实施社区首诊制必先做好条件准备

为了解决群众“看病难,看病责”的问题,国家大力发展社区卫生事业。社区首诊制作为其中一项重要的制度被各地纷纷响应,然而由于我国现阶段社区卫生事业基础尚很薄弱,开展社区首诊制的条件还不具备,因此开展起来困难重重。所以现阶段应以完善社区首诊制的基础条件为工作重心。     

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.     

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。     

基层卫生服务能力对首诊制的影响

搞好基层卫生服务,实施首诊制,是解决"看病贵、看病难"、合理配置卫生资源的重要措施.实施社区首诊制可以对患者进行合理地分流,减少专科医院资源的浪费.使得社区居民的常见病、多发病尽可能在社区内通过常规方法加以解决.     

基本药物制度对首诊制的影响及对策研究

基本药物制度实施后,药品价格降低,医保报销比例增加,有利于吸引患者到社区医疗机构就诊,促进了首诊制发展,但由于基本药物种类有限,居民用药习惯以及财政补偿不到位等都影响了基层卫生机构的功能发挥,不利于首诊制的发展.基本药物制度在实施中要不断完善,最终达到与首诊制共同发展的双赢局面.     

社区卫生服务首诊制与医师多点执业

阐述了社区卫生服务首诊制的概念及其对规范医疗卫生次序的重要作用, 深入分析了限制社区卫生服务首诊制发展的主要因素。从正反两个方面分析了医师多点执业对首诊制的影响:医师多点执业能提高社区卫生人力资源的质量, 增强民众对社区卫生机构的信任度;但是医师多点执业也会造成医院和社区卫生机构管理上的问题, 医生自身也需要时间适应自身角色的转变。鼓励大医院办社区卫生服务机构, 增加社区医疗机构的政府补偿, 吸引医师到基层多点执业, 增强社区卫生服务首诊的能力。     

分级诊疗、基层首诊与基层医疗卫生机构建设

分级诊疗、基层首诊与基层医疗卫生机构建设是我国"新医改"的重要内容,对建立新的居民就医格局和解决"看病难、看病贵"问题具有重要的意义。本文在确立分级诊疗、基层首诊和基层医疗卫生机构三者互为因果关系,并据此建立起统一分析框架的基础上,探讨了我国大医院"人满为患"与基层医疗卫生机构"门可罗雀"并存这一医改困境的成因与后果,并以广州市为实证案例分析了我国推行分级诊疗和基层首诊过程中存在的实际问题,最后分析了基层医疗卫生机构建设对实施分级诊疗和基层首诊的影响及存在的问题,并从落实基层首诊、有效实施分级诊疗的角度提出了基层医疗卫生机构建设及其配套改革的政策建议。     

“双诊制”政策的伦理合理性及伦理问题

“双诊制”是健康守门人的基本政策.“双诊制”的伦理合理性在于,该政策是把公共利益放在首位的必然选择,它维护社会公平公正原则进而维护社会公共利益,有利于公共健康利益和公共经济利益.但涉及的伦理问题也需重视,存在公共利益与患者个人利益的关系,各项政策在协调利益时的统一整合,程序公正与实质公正的关系等问题.     

基于目标导向行为模型的患者基层首诊决策机制研究

基于目标导向行为模型,采用结构方程模型方法探析患者基层首诊决策过程中的影响因素及其内在作用机制,从认知过程、情感过程、习惯过程和动机过程四方面剖析患者基层首诊行为意愿的形成机理。结果表明患者主观规范、行为态度、知觉行为控制以及正向预期情绪均正向显著影响患者基层首诊行为欲望,行为欲望和过去行为频率显著正向影响患者基层首诊行为意愿。建议强化患者基层首诊行为的价值与必要性,进一步改善患者基层就诊体验,增加患者基层首诊行为频率,激发患者基层首诊行为欲望。

     

立足城市社区 做好宗教工作北大核心CSSCISSCI

在新时期,宗教工作需要有新的工作方法。作为宗教工作的组成部分,社区宗教工作开展得如何,直接影响到宗教政策的贯彻落实。社区工作者要积极创新、砥砺前行。只有这样,才能确保基层宗教工作的扎实推进。城市社区是市场经济体制条件下的城市管理模式。社区建设打破了传统城城市的行政性管理体制,成为城市管理制度的创新。     

A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics

Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.’s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled “communication.” There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC—however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.     

Family-Centered Care to Promote Successful Community Reintegration After War: It Takes a Nation

The papers in this section focus on public health responses and implementation considerations in addressing the challenges military families confront when parents go to war. While many military families show resilience, the challenges resulting from a decade of war with multiple deployments are detailed, as are innovative military and civilian programs designed to help service members and their families reintegrate successfully into the community. As more and more service members leave active duty, the burden of meeting military families’ psychological needs will transition from the Department of Defense (DoD) and into the Veterans Administration (VA) and civilian arenas. While many strategies to support successful readjustment are offered, in this time of dwindling mental health resources and competing needs, it is unclear what priority the broader society places on meeting the needs of returning service members and their families. A growing emphasis on family-centered care in the Veterans Administration may help meet this gap.