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Influence of a specialized leg ulcer service on management and outcome

BRITISH JOURNAL OF SURGERY 2000年第8期87卷 1048-1056页

作者： Ghauri, ASK Taylor, MC Deacon, JE Whyman, MR Earnshaw, JJ Heather, BP Poskitt, KR Cheltenham Gen Hosp Gloucestershire Vasc Grp Cheltenham GL53 7AN Glos England Gloucestershire Royal Hosp Gloucester GL1 3NN England

Background: The organization of leg ulcer care is poorly defined in the community. This study assessed the overall influence of a specialized community service on management and outcome of chronic leg ulcers, irrespective of aetiology. Methods: Assessment and outcome of ulcers were compared in patient samples (n = 200) from East and West Gloucestershire, before and after the introduction of specialized clinics into East Gloucestershire, In clinics, vascular disease was routinely assessed by duplex scanning and determination of the ankle:brachial pressure index. Results: There was no coordinated community structure for the care of patients with leg ulcers before the service was introduced, and 74 and 67 per cent of limbs in East and West Gloucestershire respectively had aetiology undiagnosed. After introduction of the clinics, the 12-week healing rate increased from 12 to 22 per cent in East Gloucestershire (P = 0.05) and to 47 per cent in the specialized East Gloucestershire clinics (P < 0.001). The 12-month recurrence rate decreased from 50 to 41 per cent in East Gloucestershire and to 17 per cent in the East clinics (P < 0.001). The West Gloucestershire control showed no significant changes. Conclusion: A specialized leg ulcer service with defined protocols provides an improved management structure for treating patients with leg ulcers in the community. Accurate diagnosis of chronic leg ulcers and improved outcome may be achieved within this specialized service.

关键词：门诊医疗/方法门诊医疗/组织和管理社区卫生服务/组织和管理卫生保健提供英格兰腿溃疡/病因学腿溃疡/治疗医学审核前瞻性研究复发治疗结果人类

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徐州市农村地区基本公共卫生服务践行现状及影响因素分析

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中国校医 2015年第4期29卷 294-296页

作者：张雷乔程娄培安陈培培张盼李婷董宗美徐州市疾病预防控制中心江苏徐州221006

目的了解徐州市农村地区基本公共卫生服务开展现状及其影响因素。方法采用多阶段分层抽样,抽取徐州市农村7个县（市、区）的20家乡镇卫生院,采用自行设计的调查表对基本公共卫生服务开展情况进行调查。结果卫生院中从事基本公共卫生服... 详细信息

目的了解徐州市农村地区基本公共卫生服务开展现状及其影响因素。方法采用多阶段分层抽样,抽取徐州市农村7个县（市、区）的20家乡镇卫生院,采用自行设计的调查表对基本公共卫生服务开展情况进行调查。结果卫生院中从事基本公共卫生服务工作的人员占卫生技术人员的21.7%,专、兼职比例分别为55.0%、45.0%,35-45岁,占46.1%,中专学历,占69.5%。居民建档率为79.5%,健康教育、预防保健、传染病防治及卫生监督协管工作普遍较好,老年人健康管理率、体检率分别为88.3%、85.2%,高血压患者管理率、随访次数以及血压控制率分别为94.9%、3.8次、54.4%;糖尿病患者管理率、随访次数以及血糖控制率分别为93.8%、3.9次和67.4%。结论徐州市农村地区从事基本公共卫生服务工作的人员数量及质量有待提高;健康教育、预防接种工作、传染病防治以及卫生监督协管工作开展较好,但在居民健康档案、老年人健康管理、慢性病患者健康管理方面的服务质量需要进一步提高。加强基层卫生人才队伍建设,落实绩效考核制度,加强监管,是促进基本公共卫生服务工作高质量开展的有效途径。

关键词：社区卫生服务/组织和管理农村人口

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实施糖尿病社区综合管理模式的效果分析

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现代医药卫生 2012年第16期28卷 2544-2546页

作者：孙柏林杨辉李青文杨张璐秦虹李兴静钟雄凌重庆建设医院重庆400050

目的探讨社区糖尿病规范管理的有效模式,应用糖尿病控制单元,提高糖尿病患者的治疗达标率。方法选择已经确诊的糖尿病患者400例,按照同等病情随机分为强化组和常规组进行分组管理,强化组采用量化饮食治疗、量化运动治疗、指导合理用药... 详细信息

