Separation of Revenue and Expenditure increases first contact care in community health centers among community residents

Objective:To evaluate the impact of Separation of Revenue and Expenditure(SRE)on the first contact care in community health centers(CHCs)among community residents.Methods:Data was obtained through questionnaire survey before and after the pilot.Residents who visited CHCs within two weeks before the conduction of the surveys were included in this study.This study employed a pre-post quasi-experiment design and multiple regression models were specified based on the Andersen theoretical framework.Results:Multiple logistic regression analysis showed that the rate of first contact care in CHCs increased by 28.3%(P=0.000).Conclusions:SRE has increased the first contact care in CHCs among the community residents.

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.

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.

Challenges faced by community health nurses to achieve universal health coverage in Myanmar:A mixed methods study

Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar’s CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.

Medical care service model combined with support policy development and theoretical research

China has entered the aging society, on the one hand, the number of elderly people in the gradual increase in the number of the corresponding oldest old, disabled elderly, and other semi-disabled elderly is also increasing; on the other hand, family pension function is weakening. This brings new problems and challenges to elderly care services and medical services. How to make the elderly a sense of security, the old medical care, doctors explore new mode of raising combined pension service is very important, domestic scholars have done a lot of this, they mainly focus on the medical support pension model combining content, doctors pension service support combined mode and manner of service objects and the advantages and problems of the medical support combined pension model is discussed. Firstly, from ＂medical support integration＂ policy development view, then from the above three aspects of the research scholars to sort out and summarize, try to identify the lack of exploration and research, indicate the direction for further research.

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。

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.

深圳新型社区首诊制实施效果分析与思考

目的通过对深圳市社区卫生服务机构的病人满意度调查,了解不同社区、不同人群的病人满意度,评估社区首诊制与病人满意度的相关性,从而评价社区首诊制的实施效果。方法采用专家咨询法,选定深圳市范围内6个街道,共30个社区卫生服务中心。应用"本地化"的国际标准化满意度调查问卷(EUROPEP),对在社区卫生服务中心就诊的病人进行调查(1765例)。结果劳务工社区病人总满意度、沟通满意度、技术满意度和组织满意度与非劳务工社区比较,差异有统计学意义(P<0.01)。劳务工病人的总满意度和组织满意度与非劳务工病人比较,差异有统计学意义(P<0.01)。经历转诊与未经历转诊的病人在"给你提供有关预防疾病的服务"、"告诉你做好转诊上级医院的准备"两个问题方面的非常满意率间差异有统计学意义(P<0.05)。结论社区首诊制的实施加剧了病人对服务组织方面的不满,应改善社区医生服务的组织安排和调整社区首诊制的激励政策。

“分级诊疗制度”主题研讨

“主题研讨”主要针对全科医学／社区卫生服务领域的热点问题，邀请行业内的专家，从不同层面及角度进行主题阐述，这里面有成绩的展示，也有问题的提出。希望能够引起广大社区卫生服务工作者进一步的思考，同时也希望各位读者能够提出问题与建议，共同探讨。本期特别关注“分级诊疗制度”，针对分级诊疗制度这一主题进行了讨论，社区卫生服务管理中心与社区卫生服务中心的管理者们各抒己见，旨在为分级诊疗制度的建设建言献策，期望与全国同行共同讨论!

社区首诊制的实施困境分析及对策研究

社区首诊制的建立具有很重要的作用,但在推行过程中存在着许多问题,导致社区首诊制的发展举步维艰。本研究在分析社区首诊制的实际困境的基础上,探索促进首诊制发展的措施,从而逐步实现降低医疗费用,合理分流患者,缓解看病难、看病贵问题的作用。

中医药保健服务业发展政策研究

我国中医药健康保健服务业发展处于机遇快速的上升阶段。促进健康服务业发展具有刺激消费、拉动内需的重要意义。尽管中医药在健康服务业中独具优势,但在发展过程中由于技术标准缺失、行业规范及相关政策缺失而导致市场乱象,受固有观念和现有中医药健康保健服务企业规模、水平所限,无法得到充分发挥。本文分析了中医药保健服务业现状及存在的主要问题,并就管理体制、行业准入、人员素质等方面提出相关措施和建议。

关于我国城市社区卫生服务推行首诊制度的几点思考

推行首诊制度是构建完善的社区卫生服务网络的重要制度之一,首诊制度的推行需要政府的扶植引导,培养全科医生和社区卫生服务纳入定点医保,并与会诊和双向转诊制度同步推行,同时避免首诊可能造成的大型医院延伸垄断和社区卫生服务功能单一化等不良后果,使首诊制度成为真正的“守门人”制度。

