医学生到社区卫生服务机构实践的探讨

《国务院关于发展城市社区卫生服务的指导意见》明确医学院校应将培养医学生社区卫生服务技能作为医学教育的重要内容,并将此项作为卫生工作的重点。分析了医学生临床实习现状,论述其进行社区医学实践的意义,并着重结合国外医学生社区临床实践情况的基础上,对我国医学生到社区卫生服务机构进行临床实践提出建议。     

医学模式与医疗卫生服务的社区定向

医学模式与医疗卫生服务的社区定向广东医学院（湛江５２４０２３）王小燕一、医疗卫生服务必须以健康保障为出发点必须以把保障个人、社区和社会健康看做是医疗卫生服务的出发点,以健康为目的,以社区人群为对象进行包括通科医疗、预防、康复、社区护理等广泛的综合性卫...     

从失配到适配：农村医疗卫生服务可及性的逻辑转换

医疗卫生服务可及性作为实现供需匹配的重要手段,其实现目标既要有利于实现更高质量的医疗卫生服务均等化,又要有助于增进农民对医疗卫生服务满意度。基于公共管理的视角,可及性是一个评价医疗卫生服务供给与需求的适合度的概念,应包括可获得性、可接近性、可适应性和可承受性等内容。供需失配是农村医疗卫生服务可及性存在的基本症结,而财政失衡与资源错配是形成农村医疗卫生服务供需失配的主要原因。基于问题导向和目标导向,从医疗资源配置、服务供需精准对接、服务质量反馈、医疗卫生支出补偿等方面提升医疗卫生服务可及性,是实现农村医疗卫生服务从失配到适配逻辑转换的根本路径。     

农村医疗保障体制构建模式的选择——多层次农村医疗保障制度体系

目前农村医疗保障实行的新型农村合作医疗制度体系,很难保障农村居民的基本医疗卫生服务的需求。提出构建包括卫生防疫与基础保健功能的基础层,新型农村合作医疗制度的主体层,农村医疗救助制度的最低层,商业性医疗保险的补充层的多层次农村医疗保障制度体系,以有效解决农村居民对医疗卫生服务不同层次的需要。     

临床专业学位研究生教育与住院医师规范化培训并轨的实践研究

临床专业学位研究生培养与住院医师规范化培训为医学生提高临床能力的继续教育模式,但两者之间存在一定的重复性,造成医疗卫生资源的浪费,将两者并轨可提高医学人才培养的规范性和集约性并使医疗卫生事业资源得到充分利用。剖析住院医师规范化培训和临床专业学位研究生培养两种毕业后再教育模式的异同点及利弊,建立医学专业学位研究生培养与住院医师规范化培训在课程、临床培训、临床考核、科研训练、人文教育等方面的"双轨合一"人才培养模式,为提高临床实践能力的继续教育发展提供依据。     

论发展我国社区医学服务

本文提出发展社区医学服务是医疗卫生服务模式的一次变革。认为发展社区医学服务是适应人类疾病谱和死亡谱的变化,是适应人口老龄化发展趋势和医学模式改变的需要。作者提出社区医学服务的概念的目的是强调这种新的服务模式是集医疗,预防,保健,康复,健康教育,咨询和卫生服务为一体的全方位的全程服务模式。     

“服务学习”:一种新的医学教育模式

通过对国内外"服务学习"模式相关研究的梳理,详细描述了其内涵及特色,并发现"服务学习"模式的特性在医学教育中的显著影响,尤其是对医学生学习、社区公益和学校教育具有重要作用。此外,在医学生的知识技能实践、社会责任感、医患沟通意识和医德医风等多方面的培养具有推动意义。在此基础上,结合我国医疗环境复杂和医学教育失衡的现状,探究"服务学习"模式对我国当下医学教育改革和未来医疗环境的影响,为国内未来的医学教育提供新的思路。     

四川省首届定向医学生政策实施效果及影响因素分析

了解首届定向医学生政策实施效果及影响因素,培养更多基层医疗卫生人才,通过自编问卷对四川省166名2015届定向医学毕业生进行调查。毕业时现实履约率为83.1%,而愿意履约率为68.1%,愿意到基层医疗卫生单位工作的占50.6%,服务期满后仍愿留在基层医疗卫生单位的仅占13.3%,通过二元Logistic回归分析得出,学生家庭经济情况越困难、政策了解程度越好、回生源地工作意愿越强,对政策现实意义认同度越高越愿意履约。因此,政府应从提高基层医疗卫生工作者收入和待遇,完善保障、激励、管理政策,加强政策宣传力度等方面增强定向医学毕业生的基层服务意愿。     

医学生必须学好哲学

医学生必须学好哲学首都医科大学社科部（北京１０００５４）贾玉萍要使我国的医疗卫生事业更好地适应２１世纪发展的需要，使医学顺应时代的潮流，关键是要培养具有２１世纪各方面素质的医学人才，因为现在的医学生将是２１世纪医学的栋梁。一个善于思维的头脑比仅仅塞满...     