目的探讨社区糖尿病规范管理的有效模式,应用糖尿病控制单元,提高糖尿病患者的治疗达标率。方法选择已经确诊的糖尿病患者400例,按照同等病情随机分为强化组和常规组进行分组管理,强化组采用量化饮食治疗、量化运动治疗、指导合理用药、健康教育和心理疏导,专科医生对患者一对一的指导等治疗方法;常规组采用药物治疗和常规门诊随访。观察两组连续治疗3年病情控制情况。结果参加强化管理的糖尿病患者干预前后的空腹血糖、餐后血糖、糖化血红蛋白、三酰甘油、总胆固醇控制达标率明显优于常规治疗组,并且强化组患者对糖尿病的认知以及并发症发生率、医疗费用等均优于常规治疗组。两组比较差异具有统计学意义(P<0.01)。结论利用糖尿病控制单元实施社区糖尿病综合管理模式的效果明显优于糖尿病常规治疗,值得推广。

关键词：糖尿病/治疗综合疗法社区卫生服务/组织和管理治疗结果

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社区-医院一体化管理模式对糖尿病患者影响的研究

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中国校医 2015年第10期29卷 749-750页

作者：黄屹乎广州市黄埔区穗东街社区卫生服务中心全科门诊广东广州510700

目的探讨社区-医院一体化管理模式对糖尿病患者的影响。方法将本社区卫生服务中心就诊的140例糖尿病患者随机分为对照组和观察组各70例,前者采取普通管理,后者给予社区-医院一体化管理模式,对比2组患者糖化血红蛋白及空腹血糖水平。结... 详细信息

目的探讨社区-医院一体化管理模式对糖尿病患者的影响。方法将本社区卫生服务中心就诊的140例糖尿病患者随机分为对照组和观察组各70例,前者采取普通管理,后者给予社区-医院一体化管理模式,对比2组患者糖化血红蛋白及空腹血糖水平。结果对照组患者给予常规管理,半年后平均空腹血糖为(7.38±1.87)mmol/L,观察组给予社区-医院一体化管理模式半年后患者平均空腹血糖水平为(5.84±0.53)mmol/L,2组比较差异有统计学意义(P=0.023);对照组患者半年后糖化血红蛋白水平为(8.12±2.89)mmol/L,观察组半年后患者糖化血红蛋白水平为(6.34±1.35)mmol/L,2组比较差异有统计学意义(P=0.031)。结论社区-医院一体化管理模式能明显改善糖尿病患者不良饮食习惯,并且能有效降低血糖及糖化血红蛋白水平。

关键词：糖尿病/预防和控制社区卫生服务/组织和管理卫生保健提供,联合

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Evaluating prevention programs with the Results Mapping evaluation tool: a case study of a youth substance abuse prevention program

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HEALTH EDUCATION RESEARCH 2000年第1期15卷 73-84页

作者： Reed, K Cheadle, A Thompson, B Univ Washington Sch Publ Hlth & Community Med Dept Hlth Serv Seattle WA 98195 USA Fred Hutchinson Canc Res Ctr Seattle WA 98109 USA

The harmful effects of alcohol and other drug abuse are widespread. Our health care, social service, education and legal systems are strained under the impact of substance abuse, not to mention the economic costs associated with substance abuse. Consequently, effective strategies which prevent substance abuse must be identified and replicated. Yet, user-friendly and cost-effective evaluation tools for community-based substance abuse prevention programs are rare, A recently developed tool that has promise to overcome some of the barriers which exist when evaluating prevention programs is 'Results Mapping'. Results Mapping documents and aims to quantify the contributions of a program to future outcomes of its target population with the intention of making data meaningful at the program and funding agency level. This case study was conducted to assess the feasibility of implementing the Results Mapping evaluation tool for community-based prevention programs. The study assessed qualitatively how well Results Mapping worked for one community-based substance abuse prevention program, as well as how much time and funding it took to implement this new tool. Results suggested that Results Mapping may be a valuable documentation, planning and learning tool, but funding agencies should be cautious about using Results Mapping scores to determine funding allocations.

