加强军队干休所医疗保健工作的几点做法

<正>医疗保健是离退休干部最关心的头等大事。军队干休所老干部普遍进入高龄、高发病、高住院、高死亡期("四高期"),他们对保健工作的需求越来越高、越来越迫切,做好老干部医疗保健工作,保证他们安度晚年是卫生所的一项重要政治任务~([1])。生命之托,重于泰山。干休所医务工作者的服务质量直接关系到老干部的生命、生活质量。通过十余年为老干部服务的工作实践,笔者总结了医疗保健"六     

干休所老干部医疗保健中家庭病房的实施及意义

<正>家庭病房是指开设在患者家中,由体系医院负责管理指导,干休所卫生所负责具体实施的医疗保健服务单元,由医院、干休所和老干部家庭成员共同管理服务。是集家庭医疗、保健、护理、生活料理、心理疏导、功能康复和健康教育为一体的服务,老干部在家中即可得到全面、系统、优质、连续性     

激发军队干休所文职护士工作积极性的几点思考

<正>近年来,随着军队干休所卫生所编制体制的调整,文职护士逐渐充实到干休所医疗保健队伍,并成为军队干休所医疗保健队伍中不可或缺的力量。充分调动和激发文职护士的主观能动性,对于适应军队干休所老干部"两高期"保健需求具有十分重要的意义。笔者所在单位自2008年招聘文职护士以来,注重发挥其作用,既有效缓解了干休所医务人员短缺与"两高期"老干部保健需求越来越高的矛盾,又使文职护士思想素质与技术水平得到全面较快提升,促进了老干部医     

干休所医疗保健中心的实践

当前,干休所越来越重视老干部的医疗保健工作,许多干休所在加强医疗保健中心建设中摸索出了有效的方法和经验。本文阐述了某军队干休所通过抓教育学习、硬件建设、科学训练、严格管理、服务质量,不断加强医疗保健工作的做法与实践,为干休所搞好医疗服务保障提供了切实可行的路子。     

干休所医疗保健工作几点做法

本文从干休所卫生所这一基层医疗单位的工作实际出发,结合新形势新任务和医疗保健工作的新特点,对干休所老干部医疗保健工作进细致的分析总结,为干休所卫生所如何做好医疗保健工作提供了思路和方向。     

对积极做好军队干休所医疗保健工作的几点思考

<正>新形势下,随着军队老干部进入"双高期",军队干休所医疗保健的内容和资源不断拓展,工作量加重,难度增大。如何做好干休所医疗保健工作,深入研究老干部及遗属的健康问题和心理问题,并针对其特点制定相应的对策和措施,进一步提高服务保障质量,是干休所医疗保健工作者认真思考的课题[1]。1干休所医疗保健需求发生新变化1.1医疗保健内容增加进入"双高期"的老干部,生理和心理上发生了巨大变化。由于多病缠身、长年患病,造成耳目     

干休所中心卫生所建设中应把握的几个问题

远离体系医院的边远干休所,老干部看病难、送院难,医疗抢救多依赖于地方医疗机构,医疗经费紧缺的矛盾十分突出。各级首长、机关对此十分关注,1994,总后卫生部为摸索一条解决边远地区干休所老干部医疗保健问题的新路子,决定选择我省赣州、吉安两个边远干休所卫生所作为试点,在干休所卫生所原有基础上,增加人员、设备,开设病床,建成具备一定诊疗救治能力和收治规模的中心卫生所。中心卫生所建成后,无论是从方便老干部就医、提高医疗服务质量和扩大服务范围,还是从减少超支、增加     

军队干休所离休干部医疗服务保障实践与体会

本文针对“两高期”军队离休老干部医疗服务保障特点,从创新为老干部医疗保障模式、完善为老干部医疗保障条件、增强为老干部医疗保障实效等方面,全面总结了做好军队干休所离休干部医疗保障工作的实践经验与体会,以期为其他单位做好老干部医疗服务保障工作提供借鉴。     

