina,Rome,Trento)face the current growing risk of social,housing and economic isolation of these fragile subjects.The aim of the research is to explore the possibility of a new relationship between the social-health service and the local community.On the one hand,research investigates what the contribution of the services could be.On the other what the spaces of protagonism and participation of the community could be in inclusion process account.In order to better understand the differences between these two dimensions,a qualitative research approach was chosen through the conduct of in-depth interviews.In this way it was possible to investigate:(1)the partial representations characteristic of the single individual,family members,operators and stackholders in general;(2)the services around the topic dealt with is articulated.From the first results of the research it emerges that the territory can no longer be considered as an abstract entity,but becomes the social space within which the construction of a new community welfare can and must take place.

Advances in the Health Training Process Quality:Links between Education,Service and Community

This study proposes to discuss the experience lived by Pró-Saúde and PET-Saúde team of FACISA/ UFRN together with the Municipal Health Department of Santa Cruz/RN from a critical-reflexive perspective about the interaction between education, service and community as well as advances in approach and the strengthening between the school and Primary Health Care. This is an exploratory study with an experience report approach of the Pró-Saúde and PET-Saúde team from 2012 to 2014. The integration of these programs in experimental scenarios of the Unified Health System and the strengthening of the proposed training of human resources capable of the current healthcare system were observed. Thus, contributions in health in undergraduate courses and practices of health services are important, since the approach to the reality of the population and their social needs contribute to the vocational training quality.

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.

Contact Precaution: Acceptance of Health Professionals to Teaching Hospital

The adoption by health professionals to the practice of patient isolation is a decision that reduces patients’ risks of occupational exposure to potentially contaminated biological material and prevents nosocomial infections. Verify the compliance of health professionals to the practices of contact precautions in patients colonized by microorganisms in a teaching hospital. This was a prospective observational cohort study in a special-sized hospital located in southeastern Brazil. The observation of health professionals in delivery of health care to patients with contact precaution was performed regarding hand hygiene, use of overcoat, glove, and mask. We carried out 1502 observations involving the following professional categories: nursing technicians and/or nursing assistants (n = 1028;68.4%), nurses (n = 200;13.3%), physical therapists (n = 185;12.3%), and physicians (n = 89;5.9%), totaling 971.8 hours. Regarding the level of compliance of professionals to contact precaution practices with hand hygiene after the procedures, the use of overcoats, gloves, and masks, all were statistically significant (p Klebsiella pneumoniae was the most positive pathogen identified in laboratory tests. This study provided the mapping of the compliance of health professionals to the practices of contact precautions in order to support a safer management of patient care reducing the risks of Healthcare-Associated Infections (HAI). This study also showed that health professionals are using practice management to deal with their behavior to protect their health.

我国公立医院医生的价值医疗服务动机探究——概念建构与量表测度

健康中国建设行动彰显了以患者为中心的价值医疗理念,对医生医疗服务行为的价值诉求也日益提高。本研究试图将一般公共组织中公共服务动机概念引入公立医院之中,提出“价值医疗服务动机”概念,作为公立医院医生的一种公共服务动机表达。本文通过质性分析和量化测度,建构出“公立医院医生价值医疗服务动机”的概念,包含责任承诺、专业坚守、声誉维护、规范遵从四个概念维度,据此形成价值医疗服务动机量表。研究发现我国公立医院医生具有多维价值特征的医疗服务动机,呈现不同动机表达或行为倾向,在实现以患者为中心的价值医疗目标实践中,不断处理与平衡其中的公共价值冲突。该量表能够为测度医生价值医疗服务动机提供有效工具,为进一步发现医生价值医疗服务动机的影响因素,提升公立医院医疗服务能力、改善医疗行为、促进医患信任等提供理论与实践支持。

