基于社会分工理论的分级诊疗服务体系研究

医疗卫生服务体系结构复杂，建立规划合理、分工明确的分级诊疗服务体系是保障医疗资源合理配置、提高医疗服务协调性和连续性的重要手段。通过探讨当前分级诊疗服务体系存在的问题，进而结合社会分工理论为形成适应我国国情的分级诊疗制度提出对策建议。     

5所高职高专院校社区护理课程设置现况

目的对国内5所护理高职高专院校社区护理课程设置的现状进行分析,以探索社区护理课程在高职高专院校的改革方案。方法采用横向比较研究法,对国内5所护理高职高专院校的社区护理课程的教学内容、课时分配、实习大纲等课程设置相关资料进行分析。结果国内5所护理高职高专院校在社区护理课程设置方面进行了许多有益的探索,但还存在着一些问题,社区临床护理课程设置欠妥,人文课程安排的缺乏,理论与实践相脱节,社区护理理论课比重多大。结论社区护理课程应加强医学与护理的渗透,避免重复教学,理论与实践紧密结合,强化实践能力的培养,增加适应社会发展需要的社区护理课程内容。     

论以居民健康为中心的医疗卫生服务提供体系建设

目前我国医疗卫生服务体系已无法完全满足居民与日俱增的健康需要与需求,急需构建以居民健康为中心的整合型医疗卫生服务提供体系,包括分级诊疗模式与社区契约服务。针对医疗卫生服务体系在发展过程中所受制约,建议进一步调整完善我国的医疗卫生服务提供体系,加强机构建设与人才培养,尤其是慢病急救医疗服务体系与慢病专项人才梯队的构建;在继续推动整合型医疗卫生服务提供体系的发展中,要加强医保、医疗服务供方和需方三方联动,保证以居民健康为中心的整合型医疗卫生服务体系的构建没有短板、有效运行。     

浅谈社区护理中护士素质的重要性

随着社区护理的发展,社区卫生服务功能也在不断的完善,社区护士的工作内容不再是只需完成基本的医疗护理,还需要承担一些其他的工作,成立居民健康档案、健康教育、康复计划等多方面服务,因此对社区护士的知识水平与工作素质要求也越来越高。为探索适合我国国情的社区护理的可行途径,为担负起社区内居民的健康保健工作,培养合格的高素质的社区护士已势在必行。     

探究高职高专护理学生就业竞争能力的培养

随着社会经济的高速发展及人们对医疗卫生服务需求的不断增长,要求高职高专护理学生在进入临床工作之前,必须得到高质量、高水平的思维方式、判断、沟通、应变和动手等能力的培训。因此我院近几年来,通过构建以能力为本位的课程体系,建立校内外结合的综合实训基地,推进专业共建的职业教育环境等措施,来培养我院护理学生思维能力、沟通能力,提高学生动手能力,培养学生创新意识、实践能力,提高护理学生就业竞争能力,已取得较好的效果。     

基于新制度主义的分级诊疗制度创新研究

为了合理利用区域医疗卫生资源,国家倡导建立分级诊疗制度以缓解“看病难、看病贵”问题。但在实际实施过程中,分级诊疗制度遭遇制度动力不足和实施效率低下等问题。基于新制度主义的理论观点,认为新制度的“合法性”危机、原有体制的路径依赖以及制度变革中的权力与利益博弈是产生分级诊疗制度化困境的原因。因此,我们应该创新分级诊疗制度,建立以政府与市场共同参与的分级诊疗实施网络,重新配置医疗卫生资源,完善社区医疗机构的“守门人”制度,加快社会组织的功能实现,实现分级诊疗制度的利益共享。     

我院实施双向转诊的实践与探讨

新医改方案中明确提出了健全基层医疗卫生服务体系,建立城市医院与社区卫生服务机构的分工协作机制,引导一般诊疗下沉到基层,逐步实现社区首诊、分级医疗和双向转诊,缓解目前“看病难、看病贵”的就医矛盾。双向转诊是实施医疗卫生体制改革的突破方略。对双向转诊模式进行实践和研究,以期最终实现医疗资源的节约和人民群众的就医方便。     

农村留守孩心理健康的家庭因素研究

青少年时期是儿童个性发展的一个重要时期,个性发展有较大的可塑性。目前农村劳动力迁移导致了大批留守儿童亲子教育缺失和家庭教育缺位。本文对留守儿童心理健康的相关研究进行了整理,分析了影响留守儿童心理健康状况的四个主要家庭因素,并总结了关于为留守儿童建立社区学校和家庭的三维支持系统的建议。     

区域医疗卫生服务体系评价的重要性及建议

区域医疗卫生服务体系评价对指导区域医疗资源规划,提高国家宏观调控和监管能力,实现医疗资源优化配置有重要意义。我国目前尚未建立一套科学全面的评价方法和指标体系。通过介绍区域医疗服务体系评价的重要性和影响因素,以及美国在评价区域医疗服务体系的做法,为建立完善我国区域卫生服务体系评价制度提供建议。     

青少年亲子冲突研究现状

从发展心理学的角度来看,亲子关系中的冲突不可回避;尤其青少年时期,这是个体由不成熟的童年向成熟人生过度时期.往往和不稳定联系在一起,因此最容易发生冲突.自20世纪60年代对亲子冲突进行实证研究以来,有关青少年亲子冲突的研究已经为我们提供了不少的成果,这些成果增加了我们对青少年亲子关系的认识,为我们对青少年进行心理和家庭干预提供了有价值的参考.     