军队干休所离休老干部抑郁焦虑调查及对策研究

目的 调查军队干休所离休老干部的抑郁焦虑状态,分析护理对策的临床意义.方法 选择我干休所离休老干部70例为研究对象,采用心理评定量表SCL-90和SDS、SAS分析军队干休所离休老干部的抑郁焦虑情况,同时给予他们相应的护理干预,在第4个月时再次采用SDS、SAS分析其抑郁焦虑程度.结果 本组70例患者,存在焦虑状态患者22例,占31.4%;抑郁状态19例,占27.1%,焦虑和抑郁共存7例,占10.0%,SDS及SAS评分均高于国内常模的标准,差异具有统计学意义,P<0.01;本组焦虑与抑郁患者给予护理干预后SDS、SAS均较治疗前降低,差异具有统计学意义,P<0.01.结论 军队干休所离休老干部抑郁焦虑患病率较高,在临床护理工作中要予足够的重视,并及时给予心理护理.     

引入健康管理理念提升干休所医疗保健服务

<正>随着干休所老干部"两高期"的进程加快,老干部对医疗保健的需求日益多元和依赖。干休所卫生所作为老干部医疗保健服务的前沿,医务人员不仅要有过硬的医疗技术,还要注重运用健康管理的理念引领医疗保健服务的方向,帮助老干部确立健康新理念和健康生活方式,主动做自身健康的管理者维护者。1树立正确的健康管理理念健康管理是指以现代健康概念和新的医学模式,以及中医"治未病"理念为指导,通过采用现代医学和现代管理学的     

70岁以上离休干部卫生保健的相关性调查

目的了解70岁以上离休干部生活质量及其影响因素,为制订相应的卫生保健措施提供科学依据。方法采用问卷调查和体格检查相结合的方法,对济南部队3所干休所109名70岁以上离休干部进行调查。数据用STATA7.0软件包分析。结果本次调查表明,本组70岁以上离休干部生活质量良、中、差分别占21.10%、60.55%、18.35%。在调查的19种因素中,主要影响因素顺次为:生活习惯、健康状况、体检状况、日常生活功能、年龄、独居或与家人同住、生活满意度、社会交往、心理健康、婚姻、家庭和睦情况。结论70岁以上离休干部的生活质量较差,应针对其影响因素制定相应的医疗保健措施,提高离休老年人的生活质量和健康水平。     

556名离休干部生活质量调查分析

为了解连云港市离休干部的生活质量（Ｑｕａｌｉｔｙ ｏｆ ｌｉｆｅ）状况，采用了问卷和体检相结合的方法，对市区５５６名离休干部进行调查。结果：９３．５４％离休干部生活能自理，８４．８３％有慢性病，居一、二位的是高血压、冠心病，９８．８８％离休干部有中等以上的经济收入。自评生活满意度３３．７１％良好，６４．６１％中等，１．６９％差，１２．９２％离休干部对自己的身体健康不满意，影响其生活质量主要是心血管疾病，故重视离休干部医疗保健，才能提高他们的生活质量，实现健康老龄化。     

老干部身边公勤人员急救技能培训实践

目的 探讨一套有效提高老干部身边公勤人员院前急救技能的培训方法.方法 老干部身边公勤人员175人,年龄(23.4±3.6)岁.采用短期(20h)集中式培训,选用《现场急救教程》为培训教材,三级甲等医院高年资医师作为师资,采用理论讲课、操作练习、模拟情景等教学方法.培训前后分别采用共有25个考察院前急救知识和技能问题的自制量表进行问卷调查.结果 培训后公勤人员的院前急救知识和技能相关问题的正确率与培训前比较,均有不同程度的提高,25个题间差异有统计学意义(P＜0.05).对培训满意者152人(86.9％).结论 通过适当的培训可较好提高老干部身边公勤人员的院前急救技能.     

干部退休后1年与退休后5年心理健康情况调查分析

目的：通过对退休后1年与5年心理健康情况分析,更好地制定对退休干部的关怀措施,及时发现在查群体中的心理疾病,并适时干预。方法：采用汉密顿抑郁量表,汉密顿抑焦虑表对随机抽取112名退休1年及163名退休5年的干部进行测查。结果：退休1年以内的干部心理问题比较突出,焦虑、抑郁、睡眠障碍等较退休5年以上者明显。结论：对退休干部的体检,健康普查,必须加入心理测查内容,与精神科联手,拓宽会诊—联络精神医学的领域,早期发现,早期治疗,及时干预,避免因躯体形式障碍等精神科问题不能及时发现,因而延误治疗时机,令患者大费周折,使医疗资金过度浪费。     

