Satisfaction of Village Doctors with the Township and Village Health Services Integration Policy in the Western Minority-inhabited Areas of China

Township and Village Health Services Integration Management（TVHSIM） is an essential form of China＇s two-tiered health service integration plan at the township and village level. Its main purpose, also one of the target goals in China＇s new healthcare reform, is to gradually integrate rural health services and appropriately allocate rural health resources. This study aims to assess the village doctors＇ satisfaction with the TVHSIM and provide scientific base to further improve TVHSIM. A cross-sectional study was carried out in which 162 village doctors from Qinghai, Inner Mongolia and Xinjiang in western China were interviewed. Descriptive analysis, independent t-test, one-way ANOVA, Spearman rank correlation and multiple linear regression were used to analyze the difference and relevance between village doctors＇ personal characteristics and their satisfaction with TVHSIM and six subscales. Village doctors with different years of practice, social insurance status and essential medical knowledge level showed statistically significant differences in their satisfaction levels（all P〈0.05）. Age（P〈0.05） and years of practice（P〈0.01） were negatively correlated with Drug and Medical Device Management and Financing Management. Essential medical knowledge level（P〈0.05） was negatively correlated with Operations Management as well. However, social insurance status（P〈0.05） was positively correlated with Human Resources Management and Drug and Medical Device management. Gender, age and years of practice respectively had significant influence on village doctors＇ satisfaction with TVHSIM（P〈0.01）. In conclusion, in order to further promote TVHSIM policy in rural China, a well-rounded social insurance model for village doctors is urgently needed. In addition, the development of TVHSIM is regionally imbalanced. Efficient and effective measures aiming at rationalizing gender and age structure and enhancing essential medical training should be carefully considered.

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.

Integration of Cervical Cancer Screening Services in the Routine Examinations Offered in the Kenyan Health Facilities: A Systematic Review

Cervical cancer is the second most common cancer among women and the leading cause of deaths among women worldwide. In Kenya, uptake of screening services is at 3.2% below the targeted of 70%. Therefore, there is need to study the factors that lead to low uptake of the screening services. One way of increasing the uptake of the screening services is its integration with other routine services, thus leading to a reduction in morbidity and mortality rates associated with the disease. The objective of this study was to review and examine the importance of integrating cervical cancer screening services in the routine examinations offered in the Kenyan health facilities. A retrospective study design was adopted by this study. The review of articles, journals, strategic plans was done from the year 2012 to 2017. Data sources included Medline, PMC, Library, Pubmed, Google scholar, cancer prevention plans and strategies. About 28 data sources were reviewed with 78.5% indicating that increased knowledge and creation of awareness on cervical cancer would greatly improve the utilization of the screening services. More than 87% of the information collected among published work in Kenya demonstrated that knowledge on importance cervical cancer screening is inadequate. The primary results of this study suggest that all women of reproductive age (WRA) should undergo cervical cancer screening as a routine service. An integration approach should be adopted, to enhance knowledge on cervical cancer and the importance of screening, causes, preventive and treatment options. The study recommends that, the Government of Kenya through the Ministry of health should include cervical cancer screening as a routine procedure for all WRA.

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.

Ontological Model for Cohesive Smart Health Services Management

Health care has become an essential social-economic concern for all stakeholders(e.g.,patients,doctors,hospitals etc.),health needs,private care and the elderly class of society.The massive increase in the usage of health care Internet of things(IoT)applications has great technological evolvement in human life.There are various smart health care services like remote patient monitoring,diagnostic,disease-specific remote treatments and telemedicine.These applications are available in a split fashion and provide solutions for variant diseases,medical resources and remote service management.The main objective of this research is to provide a management platform where all these services work as a single unit to facilitate the users.The ontological model of integrated healthcare services is proposed by getting requirements from various existing healthcare services.There were 26 smart health care services and 26 smart health care services to classify the knowledge-based ontological model.The proposed ontological model is derived from different classes,relationships,and constraints to integrate health care services.This model is developed using Protégébased on each interrelated/correlated health care service having different values.Semantic querying SPARQL protocol and RDF query language(SPARQL)were used for knowledge acquisition.The Pellet Reasoner is used to check the validity and relations coherency of the proposed ontology model.Comparative to other smart health care services integration systems,the proposed ontological model provides more cohesiveness.