关键词：社区卫生服务/组织和管理健康促进一级预防方案评价/方法物质相关性障碍/预防和控制华盛顿青少年女(雌)性人类男(雄)性

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What is primary care? Developments in Britain since the 1960s

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HEALTH CARE ANALYSIS 1998年第4期6卷 324-329页

作者： Lewis, J Univ Nottingham Sch Sociol & Social Policy Nottingham NG7 2RD England

Since 1994, health policy in the UK has focused explicitly on making the NHS 'primary care-led'. However, the meaning of primary is contested by different health professions and by policy-makers. This paper charts the major points of debate since the 1960s and suggests that there are limitations as to what general practice can be expected to deliver in respect of primary care. (C) 1998 John Wiley & Sons, Ltd.

关键词：社区卫生服务/组织和管理大不列颠卫生政策模型组织管理医师家庭初级卫生保健/历史初级卫生保健/组织和管理公费医疗/历史历史 20世纪

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Truth's search for power in health policy: critical applications to community-oriented primary care and small area analysis.

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Medical care review 1992年第2期49卷 161-189页

作者： Waitzkin, H. Hubbell, F.A. Division of General Internal Medicine and Primary Care University of California Irvine United States

Explores the concept of truth and power in relation to the United States' health policy. Information on community-oriented primary care (COPC) and small area analysis (SAA); Emergence of COPC and SAA as attractive... 详细信息

关键词：加利福尼亚社区卫生服务/组织和管理卫生政策卫生服务易得程度卫生服务研究/方法卫生服务研究/标准人类以色列医疗费用无力承担模型统计学国家健康保险美国政治权力(心理学) 初级卫生保健/组织和管理小地区分析南非美国

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Targeting services to chronically disabled elderly: The preliminary experiences of the national long term care channeling demonstration

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Home Health Care Services Quarterly 1985年第2期6卷 57-79页

作者： Applebaum, Robert A. Baxter, Raymond J. Callahan, James J. Day, Stephen L. Dr. Applebaum is a researcher at Mathernatica Policy Research United States Long Term Care at Health and Hospitals Corporation United States Brandcis University Department of Mental Health for the Commonwealth of Massachusetts United States

In response to concerns about the adequate provision of long term care, the National Long Term Care Channeling Demonstration has been funded by the Department of Health and Human Services. The project is designed to provide coordinated community services as an alternative to institutionalization to those elderly individuals at risk of placement. This preliminary work examines the demonstration's experience in its attempt to target services to these individuals. Although final research results are not yet available, the method, problems, and results of the initial case finding and screening approaches provide additional knowledge concerning the targeting experience. © 1985 Taylor & Francis Group, LLC.

关键词：社区卫生服务/组织和管理合格鉴定/方法长期医疗/组织和管理模型理论试点项目转诊和会诊美国老年人人类

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Measured fairness, situated justice: Feminist reflections on health care rationing

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KENNEDY INSTITUTE OF ETHICS JOURNAL 1996年第1期6卷 53-68页

作者： Nelson, JL

Bioethical discussion of justice in health care has been much enlivened in recent years by new developments in the theory of rationing and by the emergence of a strong communitarian voice. Unfortunately, these developments have not enjoyed much in the way of close engagement with feminist-inspired reflections on power, privilege, and justice. I hope here to promote interchange between ''mainstream'' treatments of justice in health care and feminist thought.

关键词：社区卫生服务/组织和管理多数赞同文化多样性伦理理论伦理学医学卫生保健公平提供/标准人权病人遴选资源分配社会正义社会责任社会价值美国女权女(雌)性人类

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Utilizing Cooperative Extension Services to Meet Rural Health Needs

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The Journal of Rural Health 1991年第1期7卷 23-29页

作者： Halpert, Burton P. Sharp, Tessa S. CenteronAgingStudies UniversityofMissouri-KansasCity64110.

ABSTRACT: Professionals concerned with rural health issues sometimes overlook the possibilities that the Cooperative Extension Services (CES) hold for addressing rural health problems. Joint venturing between health care and CES professionals can help address the growing rural health care concerns associated with cost containment strategies and the federal deficit, as well as the traditional problems associated with the scarcity of health care resources in rural areas. Cooperative extension, a 75‐year‐old national, community‐based system can provide the structural and program delivery capacity to help shape health care delivery in rural areas through community organization and education. The structure and functions of the CES, brief examples of successful CES programs, and some helpful hints provide insights into the potential for successful cooperation and collaboration. This collaboration can represent a cost‐effective strategy to address problems in the changing health care climate. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：社区卫生服务/组织和管理健康教育/组织和管理卫生服务需求机构间关系密苏里规划技术农村卫生州卫生计划美国

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