实施社区首诊制的意义及建议

目前,实施社区首诊制有重要的意义在于,可以缓解看病难、看病贵问题,适应人口老龄化的需求,改善流动人口的健康状况,以及减少私人诊所和药店不规范医疗带来的危害。但是,首诊制的实施也必然面临一定的困难。因此,应积极倡导医保制定向社区倾斜的政策,鼓励社区提高医务人员的技术水平、服务质量,并且完善双向转诊制度。

全科医生首诊制是开展社区卫生服务的基础

随着我国社区卫生服务事业不断发展,各地社区卫生服务中心逐渐走向规范化道路的同时,也暴露了社区卫生服务发展过程中的一些问题。从目前的情况来看,造成这些问题的原因是多方面的,但全科医生首诊制的缺失已成为我国社区卫生服务走向成熟的最重要障碍。

社区卫生服务开展首诊制的影响因素及对策研究

目的:了解社区医生、医疗保险工作人员及居民对社区卫生服务机构开展首诊制的意愿及影响因素。方法:2006年4月,对江苏省南京、苏州、镇江、盐城、泰州5个市,1 141名居民、192名社区医务人员和148名医疗保险工作人员进行问卷调查。结果:居民自感病轻时,53.1%的居民会选择去社区卫生服务机构首诊。吸引居民去社区首诊的原因主要是,就近方便(75.6%)、医疗费用低(49.5%)、服务态度好(37.6%)。不愿意去社区首诊的原因主要是,不放心医疗水平(48.0%)和社区卫生服务机构设备差(27.5%)。结论:社区卫生服机构开展首诊制需加强自身建设,并同时应建立相应的政策支持。

社区首诊制下定点基层医疗机构门诊服务利用水平分析

珠海市基本医疗保险普通门诊统筹自2009年7月1日实施以来,与社区首诊制同步推进,发挥了方便群众就医、减轻患者负担、合理使用基金和强基层的积极作用。珠海市参保人社区医疗机构签约率、就诊率明显上升,医疗费用合理。本研究采集2008年8月至2012年7月珠海市基本医疗保险的全部参保人的相关数据,采用间断时间序列分析法,并利用分段回归模型对间断时间序列数据进行定量分析,分析实施社区首诊制后,珠海市参保人对社区门诊服务利用水平的变化。

建立社区健康保健服务信息系统初探

1背景在信息革命的大背景下,传统医学模式已经了发生巨大的变化,国外早在90年代就开始建立医院信息系统(HIS)。基于信息网络技术的迅猛发展。

深圳市劳务工和非劳务工社区卫生服务利用及满意度对比分析

目的:了解劳务工和非劳务工对社区卫生服务利用情况及其满意度。方法:在深圳市宝安区随机抽取街道及其社区卫生服务中心,以拦截调查的方式共调查社区卫生服务利用者8 000人,运用SPSS18.0软件对数据进行统计分析。结果:劳务工最近一年到社区卫生服务中心就诊次数为3次及以上的比例高于非劳务工,差异有统计学意义(P<0.000 1);劳务工和非劳务工就诊人群满意度前三位分别是服务态度(73.29%,73.46%)、技术水平(65.29%,67.50%)、看病方便(63.16%,64.98%);73.47%的就诊者愿意接受社区首诊制,劳务工人群相比非劳务工人群更愿意接受社区首诊(74.16%,69.71%)。讨论:深圳市劳务工社区首诊制的实施使居民社区卫生服务利用有所提高,劳务工和非劳务工对社区卫生服务的满意度较高,且差别不大。以深圳为借鉴,在全国逐步推进社区首诊制具有一定的可行性。

广州市社区居民首诊意愿、行为及影响因素分析

目的研究广州市社区居民首诊意愿及行为的影响因素,为改善居民就医环境提供合理化建议。方法按照广州市经济圈层,采用分层抽样的方式随机抽取1 800户居民,利用调查问卷进行调查。结果居民在选择首诊医院时,根据自身情况和关注点不同,有一定的选择倾向,社区卫生服务机构是目前大部分社区居民首选的诊疗单位,其就医意愿受文化程度、职业类型及医疗保障情况等因素的影响,而性别、年龄等因素无明显影响。结论通过充分发挥社区卫生服务机构的职能优势、提高全科医生诊疗水平、加强推行社区首诊制度及引导社区居民合理的就医行为等方式,有利于卫生资源的优化配置。