An Integrated Approach to Syrian Refugees’ Health Care in Lebanon

The purpose of this paper is to learn from the integrated health care approach for the Syrian Armenian refugees by the HKCC （Howard Karagheusian Commemorative Corporation） in Burj Hammoud in Lebanon from the perspective of the beneficiaries themselves, i.e. the Syrian Armenian refugees. One hundred families who had been residing in Burj Hammoud and who had been regularly benefiting from the health services of the HKCC for at least one year were interviewed. The interviewees used a semi-structured questionnaire. Data were analyzed and emerging themes were mapped. The Syrian Armenian refugees who participated in this study generally expressed their satisfaction with the equitable access afforded by the HKCC’s integrated health care approach. There were several reasons why the HKCC’s integrated approach to serve refugees and the local population on equal footing was given positive reviews by the sampled refugees. Based on the responses of the refugees, these reasons are mainly （a） the convenient location of the center, which is walking distance for most refugees; （b） the ability of the treating doctors to communicate with the refugees in Armenian, which facilitates diagnosis and understanding of the health problems; （c） suitable opening hours; （d） friendly staff; and （e） thorough doctors. The results do not statistically represent the overall refugee population that is served by the HKCC; due to the study’s limited demographic scope, the results cannot be generalized. This limitation was due to lack of funding to cover the whole beneficiary Syrian Armenian refugee population. The HKCC’s approach has helped in providing access to treatment and preventive measures to a refugee population that was in need of it; as a consequence, it may have improved the health outcomes of this refugee population, especially in regard to the immunization of children. An integrated approach to healthcare which provides “equal ability by refugees and host nationals to access the same healthcare resources from the same providers” seemed to have been successful in the case of the HKCC. This paper provided first exploration of an integrated health approach for refugee healthcare provision in Lebanon.

基于Web Services的区域卫生信息平台的研究与实现

区域内各级医疗机构存在许多异构的信息系统,这就造成系统信息交流不顺畅,系统之间产生大量的"信息孤岛",无法充分利用有限的医疗资源。提出建立基于Web Services的区域卫生信息平台,分析了平台的总体架构和信息交换的过程。通过该平台的成功实施,使区域内各医疗卫生机构的信息系统在该平台上实现无缝集成,从而消除了"信息孤岛",使这些系统能够协同工作,更进一步提高区域卫生信息化建设的效率。

Factors Associated with Accessing ICDS Services among Women in Rural Rajasthan, India

Background: The Integrated Child Development Services (ICDS) Scheme, launched in 1975 by the Government of India, provides various health services to children and their mothers at ICDS centres. Objectives: The purpose of this study is to understand 1) the extent to which women living in Rajasthan, India utilize services provided by ICDS centres and 2) the factors that are associated with their use. Methods: Freedom from Hunger and Freedom from Hunger India Trust, in collaboration with two local partners in Rajasthan, India, conducted a baseline assessment with 403 pregnant women and women with young children belonging to self-help groups to compare use of ICDS centres with key demographic variables and measures of poverty, food security and nutrition, curative care related to diarrhea, coping strategies, and household decision-making. Results: The results revealed that households that accessed ICDS services were more likely to report receiving nutrition information from ICDS centres, to purchase ORS in the last year, and to give oral rehydration solution (ORS) to children who had diarrhea. Women who decide how much food to serve each family member or spend money without discussing it first with someone else were more likely to receive benefits from ICDS centres. Those who spoke with their spouse about household nutrition needs were less likely to report accessing ICDS services. Conclusion: Interventions aimed at increasing utilization of ICDS centres in this region may find it beneficial to increase female participation in health care decisions, likely through spousal communication and gender relations.

文旅融合背景下农家书屋康养服务策略研究——以攀枝花市农家书屋为例

乡村旅游、康养正成为一种新时尚和新业态,农家书屋作为乡村公共文化服务的重要窗口,开展涵盖健康、文化、旅游的康养服务是大势所趋。文章梳理农家书屋相关研究现状,介绍攀枝花市农家书屋康养服务的探索与实践,分析其面临的困境,提出加大政策扶持力度,促进健康规范发展;突出康养属性,丰富服务内容;注重挖潜增效,提高服务效能;精心塑造品牌,形成深度影响力;多渠道宣传,提升营销效果的农家书屋康养服务策略,以期为农家书屋深入开展康养服务提供参考。

整合型健康服务组织医保支付模式的设计——基于中美比较

美国的健康管理组织(如HMO、ACO、PCMH)开展医保与医疗的深度整合,以效率为导向的医保支付设计兼顾费用控制、医疗质量、医防融合与患者流向引导,在世界范围内具有批判性借鉴意义。我国的整合型健康服务组织(如深圳罗湖城市医疗集团、三明尤溪县域医共体、天津基层数字健共体)的医保支付模式,在费用控制、服务质量、分级诊疗方面都有良好表现,但在提升患者体验、改善人群健康方面略显不足。未来的医保支付应以健康产出为引领,从总额控制转向疾病精细管理,基于循证医学证据探索慢性病目标制绩效支付方式。

