Community Health-care Service Centers Research Articles

Lower Health Literacy of Mania Than Depression Among Older People: A Random Survey of a Community Healthcare Service Center.

Purpose: This study examines health literacy among older outpatients in two Community Healthcare Service Centers in Shanghai, China to facilitate the design of public education programs for the aged population on mood disorders (both depression and mania).Patients and Methods: A total of 173 outpatients aged 60 years or more with a chronic physical illness were randomly sampled. A health literacy questionnaire was used to assess participants' awareness of depression and mania. Participants were then asked to label two vignettes depicting depression and mania and to give their recommendations for how to seek help for those in the vignettes and how mood disorders should be managed.Results: In all, 86.1 and 36.4% of participants had heard of depression and mania, respectively, with the most common source of information being relatives and friends. Over half of the participants attributed the possible causes of mood disorders to psychological trauma, pressure or stress in daily life, taking things too hard, and personality problems. Almost two-thirds of participants correctly labeled the depression vignette, but only 26.6% correctly labeled the mania vignette. The most common methods recommended by the participants as being helpful for the individuals portrayed in the vignettes were “traveling” and help-seeking from a psychological therapist/counselor, a psychiatrist, or a close family member or friend.Conclusion: The older individuals attending community healthcare service settings in Shanghai have good depression literacy but relatively poor mania literacy. However, most participants had a positive attitude toward psychiatric treatment for mood disorders.

Study on the Mode of Home Care for the Aged in the City of Qiqihar from the Perspective of Integration of Medical Service and Pension Service

The mode of providing for the aged in Qiqihar is mainly based on Home care for the age, and is also the most active mode of providing for the aged so far With the deepening of aging in our city, the elderly physical function continues to decline, we need to set up the model of integration of medical service and pension service. This paper introduces the status quo of basic mode of Qiqihar old-age home, through the analysis of the survey data of Qiqihar, the development of home care industry should pay more attention to the health of the elderly community health care service center, accelerate development, and puts forward some countermeasures and suggestions to improve and develop the home care model, to promote the development of home-based care services.

Quality of Life in Patients With Advanced Cancer at the End of Life as Measured by the McGill Quality of Life Questionnaire: A Survey in China

ContextQuality of life (QOL) is the main outcome measure for patients with advanced cancer at the end of life. The McGill Quality of Life Questionnaire (MQOL) is designed specifically for palliative care patients and has been translated and validated in Hong Kong and Taiwan. ObjectivesThis study aimed to investigate the QOL of patients with advanced cancer using the MQOL-Taiwan version after cultural adaptation to the Chinese mainland. MethodsA cross-sectional survey design was used. QOL data from patients with advanced cancer were gathered from 13 hospitals including five tertiary hospitals, six secondary hospitals, and community health care service centers in Shanghai and analyzed. QOL was assessed using the MQOL-Chinese version. Statistical analyses were performed using descriptive statistics, multiple regression analysis, and Spearman rank correlation analysis. ResultsA total of 531 cancer patients (297 male and 234 female) in 13 hospitals were recruited into the study and administered the MQOL-Chinese. The score of the support subscale was highest (6.82), and the score of the existential well-being subscale was the lowest (4.65). The five physical symptoms most frequently listed on the MQOL-Chinese were pain, loss of appetite, fatigue, powerless, and dyspnea. Participants' sex, educational level, number of children, disclosure of the disease, and hospital size were associated with their overall QOL. The Spearman rank correlation analysis found that Karnofsky Performance Status scores correlated with the MQOL-Chinese single-item score, physical well-being, psychological well-being, existential well-being, and support domains (P < 0.05). ConclusionOur results revealed the aspects of QOL that need more attention for Chinese palliative care patients with advanced cancer. The association between the characteristics of patients, Karnofsky Performance Status, and their QOL also was identified.

Studies on the criteria of two-way referral between hospital and community health-care service centerfor patients with cerebral hemorrhage: an analysis of 91 cases

This study aimed to study the criteria of two-way referral between tertiary-care hospital and community health-care service center for patients with cerebral hemorrhage and a protocol of implementation to promote its treatment and rehabilitation.The criteria of two-way referral between tertiarycare hospital and community health-care service center for patients with cerebral hemorrhage after surgical operation were formulated on a trial basis with mutual consultation by the department of neurosurgery,Shenzhou hospital affiliated to Shenyang Medical College and Hunhewan Community Health-Care Service Center,Heping district,Shenyang. Totally,91 patients of cerebral hemorrhage admitted to the hospital during October 2007 to September 2010 were recruited for the study,46 in the intervention group with two-way referral and 45 in the control group by self-referral determined by their family members.All the patients of the two groups were followed-up for three years.During the follow-up in the intervention group,40 of 46 (95％) patients could comply with taking medication ordered by physicians,ability of daily living remarkably improved by Barthel index in 21 (50％),physical function recovered well in 33 (79％),34 (81％) could insist in self-monitoring and 32 (76％) could visit physicians for regular consultation,all these being significantly better than those in the control group (64％,31％,28％,25％ and 25％,respectively) (P ＜0.01 ).Medical and rehabilitative cost for patients with cerebral hemorrhage accounted for 575 RMB yuan per month in intervention group,as compared to 2246 RMB yuan for those in control group.Two-way referral for patients with cerebral hemorrhage can reduce their medical cost and promote their better rehabilitation. Key words: Cerebral hemorrhage; Referral and consultation