The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective:This study focuses on Hangzhou,a Chinese city with a population of nine million urban and rural residents,to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then dis-seminate the findings through international third parties.Methods:Measures such as data analysis,study of documents and regulations,fieldwork,and expert discussions were used to systematically investigate primary health care in Hangzhou.The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.Results:Community health services in Hangzhou are characterized as follows:They are gov-ernment led;they are guaranteed with enough financing,personnel,facilities,and regulation;sup-ported by the unified information platform;general practitioners have been assigned the key role of health‘gatekeepers’;they provide primary care combined with basic public health services;there are integrated urban and rural health services and insurance coverage;and there is health care-pen-sion-nursing integration and general practitioner-contracted‘smart’services.Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole,and some health indicators in Hangzhou are comparable to those in Western developed countries.Conclusion:It is reasonable to believe that the primary health care level in China,including Hangzhou,will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

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。

“十三五”期间广州市不同结核病防治管理模式实施效果评价

目的:评价广州市现存结核病管理模式的实施效果,为不断完善结核病防治服务体系提供依据和实例。方法:从广州市结核病监测信息报告管理系统和广州市“十三五”结核病防治规划终期评估报告中搜集2016-2020年广州市4种结核病防治管理模式(慢病管理模式、“三位一体”模式、综合医院管理模式和委托服务模式)下的结核病疫情资料,计算不同模式下的肺结核患者登记率、病原学阳性率、治疗成功率、管理率和规范管理率等,并进行实施效果的成本-效用分析。结果:2016-2020年,广州市肺结核年均总登记率为51.78/10万(46 228/89 280 200),4种模式年均登记率由高及低依次为委托服务模式[74.37/10万(10 522/14 148 900)]、“三位一体”模式[50.17/10万(11 349/22 619 500)]、慢病管理模式[47.37/10万(14 588/30 793 700)]和综合医院管理模式[44.98/10万(9769/21 718 100)],差异有统计学意义(χ^(2)=222.422,P<0.001)。总病原学阳性率为49.33%(22 806/46 228),以慢病管理模式为最高[50.98%(7437/14 588)],委托服务模式为最低[48.07%(5058/10 522)];总治疗成功率为93.26%(43 113/46 228),以综合医院管理模式为最高[95.73%(9352/9769)],“三位一体”模式为最低[90.30%(10 248/11 349)];总规范管理率为89.08%(13 254/14 879),以委托服务模式为最高[95.40%(2573/2697)],“三位一体”模式为最低[82.69%(3100/3749)];差异均有统计学意义(χ^(2)=27.302,P<0.001;χ^(2)=306.666,P<0.001;χ^(2)=294.272,P<0.001)。总人均投入0.86元(76 477 200/89 280 200),挽回1个伤残调整生命年(DALY)损失需要投入的费用以“三位一体”模式为最高[188.20元(20 326 600/108 003.67)],综合医院管理模式为最低[153.77元(15 155 800/98 560.73)]。结论:“十三五”期间广州市4种结核病防治管理模式各有其优势及不足,未来仍需结合各区需求导向,从政府部门、系统到人才建设,积极采取措施,完善其现存结核病防治服务体系中的不足,以进一步提升患者登记率、病原学阳性率和总规范管理率。

家庭医生签约服务背景下签约居民基层首诊效果评价研究

背景2016年全面推行家庭医生签约服务以来,居民基层首诊意愿逐步提升,但签约居民基层首诊效果评价尚需进一步探讨。目的了解签约居民的首诊性评价现状,探讨其影响因素并提出改善策略。方法采用多阶段分层随机抽样法在山东省三市抽取54所社区卫生服务机构/乡镇卫生院,共4000名签约居民。采用汉化版基本医疗质量评估量表(PCAT)的首诊性维度问卷进行调查,比较不同特征的签约居民首诊性维度得分,采用多元线性回归分析影响签约居民首诊性评价的因素。结果共回收有效问卷3859份,问卷有效回收率为96.48%。其中,乡镇卫生院签约居民为2086名(54.1%),社区卫生服务中心为1773名(45.9%);三个地区的首诊性维度总得分为3.49分,得分最高的条目是“您的签约机构周六、周日开门吗”(3.74分);得分最低的条目是“在非营业期间,如果您在晚上生病了,您的签约机构会有医生或护士出诊吗?”(3.05分)。多元线性回归分析结果显示,签约机构、个人月收入、文化程度、婚姻状况、职业、身体健康、是否确诊慢性疾病是签约居民首诊性维度得分的影响因素(P<0.05)。结论签约居民的首诊性评价较好,但还需加强家庭医生签约服务政策宣传,引导签约居民形成基层首诊的就医观念,通过明确非工作日出诊流程、提升基层医疗卫生机构服务供给能力、加强医疗卫生机构共享平台建设、发挥医疗保障制度杠杆作用等措施推动居民基层首诊,进而提升签约居民首诊性评价。