中医药服务参与医养结合机构的困境与出路

随着中医药文化传播和健康老龄化观念普及,中医药逐渐开展医养结合发展模式研究。目前,中医药与养老产业融合尚不紧密,本文通过走访调查、政策分析、文献梳理等方法,揭示中医药参与医养行业实践现状及存在问题,探索具有中医药特色的医养结合模式。

家庭医生签约服务对糖尿病患者认知、行为和健康结果的影响研究

背景 我国基层卫生服务体系正在推进的家庭医生签约服务致力于为居民提供整合、连续性服务,这也是糖尿病等慢性病患者亟须的服务特征,现有研究多聚焦于家庭医生签约服务覆盖率的描述性分析,对其在慢性病服务中的实际效果评估尚显不足。目的 了解家庭医生签约服务对糖尿病患者认知、行为及健康结果的影响。方法 于2023年2月22—25日,采用多阶段分层随机抽样法在山东省某市抽取716例登记在册的糖尿病患者进行问卷调查。问卷内容涉及患者的人口学信息、患病和就医情况、接受糖尿病管理服务情况,以及患者的疾病认知、健康管理行为、健康结果。对患者接受的糖尿病管理服务项目覆盖率进行描述性分析,以反映家庭医生团队服务的整合性;采用多因素Logistic回归分析探讨签约家庭医生对患者疾病认知、健康管理行为、健康结果的影响。结果 579例(80.9%)糖尿病患者已签约家庭医生,其中277例(47.8%)认为家庭医生了解其心理状况。643例(89.8%)患者近期接受过随访,其中489例(76.0%)接受了糖尿病健康教育,282例(43.9%)进行了眼底、心电图及足背动脉搏动等并发症相关检查。37.7%(32/85)出现突发病情加重/急性并发症的患者联系了家庭医生,其中37.5%(12/32)得到了紧急处理,25.0%(8/32)得到了转诊服务。患者对糖尿病诊断的认知正确率为19.8%(142/716),对除药物治疗以外的干预方法的认知正确率<70.0%。多因素Logistic回归分析结果显示,签约患者疾病认知评分>5.5分的概率更高[OR(95%CI)=1.80(1.23~2.62),P<0.05],进行糖化血红蛋白检测的概率更高[OR(95%CI)=2.67(1.75~4.18),P<0.05],定期自我监测血糖的概率更高[OR(95%CI)=4.28(2.57~7.09),P<0.05],进行饮食干预的概率更低[OR(95%CI)=0.46(0.28~0.80),P<0.05],糖尿病相关费用的接受率更高[OR(95%CI)=1.58(1.04~2.39),P<0.05]。结论 家庭医生签约服务中的慢性病管理服务质量明显提高,但签约服务包中的患者健康教育及心理关怀内容需进一步完善,应建立健全转诊机制和糖尿病并发症筛查工作,同时对未签约患者的健康服务给予更多关注。

基于Web Service的系统集成技术在社区公共卫生服务网络系统的应用

Web Service是Internet上新兴的应用通信和集成技术,本文先简单介绍了XML和Web Service技术,然后着重讨论了基于Web Service的系统集成技术的特点和优势,以及通过实际的开发实例介绍了基于Web Service的系统集成技术在社区公共卫生服务网络系统实现中的应用。

一站式学生社区建设影响因素与评价方法探析

为探讨一站式学生社区建设的影响因素与评价方法,通过文献分析与专家访谈法确定了制度设计、资源配置与环境建设、学生需求与文化氛围等主要影响因素。采用层次分析法(AHP)构建相关评价体系,基于受访者的反馈计算指标层与准则层的权重。结果表明,该评价体系能够科学评估一站式学生社区建设的各关键要素,能为进一步优化学生社区建设提供理论支持。

医防融合的关键问题、机制创新与实现路径

我国医疗服务与公共卫生服务相互割裂的问题由来已久,医防融合是新时代背景下实现健康中国战略的重要举措。当前,在医防融合试点实践中,存在医疗卫生服务体系多头管理、紧密型医联体尚未真正形成、医院“重医轻防”理念仍未转变、医防信息不能互联互通等问题。对此,可以借鉴宿迁的经验,从组织管理、医防服务供给、卫生筹资、医防人才与医防信息等方面入手,实现医防融合的机制创新,在此基础上,将医防融合作为常态化制度持续向纵深推进。