Effectiveness of guideline-oriented training for community health-care workers with "Applied Standards for Hypertension Prevention and Control at the Grassroots"

Objective To evaluate effectiveness of guideline-oriented training for community healthcare workers (HCWs) with The Applied Standards for Hypertension Prevention and Control at the Grassroots to provide guidance to hypertension management in communities. Methods In 2003, four community health-care service centers in Beijing were selected and assigned as intervention (one at urban and one at rural) and control (one at urban and one at rural ) groups, respectively. HCWs in the intervention group received guideline-oriented training based on The Applied Standards for Hypertension Prevention and Control at the Grassroots, while HCW in the control group did not. All HCWs participated in tests of the knowledge of hypertension management using the same questionnaire before and after the training to analyze their changes in awareness scores with a full of 32. Results There were 39 and 33 HCWs in the intervention group and 15 and 16 HCWs in the control group, respectively at urban, and 30 and 33 HCWs in the intervention group and 21 and 22 HCWs in the control group, respectively at rural before and after the training were involved in the tests, respectively. After training, overall knowledge scores of hypertension prevention and control in HCWs in the intervention group at urban increased obviously, with an average score of 26 of 32 ( 81.0% ) after training from 15 of 32 (45. 6% ) before it ( P ＜ 0. 01 ) , with a net increase of 28.5% (9/32), as compared to HCWs in the control group. Those at rural increased to 6. 6% (20/32) after training from 40. 7% (13/32) before it ( P ＜ 0.01 ), with a net increase of 22. 2 percent (7/32), as compared to HCWs in the control group. Their awareness of knowledge of hypertension prevention and control significantly improved, with the most obviously in the target of blood pressure control (51.7% vs. 31.5% ) and principles of pharmaceutical therapy (42. 2% vs. 27. 6% ). Conclusions Guideline-oriented training based on The Applied Standards for Hypertension Prevention and Control at the Grassroots can effectively improve community HCWs' awareness of knowledge of hypertension management and should be widely promoted in communities. Key words: Hypertension; Intervention study; Health-care worker, community

A survey on training and satisfaction of staff working at community health-care service centers employing appropriate techniques on a trial basis in east and west China

Objective A cross-sectional survey was conducted to investigate difference in job-related satisfaction indexes among staff working at community health-care service centers ( CHSC ) employing appropriate techniques on a trial basis between east and west areas of China. Methods In total, 339 staff members working at CHSC employing appropriate techniques on a trial basis, including good practice of community medical records management for hypertension , good practice of community case management for type 2 diabetes , good practice of community case management for , etc. , were recruited for questionnaire survey from Tianjin, Jinan and Shenzhen of east China and Chengdu and Chongqing in westChina by cluster sampling. Their demographic information, training for appropriate techniques and job-related satisfaction were collected. Results There was a significant difference in proportion of CHSC staff who receiving training for tuberculosis management launched by local government between west and east areas (34. 8% vs. 41. 4% , P <0. 05). There also was significant difference in satisfaction with the support from the superior sectors of government between west and east areas ( 59. 6% vs. 52. 0% , P = 0. 022 ) . Satisfaction towards income ranked the highest, and that towards work environment the lowest among the staff either in west or east areas. Conclusions Proportion of CHSC staff receiving training for tuberculosis and satisfaction with the support from superior sectors of government vary with communities in east and west areas employing appropriate techniques on a trial basis, and work condition of CHSC should be improved further. Key words: Community health services; Community health planning; Questionnaires

Current state of community nurse training in Jilin province and its development orientation

Objective To understand the current state of community nurses in Jilin Province and its nursing training so as to provide basis for constructing community nursing training system. Methods 583 community nurses from community health care service centers (stations) in three cities of Jilin Province were investigated with cluster random sampling method to acquire their proficiency level of community nursing knowledge and its demand. Results Common basic nursing knowledge was best mastered by community nurses (63.8%), while knowledge about scientific research was worst mastered (13.6%). Community nurses who were young, in low positions, with work experience for 5 to 9 years, mastered the knowledge worse, 42.9% of them did not attend training. The commonest training problem was that the training period was too short (64.6%); the highest demand was common diseases training for the elderly. Conclusions Nursing training is an important way to improve overall quality of community nurses in the light of unbalance status of their quality in our province and training not being put into place. Key words: Human resources; Post training; Community nurse; Community nursing

Effectiveness of one-year community management for patients with chronic obstructive pulmonary disease

