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.

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.

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.

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.

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。

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。

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.

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.

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.

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。

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。

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

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。

全科医生视角下影响社区医疗机构开展体医融合服务的质性研究

背景体医融合是推动社区居民健康的基础环节,也是助力社区医疗服务高质量发展的重要保障,而全科医生又是践行体医融合服务的落脚点与着力点,但目前缺乏基于全科医生视角的影响社区医疗机构开展体医融合服务的相关研究。目的研究全科医生对影响社区开展体医融合服务的理解和看法,旨在为社区更好地开展体医融合服务工作提供思路和参考。方法于2023年3—4月,通过目的抽样法,在湖南省株洲市选取5家社区卫生服务中心(站)的11名全科医生作为调查对象,利用“一对一”半结构化深度访谈的研究方法,借助内容分析软件Nvivo 12.0对访谈内容进行录音文本转录、分析单元形成、内容编码以及主题提炼。最后利用描述现象学分析法对访谈资料进行逻辑分析,掌握全科医生对影响社区开展体医融合服务的理解和看法,并归纳总结出访谈主题。结果影响社区开展体医融合服务的内容可归纳为4个主题和10个亚主题:体医融合服务环境亟待优化(场地供给不足、氛围滞后、宣传不足)、全科医生能力亟待提高(体医融合认知能力不足、开具运动处方能力缺乏)、社区卫生服务机构支持乏力(体医融合相关培训活动匮乏、经费划拨不足、人力资源短缺)、患者对体医融合服务认知不足(患者对体医融合疗效认知不足、患者对体医融合风险认知不够)。结论社区全科医生在体医融合服务能力方面还存在诸多不足,为了促进社区体医融合服务更好地发展,亟须优化社区体医融合服务环境;提高全科医生体医融合认知能力与开具运动处方能力;加强社区卫生服务机构支持保障力度;提升患者对体医融合服务的疗效和风险认知。

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。

南非儿童青少年心理健康服务研究

文章采用文献分析法,对南非当前儿童青少年突出的心理健康问题以及心理健康服务现状进行了研究。结果表明,南非儿童青少年的心理健康问题主要包括情绪问题、酒精与药物滥用、校园暴力和自杀等。同时,南非依托卫生、社会发展和基础教育等政府部门,联合“家庭-学校-社会”多方资源,构建了全方位、多渠道的心理健康支持体系,为儿童青少年的健康发展提供了重要保障。目前,南非对心理健康服务领域的关注度和投入比例逐渐提高,但仍然面临资源不足、覆盖率低等一系列挑战,尤其在信息技术应用方面目前仍有较大提升空间。

居家社区医养结合服务能力及提升路径研究:基于39个案例的模糊集定性比较分析

目的:实证分析我国居家社区医养结合服务能力的多元驱动路径,为促进医养结合服务体系完善提供有益参考。方法:基于世界卫生组织老年人综合照护(ICOPE)实施框架构建分析框架,选取我国无锡市、焦作市、长沙市、成都市、重庆市的39个区(县)作为样本案例,采用模糊集定性比较分析(fsQCA)方法剖析高或非高水平居家社区医养结合服务能力的组态路径。结果:居家社区医养结合服务能力的提升是各要素组合作用的结果。研究发现4条路径组合将有助于居家社区医养结合服务能力发展,另有3条路径组合或将阻碍居家社区医养结合服务能力发展;制度环境支持、筹资保障水平与区域老年人口需求程度是其中的关键因素。结论:我国居家社区医养结合服务能力受到多重因素间的相互作用与影响,应从多方面出发共同施策以提升服务能力。

基于霍恩-米特模型的医防融合执行影响因素分析

医防融合作为我国医药卫生体制改革的重要方向,对于满足人民群众全方位的健康需求具有重要意义,如何建立科学、有效的医防融合模式是当务之急。本研究运用文献分析等方式收集资料,综述我国医防融合政策的实施现状及困境,并基于霍恩-米特模型的6个维度,对医防融合政策执行影响因素进行分析。在此基础上提出应细化政策目标,明确政策执行标准,加大资源供给力度,丰富政策执行方式,探索医防机构利益共同点、完善“协同机制”,积极引导政策执行者开展医防融合服务等举措,旨在为今后医防融合服务得到高质量提升提供借鉴意义。

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。