政府转型与中国医疗服务体系的改革取向

在中国的医疗卫生服务领域,出现了市场失灵和政府失灵并存的现象.市场与政府双失灵造成的恶果是,无论是市场主导的还是政府主导的医疗卫生资源,都涌向城市、涌向经济发达地区;在农村地区,在经济落后地区,在城乡结合部,不仅高层次医疗卫生专业力量不足,设备不足,甚至连机构的数量也不足.针对这些问题,一种流行的解决思路是恢复医疗卫生服务的计划体制,但计划经济时代农村同样是缺医少药.正确而且唯一的改革道路,就是两条腿走路:第一条腿是全面放宽对社会资本进入医疗卫生服务领域的管制,为所有的医疗机构(不论民营还是公立,不论是非营利性还是营利性)创造一个公平竞争的制度环境;第二条腿是政府将新增公共资源更多地投入到市场不足的地方和市场失灵的领域,从而引导整个医疗卫生服务体系健康均衡地发展.     

实施社区首诊制的意义及建议

目前,实施社区首诊制有重要的意义在于,可以缓解看病难、看病贵问题,适应人口老龄化的需求,改善流动人口的健康状况,以及减少私人诊所和药店不规范医疗带来的危害。但是,首诊制的实施也必然面临一定的困难。因此,应积极倡导医保制定向社区倾斜的政策,鼓励社区提高医务人员的技术水平、服务质量,并且完善双向转诊制度。     

Sexual assault history and use of health and mental health services

A history of sexual assault may be associated with increased current use of mental health and medical services because of the psychologically and physically disruptive consequences of assault. To test this hypothesis, we estimated rates of mental health and medical services use among 2560 randomly selected community residents, 343 of whom had been sexually assaulted. Sexual assault was associated with seeking both forms of care. Controls for demographic variables, psychiatric diagnosis, health status, and insurance suggested that assault increases use indirectly, through poor mental and physical health. Uninsured, assaulted respondents were especially likely to consult medical providers. Respondents assaulted during childhood were particularly likely to seek mental health care. Assault was more common among mental health service users than nonusers, and among women using medical services compared to female nonpatients. The high prevalence of assault among service users underscores the need for providers to recognize and treat sexual assault-related problems.     

总结经验 推进新一轮卫生改革

着眼于实现为人人提供保健服务目标的医疗改革,要求卫生服务与医药购销制度的改革必须适应广覆盖、低成本的医疗保险制度;确保公共卫生、社区卫生与合作医疗在整个保健服务体系中的主体地位,在基本卫生保健服务机构与大医院之间建立合作、互补、互制的关系;坚定地对大医院实行调整和管理;构建医药分开的管理与流通体制;政府主导作用到位,投入方向合理,以顺利推进新一轮医疗改革。     

中部崛起背景下的城市社区卫生服务主要影响因素研究

通过武汉市中心城区社区卫生服务的实证调研,多因素分析和建模,寻求影响中部地区城市社区卫生服务的主导因素,在此基础上提出若干可行的政策建议,旨在为管理决策、促进社区卫生服务及构筑新型城市卫生服务体系等提供信息支持服务。     

中国医疗事业发展的思考

中国医疗事业有了很发展,医疗资源显著增加,城乡居民医疗服务水平明显提高。面临的主要问题是医疗资源的城乡及地区判别仍很大;干部,职工及农民的医疗服务水平存在明显差距。医疗机构的服务效率及效益逐年下降,医疗资源不足与浪费现象同时存在。中国医疗改革的策略应是：改革现行医疗保健制度提高城市居民的医疗保健水平;改革现行医疗机构的经济补偿机制,以控制医药费上升速度;加强政府对医疗事业的宏观管理,调整医疗资源的     

Health and Social Services for Male-to-Female Transgender Persons of Color in San Francisco

SUMMARY

This article presents findings from an investigation of health needs, service utilization, and perceived barriers to services among male-to-female (MtF) transgender persons of color in San Francisco. Focus groups (n = 48) and survey interviews (n = 332) were conducted with convenience samples recruited from the community. Participants reported a range of health and social services needed during the previous year, with African-Americans and Latinas showing particularly strong service needs. Rates of utilizing services were high for basic health care but lower for social services, substance abuse treatment, psychological counseling, and gender transition-related medical services. No significant ethnic group differences in health service utilization were found. Qualitative findings evinced the call for transgender-specific programs and advanced provider training on transgender issues such as hormone use, gender transition, HIV/ AIDS care and prevention, substance abuse, and mental health problems.     