Group Occupational Health Service in a Developing Country

In 1967 an experimental group occupational health service was set up in Dar es Salaam to provide direct service to industrial firms. Larger companies were visited by a doctor, smaller firms in rotation by auxiliaries. After three years 65 companies had joined with over 15,000 employees, and workers were attending the group dispensaries at a rate of over 250,000 visits a year. Such an approach through direct service to the working community appears to be more appropriate to a developing country than a purely advisory central occupational health unit.     

In vitro fertilisation in a small unit in the NHS

In vitro fertilisation is one of the most effective new treatments for infertility, but financial restrictions have made it impossible for it to be widely carried out in the National Health Service. We report on the establishment of a small, largely self funded, unit that was set up with the help of the local health service management. All cycles are programmed so that most work is carried out during the working week; oocyte recoveries are performed as outpatient procedures without general anaesthesia and guided by ultrasound. Roughly a tenth of treatment cycles and roughly a fifth of embryo transfers resulted in a clinical pregnancy.     

First seven years of a new NHS mental handicap service 1974-81.

A new community-focused mental handicap service was started in a single-district area health authority in 1974. Almost 90% of all the severely mentally handicapped people in a population of 250,000 are now known to the service. Although two-thirds of long stay inpatients originally admitted with major behavioural problems have had them resolved, the remaining one-third with persisting problems are noted to have spent many years in large understaffed wards before transfer. Specialist services to mentally handicapped people are not synonymous with beds. The learning opportunities during the waking hours of a mentally handicapped person are where professional help must be concentrated, and extensive support services for those caring for the mentally handicapped at home must be set up. Absence of shared philosophies, policies, and planning among the health and local authorities has produced the problems and frustrations familiar to many professionals in mental handicap. Future developments must be based on clearly defined and declared principles.     

Benefits of effective hospital services for elderly people.

An age related hospital service for elderly people was set up in Waltham Forest Health Authority to provide acute medical care when needed. Despite a reduction in the allocation of funds over the years 1982-4 the health authority increased the number of district general hospital beds available for elderly patients and improved home nursing services. The outcomes of the changes made were assessed against the aims of the service by using data from the Hospital Activity Analysis, SH3 returns, government population estimates, and yearly figures collected in our department. It is concluded that introducing an age related service in our health authority has benefited people aged over 65.     

同一个世界 同一个健康

随着工业化和城镇化水平的持续提高,人类的生活方式发生了翻天覆地的变化,在传统因素依然制约人类健康的同时,食源性疾病与营养结构不合理、畜禽养殖方式转变与宠物快速发展带来人与动物关系深刻变化、生态环境与居住环境变化等非传统因素,对人类健康的制约凸显。面对这些人类健康的新挑战,我们必须因应时代变化,在大力发展医疗卫生事业的同时,树立营养健康、动物健康、环境健康三位一体的现代健康新理念。努力提高营养健康水平,以宠物健康为新的关注点高度重视动物健康,以人居、社区环境为重点营造健康生态环境,建立起现代健康新模式。     

Interoperability of CABRI Services and Biochemical Pathways Databases

Common Access to Biological Resources and Information (CABRI) service is a 'one-stop-shop' for materials that are collected by a number of European culture collections that engage themselves in a quality service for the scientific community by adhering to Quality Guidelines for the management of resources and related information. It includes collections' catalogues that can be searched in an SRS implementation. A simple search facility, including a synonym search and a shopping cart, is also available. Within the European Biological Resource Centres Network (EBRCN) project, an extension and improvement of the catalogues' information is under way. This includes adding links to bibliographic databanks and sequence databases. Revision of 'in-house' controlled vocabularies used by data annotators is under way, in order to improve the setting up of external links, and new links to biochemical pathways databases are being set up for some of the catalogues.     

The quality of health care in prison: results of a year's programme of semistructured inspections.