杭州地区基层医疗卫生机构实施国家基本药物制度现状的调查分析

目的:为国家基本药物制度的有效实施提供参考。方法:采用简单随机抽样问卷调查和非结构式访谈方法,对杭州地区基层医务人员和患者进行调查,并将对国家基本药物制度的调查结果进行统计、分析。结果:居民对国家基本药物制度"零差率"知晓率不足50%,居民放弃去基层医疗卫生机构就医的主要原因在于基本药物配备不齐。国家基本药物制度满意度主要影响因素包括受访者的性别、年龄、月收入及就医方便性。结论:居民的国家基本药物制度认知度和信赖感有待增强,国家基本药物制度实施效果尚未凸显,总体满意度有待提高,建议加强宣传力度、完善多渠道补偿机制等,以促进国家基本药物制度可持续发展。     

家庭医生开展中医预防保健服务的做法和作用

目的：基于中医治未病理论,以体质辨识为抓手,在家庭医生责任制模式中引入中医预防保健服务功能,推进社区中医预防保健服务的开展。方法：在现有家庭医生责任制模式中,建立中医预防保健服务的管理、宣传和健康管理机制,为签约居民开展体质辨识,根据辨识结果将人群分为未病、欲病和已病3种,提供不同的中医健康管理服务。结果：初步形成家庭医生责任制模式中中医预防保健服务的运行方法,形成家庭医生、社区护士和中医师分工合作机制。结论：中医预防保健服务符合经济、适用、有效、覆盖面广的社区卫生服务要求,与家庭医生责任制结合将进一步完善社区卫生服务中心的服务内涵,符合社区卫生改革发展的方向。     

The Asheville Project: participants' perceptions of factors contributing to the success of a patient self-management diabetes program

OBJECTIVE: To ascertain patients', providers', and managers' perceptions of the factors that contributed to the success of the Asheville Project. DESIGN: One-time focus groups of patients and diabetes care providers and individual interviews with managers involved in the project. SETTING: The City of Asheville and Mission-St. Joseph's Health System (MSJ), Asheville, N.C. PATIENTS AND OTHER PARTICIPANTS: Twenty-one patients with diabetes who were employees of the two self-insured employers participating in the Asheville Project; four specially trained pharmacists who provided diabetes-related pharmaceutical care and one diabetes educator, all of whom received reimbursement for their services; six managers employed by the City of Asheville or MSJ who were involved in the project. INTERVENTION: A trained facilitator conducted four focus groups and six manager interviews in September 2001. Each session lasted 60 to 90 minutes, and the facilitator used a standard list of open-ended questions. The focus group sessions were recorded for subsequent analysis. MAIN OUTCOME MEASURES: Perceptions of focus group participants and managers of how the Asheville Project enabled patients with diabetes to become more responsible and successful in self-managing their condition. RESULTS: Focus group participants and managers were enthusiastic about their experiences with the project. Patients valued the relationships they established with their pharmacist or diabetes educator; as a result of these providers' support, patients felt more in control of their lives and were healthier. The waived co-payments for diabetes medications and related supplies was the decisive incentive for getting many patients to enroll in the project. For the providers, the project was a source of professional growth and satisfaction. Managers felt the project helped them fulfill their health care responsibilities to their employees, reduced overall costs, enhanced their organizations' reputations in health care delivery, and resulted in less absenteeism. CONCLUSION: Patients, providers, and managers in the Asheville Project believed that aligned incentives and community-based resources that provide health care services to patients with diabetes offer a practical, patient-empowering, and cost-effective solution to escalating health care costs.     

