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. Result...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.展开更多
Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care services.Methods:Qualitative methods were used to st...Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care services.Methods:Qualitative methods were used to study strategies for obtaining specialty health care for uninsured patients.Data were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews,23 brief interviews,and 45 h of direct observations.We captured additional data by studying cases of referred uninsured patients.Results:The following six strategies were identified:(1)quid pro quo-a specialist accept-ing the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients;(2)over referral-clinicians referred insured patients whose needs could have been met at the FQHC;(3)brief hospitalization-when a specialist could not be obtained,high-risk patients were briefly hospitalized;(4)case building-diagnostic tests were conducted at the FQHC to justify a referral;(5)direct communication-communication between clinicians and specialists was neces-sary when requesting a referral;(6)specialty clinics-in return for conducting a specialty clinic at the FQHC,the specialist received all referrals of insured patients.Conclusion:Uninsured FQHC patients encountered difficulties accessing specialty health care,and in response,clinicians developed a range of innovative strategies.展开更多
Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for suc...Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for such austere settings based on predicted symptomology. Objective: We aimed to prospectively document the epidemiology of patients seen during two low-resource clinics on a MST in Honduras and apply predefined case definitions adapted from guidelines used by international healthcare organizations (e.g. World Health Organization). Methods: An observational design was used to track the epidemiology during two clinics on an MST in Limon, Honduras in March 2015. The QuickChart mobile electronic medical record (EMR) application was piloted to document diagnoses according to predefined case definitions. Results: The most commonly diagnosed syndromes were upper respiratory complaints (20.19%), nonspecific abdominal complaints (20.19%), general pain (15.38%), hypertension (9.62%), pruritus (6.73%), and asthma/ COPD (4.81%). The case definitions accounted for 94% of all complaints and diagnoses on the brigade. Discussion: The distribution of common patient diagnoses on this MST was similar to that which had been reported elsewhere. The use of broader symptom-based case definitions for epidemiologic surveillance could also facilitate the syndromic management of patients seen on MSTs, and improve the consistency of treatment offered. Conclusion: Case definitions for common syndromes on primary care MSTs may be a feasible method of standardizing patient management. Preliminary use of the QuickChart EMR was acceptable for documentation of epidemiology in the field. Further study is necessary to investigate the reliability of syndromic diagnostic criteria between different clinicians and in a variety of MST settings.展开更多
背景近十年来,随着医疗保健生态学模型(ecology of medical care model)应用价值的突显,该模型得到了学者们的高度关注。医疗保健生态学理论模型构建的差异与变化在一定程度上可以反映医疗模式的转变,为了解我国人群健康需求和卫生服务...背景近十年来,随着医疗保健生态学模型(ecology of medical care model)应用价值的突显,该模型得到了学者们的高度关注。医疗保健生态学理论模型构建的差异与变化在一定程度上可以反映医疗模式的转变,为了解我国人群健康需求和卫生服务利用情况提供证据基础。目的对运用医疗保健生态学模型的研究进行整合和对比,以描述使用医疗保健生态学模型建立的研究现状、对比研究方法和主要发现。方法于2022年6月,在PubMed、Ovid Medline、Web of Science、EmBase、中国生物医学文献服务系统、中国知网、万方数据知识服务平台中根据关键词、不限制语种开展检索,检索时限为1961-2022年。在Joanna Briggs Institute(JBI)概况性评价方法学手册的指导下,对文献进行筛选、信息提取,并开展描述性分析。结果共纳入符合要求的文献28篇,其中22篇(78.6%)发表于2010年以后。多数研究运用医疗保健生态学模型重点关注人群的健康需求、医疗资源利用模式,聚焦就医行为模式、疾病转诊等问题。在研究人群方面,多数研究覆盖全年龄段人群(11篇,39.3%),针对特定人群开展的研究有7篇(25.0%)。有4项研究在中国开展,均针对城市地区。相较于发达国家(地区),发展中国家(地区)研究中较少关注患者自我寻求帮助(非处方药、按摩等)情况,已有的医疗保健生态学模型反映出发展中国家(地区)具有较低的患者自报有健康问题(症状)比例,但具有更高的医院门诊就诊和急诊就诊比例。结论医疗保健生态学模型及其研究方法在过去20年间不断演进,仍然是帮助研究者和政策制定者了解医疗保健需求和医疗资源供需关系的重要工具。目前,中国对医疗保健生态学框架的应用程度不高,未来可更多地运用该模型反映卫生服务不平等和健康需求未被满足情况,并可开展群医学等领域的研究,为提高我国人群健康资源合理分配提供证据基础。展开更多
基金Supported by Humanities and Social Science Research Project of the Ministry of Education in 2010 (10YJC840088)
文摘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.