OBJECTIVES: To assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales. DESIGN: Inspections based on a set of "expectations" derived mainly from existing healthcare quality standards published by the prison service and existing ethical guidelines; questionnaire survey of prisoners. SUBJECTS: 19 prisons in England and Wales, 1996-7. MAIN OUTCOME MEASURES: Appraisals of needs assessment and the commissioning and delivery of health care against the inspectorate''s expectations. RESULTS: The quality of health care varied greatly. A few prisons provided health care broadly equivalent to NHS care, but in many the health care was of low quality, some doctors were not adequately trained to do the work they faced, and some care failed to meet proper ethical standards. Little professional support was available to healthcare staff. CONCLUSIONS: The current policy for improving health care in prisons is not likely to achieve its objectives and is potentially wasteful. The prison service needs to recognise that expertise in the commissioning and delivery of health care is overwhelming based in the NHS. The current review of the provision of health care in prisons offers an opportunity to ensure that prisoners are not excluded from high quality health care.     

Breast cancer in South Asia: A Bangladeshi perspective

South Asian countries are facing a hidden breast cancer epidemic. A significant proportion of the breast cancer cases occur in premenopausal women. Knowledge of the various aspects of breast cancer in different geographical regions is limited in South Asia. In this article, we review the Bangladeshi perspective of the epidemiology, risk factors, pathology, diagnosis and treatment of breast cancer. As in other developing countries, because of the lack of breast cancer awareness in Bangladeshi population and inadequate access to health care, most patients are diagnosed at an advanced stage of the disease. Early detection has a crucial impact on overall treatment outcomes. To battle against breast cancer in resource-limited countries like Bangladesh, it is not feasible to set up a parallel health service system solely dedicated to cancer. Therefore, a cost-effective public health strategy is needed which could reach a large number of women in the country. Considering all these issues, we propose an innovative female-based primary healthcare approach focused on awareness, screening and early detection of breast cancer in Bangladesh. This preventive strategy could be a model for other resource-limited developing countries.     

Monitoring Intervention Coverage in the Context of Universal Health Coverage

Monitoring universal health coverage (UHC) focuses on information on health intervention coverage and financial protection. This paper addresses monitoring intervention coverage, related to the full spectrum of UHC, including health promotion and disease prevention, treatment, rehabilitation, and palliation. A comprehensive core set of indicators most relevant to the country situation should be monitored on a regular basis as part of health progress and systems performance assessment for all countries. UHC monitoring should be embedded in a broad results framework for the country health system, but focus on indicators related to the coverage of interventions that most directly reflect the results of UHC investments and strategies in each country. A set of tracer coverage indicators can be selected, divided into two groups—promotion/prevention, and treatment/care—as illustrated in this paper. Disaggregation of the indicators by the main equity stratifiers is critical to monitor progress in all population groups. Targets need to be set in accordance with baselines, historical rate of progress, and measurement considerations. Critical measurement gaps also exist, especially for treatment indicators, covering issues such as mental health, injuries, chronic conditions, surgical interventions, rehabilitation, and palliation. Consequently, further research and proxy indicators need to be used in the interim. Ideally, indicators should include a quality of intervention dimension. For some interventions, use of a single indicator is feasible, such as management of hypertension; but in many areas additional indicators are needed to capture quality of service provision. The monitoring of UHC has significant implications for health information systems. Major data gaps will need to be filled. At a minimum, countries will need to administer regular household health surveys with biological and clinical data collection. Countries will also need to improve the production of reliable, comprehensive, and timely health facility data. Please see later in the article for the Editors'' Summary

Summary Points

• Monitoring universal health coverage (UHC) should be integral to overall tracking of health progress and performance, which requires regular assessment of health system inputs (finances, health workforce, and medicines), outputs (service provision), coverage of interventions, and health impacts, as well as the social determinants of health.
• Within this overall context, we propose that UHC monitoring focus on financial protection and intervention coverage indicators, with a strong equity focus. This paper focuses on intervention coverage.
• Progress towards UHC should be tracked using tracer intervention coverage indicators selected on the basis of objective considerations and designed to keep the numbers of indicators small and manageable while covering a range of health interventions to capture the essence of the UHC goal.
• Since UHC is about progressive realization and countries differ in epidemiology, health systems, socioeconomic development, and people''s expectations, the indicator sets will not be the same everywhere.
• Coverage indicators should cover promotion and prevention, as well as treatment, rehabilitation, and palliation. While there are several suitable indicators for the first two, there are major gaps for coverage indicators of treatment, as population need for treatment is difficult to measure.
• A small set of well-established international intervention tracer coverage indicators can be identified for monitoring UHC. Where no good indicators are currently available, proxy indicators and equity analysis of service utilization can provide some insights.
• Special attention needs to be paid to quality of services, either through the tracer indicator itself (referred to as effective coverage) or through additional indicators on quality of services or health impact of the intervention.
• Targets should be set in accordance with baseline, historical rate of progress, and measurement considerations.
• The main data sources of intervention coverage indicators are household surveys and health facility reports. Investments in both are needed to improve the ability of countries to monitor progress towards UHC.
• It is essential to find effective ways of communicating progress towards UHC in ways that are meaningful to the general public and that capture the attention of policy makers.

This paper is part of the PLOS Universal Health Coverage Collection.