Assessment of satisfaction with pharmaceutical services in patients receiving antiretroviral therapy in outpatient HIV treatment setting

Background The patient’s perception and satisfaction are increasingly considered as a useful factor in the assessment of competency of health care providers and quality of care. However, these patient focused assessments are largely ignored when assessing health care outcomes. Objective The study assessed the perception and satisfaction of patients receiving antiretroviral therapy (ART) with pharmaceutical services received in outpatient HIV treatment settings. Setting Seventeen HIV treatment centres in Nigeria. Methods This cross-sectional survey included 2,700 patients randomly selected from 26,319 HIV patients on ART, who received pharmaceutical services in the study setting. A study-specific Likert-type instrument was administered to the participants at point of exit from the pharmacy. Midpoint of the 5-point scale was computed and scores above it were regarded as positive while below as negative. Chi-square was used for inferential statistics. All reported p values were 2-sided at 95 % confidence interval (CI). Main outcome measure Patient satisfaction with pharmaceutical services. Results Of 2,700 patients sampled, data from 1,617 (59.9 %) were valid for analysis; 62.3 % were aged 26–40 years and 65.4 % were females. The participants had received pharmaceutical services for a mean duration of 25.2 (95 % CI 24.3–26.1) months. Perception of participants regarding the appearance of pharmacy was positive while that regarding the pharmacists’ efforts to solve patients’ medication related problems was negative. The participants’ rating of satisfaction with the waiting time to access pharmaceutical services was negative; the satisfaction decreases with increasing waiting time. However, the satisfaction with the overall quality of pharmaceutical services received was rated as positive; 90.0 % reported that they got the kind of pharmaceutical services they wanted; 98.2 % would come back to the pharmacy if they were to seek help again and would recommend services to others. The level of satisfaction was found to be associated with educational status of the participants (p = 0.006) unlike age, sex, marital and employment status. Conclusion The satisfaction with overall quality of pharmaceutical services received by participants was positive. Longer waiting times resulted in lower patient satisfaction. High patient load may be the cause of the long waiting time and the inadequate duration of interaction between pharmacist and the patient.     

The influence of distance on utilization of outpatient mental health aftercare following inpatient substance abuse treatment

This study examined whether substance abuse patients who live farther from their source of outpatient mental health care were less likely to obtain aftercare following an inpatient treatment episode. For those patients who did receive aftercare, distance was evaluated as a predictor of the volume of care received. A national sample of 33,952 veterans discharged from Department of Veterans Affairs (VA) inpatient substance abuse treatment programs was analyzed using a two-part choice model utilizing logistic and linear regression. Patients living farther from their source of outpatient mental health care were less likely to obtain aftercare following inpatient substance abuse treatment. Patients who traveled 10 miles or less were 2.6 times more likely to obtain aftercare than those who traveled more than 50 miles. Only 40% of patients who lived more than 25 miles from the nearest aftercare facility obtained any aftercare services. Patients who received aftercare services had fewer visits if they lived farther from their source of aftercare. Lack of geographic access (distance) is a barrier to outpatient mental health care following inpatient substance abuse treatment, and influences the volume of care received once the decision to obtain aftercare is made. Aftercare services must be geographically accessible to ensure satisfactory utilization.     

Drinking patterns,gender and health II: Predictors of preventive service use

Background: Chronic diseases and injuries are elevated among people with substance use problems/dependence, yet heavier drinkers use fewer routine and preventive health services than non-drinkers and moderate drinkers, while former drinkers and abstainers use more than moderate drinkers. Researchers hypothesize that drinking clusters with attitudes and practices that produce better health among moderate drinkers and that heavy drinkers avoid doctors until they become ill, subsequently quitting and using more services. Gender differences in alcohol consumption, health-related attitudes, practices, and prevention-services use may affect these relationships.

Methods: A stratified random sample of health-plan members (7884; 2995 males, 4889 females) completed a mail survey that was linked to 24 months of health-plan records. Data were used to examine relationships between alcohol use, gender, health-related attitudes/practices, health, and prevention-service use.

Results: Controlling for attitudes, practices, and health, female lifelong abstainers and former drinkers were less likely to have mammograms; individuals with alcohol-use disorders and positive AUDIT scores were less likely to obtain influenza vaccinations. AUDIT-positive women were less likely to undergo colorectal screening than AUDIT-positive men. Consistent predictors of prevention-services use were: self-report of having a primary care provider (positive); disliking visiting the doctor (negative); smoking cigarettes (negative), and higher body mass index (BMI) (negative).

Conclusions: When factors associated with drinking are controlled, patterns of alcohol consumption have limited effects on preventive service use. Individuals with stigmatized behaviors (e.g., hazardous/harmful drinking, smoking, or high BMIs) are less likely to receive care. Making care experiences positive and carefully addressing stigmatized health practices could increase preventive service use.