探讨三级综合医院基于信息交互体系的双向转诊

建立基于信息交互体系的双向转诊信息平台,通过大连市某三级综合医院与社区卫生服务中心双向转诊研究,着重于探索临床路径这一研究方向对双向转诊的意义。用同期非随机对照试验,收集大连市黄河路社区上转患者人次和医院下转患者人次,以及分别比较转诊费用和医患转诊认知度。结果,上转患者402人,下转患者179人,上转服务明显好于下转,试验组和对照组患者医疗费用（除诊疗费）差异有统计学意义（P〈0．05）,双向转诊认知度差异有统计学意义（P〈0．05）。目前双向转诊还处于单向流动状态,上转率明显高于下转率,双向转诊节省了医疗费用,在医患对其认知度方面,前者明显高于后者,制度上的支持是双向转诊顺利实施的关键。     

Connections between Family Centered Care and Medical Homes of Children with Neurodevelopmental Disabilities: Experiences of Diverse Families

Cultural issues tied to race/ethnicity are important aspects in delivering medical home services to children with neurodevelopmental disabilities and their families. To better understand family satisfaction with family centered care (FCC) in medical homes of children with disabilities, this study investigated whether family race/ethnicity, in addition to parent and child characteristics, significantly influenced family perceptions of FCC in three areas: family-provider partnership, care setting practices and policies, and community coordination and follow-up. Based on the life course theory for optimizing children's developmental trajectories, examining connections between family race/ethnicity and satisfaction with health care allows for identification of strengths and weaknesses in medical home services delivery, and offers opportunities for family support and improvement in outcomes for children with disabilities. This study developed an original empirical survey using a structured questionnaire developed by Family Voices, a national advocacy organization dedicated to promoting the well-being of children with disabilities and their families. The study collected data for 122 families in a large urban area in the northeastern United States. Multivariate analyses revealed that family race/ethnicity significantly contributed to the prediction of parental satisfaction with medical homes of children with disabilities, and to families' perceptions of FCC in care setting practices and policies, and community coordination and followup, but not to family provider partnership. Non-White families reported significantly lower satisfaction. Discussion emphasizes that health care providers need to become more vigilant in providing culturally sensitive care. To enhance FCC practices and policies, the study advances a checklist of ten essential areas that promote culturally sensitive interactions between families of children with disabilities and their medical and non-medical health care providers.     

Transition planning and recidivism among mentally ill juvenile offenders

OBJECTIVES: To determine the extent to which transition planning and community service would predict lower levels of recidivism among mentally ill juvenile offenders. DESIGN: Review of legal, medical and social service records including examination of 3-month period following community release. PARTICIPANTS: Juvenile offenders incarcerated for 6 months or more (N = 44) transitioning to community. MEASURES: Child and Adolescent Functional Assessment Scale (CAFAS), sum of different documented pre- and post-release discharge planning contacts, documented community service contacts. OUTCOMES: Re-offense during the first year post-release. RESULTS: Documented community service contacts in the 3 months following discharge were rare for mental health (20.5%), substance abuse (38.6%), financial assistance (29.5%), and school placement (34.1%). The average number of different pre-release and post-release discharge planning contacts was also low, M(SD)=1.86(1.68) and M(SD)= 2.34(1.71) respectively. Post-release discharge planning and the receipt of financial assistance and mental health services were all associated with lower levels of reoffending. CONCLUSIONS: Community transition planning, including the coordination and provision of community services, is an essential component of community reintegration for juvenile offenders and is associated with lower rates of recidivism during the first year post-discharge.     

我国现阶段的卫生财政政策及其理念分析

系统地描述和总结了我国现行的卫生财政政策,分析了其理念,指出了其不足之处。政府应当担负起社会合作的责任,建立起卫生财政转移支付制度,在不同行政区域之间,在城市与农村之间,公平地分配公共卫生服务物品和基本医疗服务物品。以药品差价收入补偿医疗机构的卫生财政政策理念是有害的。