基金the Clinical and Translational Science Collaborative of Cleveland,UL1TR000439 from the National Center for Advancing Translational Sciences component of the National Institutes of Health(NIH)the NIH Roadmap for Medical Research,by Case Comprehensive Cancer Center Support Grant P30CA43703-23 from the National Cancer Institute of the NIH,and by the Centers for Primary Care Practice-Based Research and Learning from the Agency for Healthcare Research and Quality through grant P30HS021648-03.
文摘Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care services.Methods:Qualitative methods were used to study strategies for obtaining specialty health care for uninsured patients.Data were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews,23 brief interviews,and 45 h of direct observations.We captured additional data by studying cases of referred uninsured patients.Results:The following six strategies were identified:(1)quid pro quo-a specialist accept-ing the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients;(2)over referral-clinicians referred insured patients whose needs could have been met at the FQHC;(3)brief hospitalization-when a specialist could not be obtained,high-risk patients were briefly hospitalized;(4)case building-diagnostic tests were conducted at the FQHC to justify a referral;(5)direct communication-communication between clinicians and specialists was neces-sary when requesting a referral;(6)specialty clinics-in return for conducting a specialty clinic at the FQHC,the specialist received all referrals of insured patients.Conclusion:Uninsured FQHC patients encountered difficulties accessing specialty health care,and in response,clinicians developed a range of innovative strategies.
文摘Rationale: Medical treatment on short-term primary care medical service trips (MSTs) is generally symptom-based and supplemented by point-of-care testing. This pilot study contributes to the effective planning for such austere settings based on predicted symptomology. Objective: We aimed to prospectively document the epidemiology of patients seen during two low-resource clinics on a MST in Honduras and apply predefined case definitions adapted from guidelines used by international healthcare organizations (e.g. World Health Organization). Methods: An observational design was used to track the epidemiology during two clinics on an MST in Limon, Honduras in March 2015. The QuickChart mobile electronic medical record (EMR) application was piloted to document diagnoses according to predefined case definitions. Results: The most commonly diagnosed syndromes were upper respiratory complaints (20.19%), nonspecific abdominal complaints (20.19%), general pain (15.38%), hypertension (9.62%), pruritus (6.73%), and asthma/ COPD (4.81%). The case definitions accounted for 94% of all complaints and diagnoses on the brigade. Discussion: The distribution of common patient diagnoses on this MST was similar to that which had been reported elsewhere. The use of broader symptom-based case definitions for epidemiologic surveillance could also facilitate the syndromic management of patients seen on MSTs, and improve the consistency of treatment offered. Conclusion: Case definitions for common syndromes on primary care MSTs may be a feasible method of standardizing patient management. Preliminary use of the QuickChart EMR was acceptable for documentation of epidemiology in the field. Further study is necessary to investigate the reliability of syndromic diagnostic criteria between different clinicians and in a variety of MST settings.
文摘背景近十年来,随着医疗保健生态学模型(ecology of medical care model)应用价值的突显,该模型得到了学者们的高度关注。医疗保健生态学理论模型构建的差异与变化在一定程度上可以反映医疗模式的转变,为了解我国人群健康需求和卫生服务利用情况提供证据基础。目的对运用医疗保健生态学模型的研究进行整合和对比,以描述使用医疗保健生态学模型建立的研究现状、对比研究方法和主要发现。方法于2022年6月,在PubMed、Ovid Medline、Web of Science、EmBase、中国生物医学文献服务系统、中国知网、万方数据知识服务平台中根据关键词、不限制语种开展检索,检索时限为1961-2022年。在Joanna Briggs Institute(JBI)概况性评价方法学手册的指导下,对文献进行筛选、信息提取,并开展描述性分析。结果共纳入符合要求的文献28篇,其中22篇(78.6%)发表于2010年以后。多数研究运用医疗保健生态学模型重点关注人群的健康需求、医疗资源利用模式,聚焦就医行为模式、疾病转诊等问题。在研究人群方面,多数研究覆盖全年龄段人群(11篇,39.3%),针对特定人群开展的研究有7篇(25.0%)。有4项研究在中国开展,均针对城市地区。相较于发达国家(地区),发展中国家(地区)研究中较少关注患者自我寻求帮助(非处方药、按摩等)情况,已有的医疗保健生态学模型反映出发展中国家(地区)具有较低的患者自报有健康问题(症状)比例,但具有更高的医院门诊就诊和急诊就诊比例。结论医疗保健生态学模型及其研究方法在过去20年间不断演进,仍然是帮助研究者和政策制定者了解医疗保健需求和医疗资源供需关系的重要工具。目前,中国对医疗保健生态学框架的应用程度不高,未来可更多地运用该模型反映卫生服务不平等和健康需求未被满足情况,并可开展群医学等领域的研究,为提高我国人群健康资源合理分配提供证据基础。