Insights into the Social Determinants of Health in Older Adults

In this paper, we review the social determinants of health in older adults and their complex interrelationship with medical diseases. Also, we provide recommendations to address these determinants in the integrated healthcare plan. The social determinants in older adults and its influence in health outcomes have been studied for decades. There is solid evidence for the interrelationship between social factors and the health of individuals and populations;however, these studies are unable to define their complex interrelatedness. Health is quite variable and depends on multiple biological and social factors such as genetics, country of origin, migrant status, etc. On the other hand, health status can affect social factors such as job or education. Addressing social determinants of health in the integrated healthcare plan is important for improving health outcomes and decreasing existing disparities in older adult health. We recommend a person-centered approach in which individualized interventions should be adopted by organizations to improve the health status of older adults at the national and global level. Some of our practical recommendations to better address the social determinants of health in clinical practice are EHR documentation strategies, screening tools, and the development of linkages to the world outside of the clinic and health system, including social services, community activities, collaborative work, and roles for insurance companies.

整合型服务体系构建背景下医防融合实现机制研究

背景实现基层医防融合,创新医防协同、医防融合机制是我国医疗卫生领域在“十四五”期间的重要任务。目的分析整合型服务体系构建背景下医防融合的实现机制,为探索适应健康中国战略的医防融合路径提供参考。方法以2018年为时间节点,以“医防融合”“医防协同”“防治结合”为关键词检索中国知网和万方数据知识服务平台相关文献,筛选出对医共体、医联体等整合型服务体系案例政策措施和实施效果进行研究的文献,最终筛选出文献18篇,案例15个。基于彩虹模型,从宏观、中观、微观三个层面以及支持要素确定系统整合、组织整合、专业整合、服务整合、功能整合、规范整合为条件变量,以良好医防融合效果为结果变量,采用定性比较分析方法探索整合型服务体系构建背景下的医防融合实现机制。结果共有4条组态路径能有效提升医防融合效果,4条路径分别符合多层面整合型、中微观整合型路径,同时得出以下结果:(1)依托整合型服务体系开展医防融合更为有效,在整合型服务体系下存在多种路径可有效提升医防融合效果;(2)服务整合对提升医防融合效果起着基础保障作用;(3)对提升医防融合的系统整合、专业整合和功能整合相关政策指标设置尚不健全。结论(1)依托医联体、医共体等中国特色的整合型服务体系提升医防融合效果;(2)充分发挥服务整合的基础保障作用;(3)参考多层面整合型案例的成功经验,均衡设置宏观、中观、微观层面政策指标,同时完善系统整合、专业整合以及支持要素的整合。

新质生产力赋能社区老年“体医养融合”健康服务困境与纾解

由新技术、新产业、新要素、新组织构成的新质生产力,为老年健康服务发展注入了新的活力。研究运用文献资料法和逻辑分析法,探究新质生产力赋能社区老年“体医养融合”健康服务的价值、内涵、逻辑、困境和策略。研究认为,新质生产力赋予“体医养融合”健康服务新的内涵,包括但不限于健康服务技术突破与创新、生产要素配置创新性、服务模式“高智高效高质”。新质生产力赋能社区老年“体医养融合”健康服务要突出引领与指导的理论先导逻辑、创新与突破的技术驱动逻辑、互动与合作的资源开发逻辑、优化与互补的结构支撑逻辑。“体医养融合”健康服务能满足老年多元化、个性化健康需求,但面临新型劳动者匮乏、劳动资料升级滞后、老年群体认知落后、生产要素不协同等困境。提出以下纾解策略:引导劳动者技能升级与角色重塑,激发新质生产力赋能活力;促进劳动资料创新与升级,启动新质生产力赋能引擎;聚焦老年群体特点与需求,助力老年群体融入新生产力时代;探索生产要素重组与优化,推动新质生产力赋能升级。

城市社区老年人“医体结合”健康促进服务需求的调查研究

伴随着人口老龄化的持续推进,我国在养老方面的形势日益严峻,该文具体结合了医体结合的理念背景,分析城市社区老年人医体结合健康促进服务的需求现状。采用问卷调查法对城市社区老年人的体育健康需求、医疗健康需求进行调查分析。结果发现,目前,在城市社区内部,医疗和体育两大模块的配合度不足,同时老年人对其的需求却比较高。基于此,该文进一步就老年人医体结合的健康促进服务,提出相应的建议,希望进一步丰富相关研究,为城市社区老年人健康服务新模式的提出提供一定的参考。

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

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