基于供方感知视角的家庭医生签约服务质量评价及影响因素研究

背景家庭医生签约服务是基层卫生服务改革工作的重点,当前我国签约服务的覆盖率稳步提升,但履约服务的提供仍存在诸多问题,家庭医生团队对签约服务质量的评价尚不明晰。目的研究家庭医生团队的履约服务现状及影响因素。方法于2022年10月,通过立意抽样和分层整群抽样,选取广西壮族自治区南部、中部、北部和东部的780例家庭医生团队成员进行问卷调查。采用初级卫生保健质量评价工具-供方简化版(PCAT-PS)量表对纳入对象展开调查,涵盖首诊、连续性、协调性等8个维度、43个条目。采用多元线性回归分析家庭医生团队成员PCAT-PS得分的影响因素。结果共回收有效问卷775份,问卷有效回收率为99.36%。家庭医生团队成员PCAT-PS量表平均得分为(32.55±3.90)分。其中,得分较高的2个维度分别为以病人及家庭为中心、综合性(提供的服务),得分较低的2个维度分别为首诊(可及性)、连续性。多元线性回归分析结果显示,机构类别、年龄、职称、团队职责分工和工作方式的变化情况是家庭医生团队PCAT-PS量表得分的影响因素(P<0.05)。结论广西壮族自治区家庭医生团队成员对签约服务质量的评价整体良好,城乡基层医疗卫生机构的感知质量评分存在差异,以团队为形式开展的家庭医生工作模式有利于签约服务质量的提升。建议加快推进“质”“量”并重的家庭医生团队建设,探索薪职一体化协同发展路径,打造“政府-社区-家庭”共同治理、资源共享的整合型家庭医生签约服务网络。

康养旅居产业视域下的康养设施设计

目的:研究康养旅居环境中健康、养生、医疗、旅游等方面存在的潜在需求,解决康养人群的不同需求,例如针对老年人在带小孩的生活中,缺少休憩和锻炼的时间和机会,提出一种适用于这类老年群体的康养互动健身器材和休憩设施的设计方法。方法:针对康养旅居生活中户外运动、休憩、室内服务设施进行研究,构建公共康养设施设计策略,阐述设计实践的过程与内容,运用人机工程学原理进行人群行为分析,指导相关的适老化康养设施和产品设计。结果:通过对上述康养需求的研究,设计出能解决康养人群中的休憩、健身、生活等方面的适老化产品,以改善康养环境的硬件设施,优化康养人群的生活品质。结论:随着中国“老龄化”进程的加速,康养设施匮乏已经成为一个非常严峻的社会问题,以改良和创新相结合的方式,将康养服务理念融入公共设施设计中,促进未来康养产业的发展,从而满足更多人群对康养环境的产品需求,让老年人拥有更幸福的康养时光。

病有所医、病无所恐:我国农村合作医疗制度发展历程、运行逻辑与未来进路

新中国成立70多年来,国家一直在探索如何更好地为农村人口供给可负担、高质量的医疗保障,在经历了从传统农村合作医疗到新型农村合作医疗的不间断探索后,形成了中国特色社会主义制度下的农民医疗保障全覆盖模式,这种连续性、从未间断的合作医疗形成了新中国治理变迁的独特经验,是形成国家发展的“中国奇迹”的一种基础保障力量。以历史变迁的长镜头观之,我国合作医疗历经了从“集体福利”“个体消费”“民生服务”走向基本公共服务均等化的实践轨迹,各个阶段都努力在现实需求与资源约束的矛盾运动下最大限度保证农民群众“人人看得起病”。为了在更高水平上保障农民“病有所医、病无所恐”,未来需要继续大力推动城乡居民基本医疗保障制度的一体化改革,扩展农民群众医保报销范围、降低个人承担份额,最终实现城乡居民人人享有健康权利的国家战略规划,迈向以人民为中心的社会主义“共同健康”之路。

西部地区基层医疗卫生服务质量及提升策略

在开启全面建设社会主义现代化国家新征程中,如何衡量及提升西部地区以基层为重点的医疗卫生服务质量,是践行“共建共享,全民健康”健康中国战略的关键内容。基层医疗卫生机构为当地居民提供常见病、多发病在内的基本医疗服务和预防保健在内的基本公共卫生服务,在降低卫生支出、分流就医患者、提高卫生服务体系效率方面发挥着重要作用。高质量的基层医疗卫生服务与更积极的出生结局、更长的预期寿命、更低的年龄调整死亡率、更低的可避免死亡率、更少的可避免住院治疗和更好的自我报告健康状况之间具有普遍的一致性。然而,当前西部地区基层医疗卫生服务仍存在服务有效性水平较低、处方合理性较差、医疗服务连续性不强等问题。基于中国基层卫生保健质量队列研究,通过匿名标准化患者方法,应用偏头痛、产后抑郁、小儿腹泻、普通感冒、胃炎、哮喘、心绞痛、腰背痛、压力性尿失禁、高血压、肺结核和糖尿病在内的11种匿名标准化患者病例,探索陕西省基层医疗卫生服务质量概况及提升策略。以社区卫生服务中心/站、乡镇卫生院、村卫生室、诊所/门诊部内的执业医师、执业助理医师、注册村医以及持有全科、内科、产科/妇科和儿科执照的临床医生为受访对象,采用多阶段分层整群抽样方法,在陕西省154家医疗机构对11种病例进行了259次访问。结果显示,陕西省基层医疗服务机构接诊医生问诊条目完成率为13.63%(8.33%,21.05%),检查条目完成率为6.25%(0,25.00%);访问中获得正确诊断次数为58次,占比27.36%;处置得分为0.49(0.33,0.70)分。PPPC-CN量表得分为2.38(2.12,2.76)分。USP候诊时间为4(1,10)分钟,就诊时间为7(5,10)分钟,就医总时间为15(10,25)分钟。USP就诊的总费用为12(0,45)元。总之,陕西省基层医疗服务质量的有效性、以患者为中心、及时性和效率均有较大的提升空间。相关部门应加快基层医疗信息化建设,构建基层临床路径以有效提高基层常见病、多发病的首诊能力,加强以患者为中心服务模式,实施综合培训模式以提升知识水平和实践能力,做好居民健康“守门人”。

协和继续医学教育助力国家乡村振兴健康战略

党的十九届五中全会明确“全面推进健康中国建设”的战略部署,要把人民健康放在优先发展的战略地位。乡村振兴战略的实施是推动新时代高质量发展的重大部署,决定着我国全面建成小康社会的成色和社会主义现代化的质量。百年协和发挥行业引领作用,协和继续教育学院的“顶天立地”项目,“顶天”计划包括以北京协和医学院创新领军学者临床新技术新进展培训项目在内的,偏向公益性质的继续医学教育项目;“立地”计划包括在西藏、新疆维吾尔自治区、青海省、贵州省、福建省等“老、少、边”地区开展基层医务工作者的培训项目。要用协和的优质继续教育资源为国家的乡村振兴战略做出贡献。为乡村振兴承担对口帮扶任务,为国家培养高素质的医疗卫生人才,努力把协和创新领军学者办成在全国具有影响力、标志性的公益培训品牌。更好地为我国的乡村振兴战略服务。

公共图书馆康养服务策略研究——以攀枝花市公共图书馆为例

我国正处于老龄化加速时期,康养服务已成为政府高度重视、公众迫切需求的重大民生工程,公共图书馆作为提供公共文化服务的重要窗口,开展公民康养服务是大势所趋。论文梳理了公共图书馆康养服务相关研究现状,介绍了攀枝花市公共图书馆康养服务的探索与实践,并基于此提出统筹规划全局、形成康养服务体系,突出“康养”特色、推行人性化服务,注重内涵发展、打造康养文化品牌,加强复合型人才培养与引进、筑牢康养人才根基,加大宣传力度、提升影响力等服务策略,以期为公共图书馆深入开展康养服务工作提供借鉴与参考。