Objective To evaluate effectiveness of prevention and treatment for patients with chronic obstructive pulmonary disease (COPD) for one year at community health-care service (CHS)centers. Methods A quasi-experiment design was used to evaluate effectiveness of community management for patients with COPD who visited and registered at Xiaokunshan and Xinbang CHS centers in Songjiang district of Shanghai in 2008, with COPD patients from Xiaokunshan community CHS center as management group and those from Xinbang as control. Measures for community management included training for local general practitioners in essential knowledge of COPD prevention and treatment, allocation of necessary drugs for COPD treatment, and health education for COPD patients and their family members. No special measures were taken for control group except routine treatment. Results A total of 132 patients were diagnosed as COPD according to their pulmonary function on 2008, 61 at Xiaokunshan and 71 at Xinbang CHS canters.One hundred and two patients, 47 at Xiaokunshan and 55 at Xinbang, finished one-year follow-up. Five patients from Xiaokunshan who were smokers at their first visits and three of them quitted smoking after oneyear management. Meanwhile, none of nine smoked patients from Xinbang quitted smoking in the same period. There was no statistically significant difference in symptom scores, pulmonary function, and forced expiratory volume at the first second (FEV1) between patients in the two groups during one-year follow-up.Average score of quality of life in patients at Xiaokunshan dropped to 39. 12 after one-year management from 46. 96 at their first visits, and that in patients at Xinbang increased to 62. 11 from 56. 55 (P＜0.01).Average six-minute walking distance (6-MWD) in patients at Xiaokunshan reduced to 354. 26 meters after one-year management from 361.66 meters at their first visits, meanwhile that in patients at Xinbang reduced to 351.18 meters from 398.07 meters (P =0. 008). Scores of functional dyspnea in patients at Xiaokunshan fell to 0.34 from 0.40 at their first visit, meanwhile that in patients at Xinbang increased to 1.00 from 0.95(P =0.038). During the one-year follow-up, 13 patients at Xiaokunshan and 53 at Xinbang visited emergency departments for treatment, and four at Xiaokunshan were hospitalized and none died, and five at Xinbang were hospitalized due to acute exacerbation of COPD and four of them died. Conclusions The study suggests that strengthening prevention and treatment for COPD patients at community level by general practitioners, patients themselves and their family members can improve their quality of life, reduce emergency visits and hospitalization, alleviate dyspnea symptoms and delay the decline of 6MWD. Key words: Pulmonary disease, chronic obstructive; Community health centers; Disease management

Thinking of training for general practitioners and its preliminary practice

For the issues existed in training of general practitioners, with characteristics of community health-care service centers (CHS) and large-scale urban hospitals, a training model of exchange physicians between hospitals and CHSs was formulated. After three-month practice, a general practitioner-specialist technical cooperation group was established. The new model not only promoted construction of a two-way referral system, but also created environmental condition for training community physicians. Key words: Education, continuing; Professional competence

A survey on current status of clinicians in community health-care service centers of three cities in China

Objective To understand current status and problems existed among clinicians workforce in several community health-care service centers of China to provide evidence for relevant policy-making. Methods Sixty-two community health-care service centers were selected from two districts each in Tianjin, Nanjing and Wuhan Cities, respectively, for the survey with questionnaire and focus group discussion. Results ①Fifty-eight of 62 community health-care service centers surveyed (93.5 percent) were qualified as a legal entity, 60 (96.8 percent) registered as medical insurance institutions designated by government, and 59 (95.2 percent) were state-owned or run by state-owned hospitals. All the 60 institutions provided service in public health and essential medical care for communities and were economically running relatively good. ②There were totally 1664 registered clinicians with an average age of 45 years ( and a standard deviation of 11 ), 942 of them ( 56.6 percent) at age above 45, 406 ( 24.4 percent) at age below 35, and 1166 (70.1 percent) with college education. ③Thirty-eight of 874 clinicians with medium or senior professional titles (4.4 percent) were qualified as general practitioners (GPs). ④Five hundred and thirty-eight of 1024 licensed clinicians or assistant clinicians (52.5 percent) were registered as internists for permit to practice medicine, and 65 registered as GPs (6.3 percent). There were totally 257 GPs in general practice clinics and 45 of them registered as GPs (17.5 percent) for permit to practice medicine. ⑤One hundred and five clinicians were promoted in the past three years and 17 of them were registered as GPs (16.2 percent). ⑥Three hundred and fifty-four clinicians were temporarily employed (21.3 percent) of those in service. Conclusions ①A lot of clinicians at general practice consultation rooms in community health-care service centers practiced medicine often beyond their duties registered. ②Few clinicians extended their willingness to be promoted as GPs, with too lower percentage of them taking promotion examinations. ③The number of GPs was in short obviously and quality of GPs was poor in general with their relatively older age.④It is suggested that more investment should be input, relevant policies perfected, attraction to GP position increased, human resource management and legal management of GPs strengthened, and non-registered practicing behavior should be eliminated by government. Key words: Community health center; Questionnaires; Interviews; General practitioner

An investigation on current status of general practitioners-in-charge in three large cities of China

Objective To study current status of health professionals before and after promotion to general practitioners (GPs)-in-charge to provide evidence for related policy decision-making. Methods From November 2007 to March 2008, 524 general practitioners-in-charge who passed national qualification examinations of medium-level health professionals were interviewed with questionnaire, as well as by focus group discussion, in cities of Tianjin, Nanjing and Wuhan during 2001 to 2007. Results One hundred and thirty-three of 524 respondents (25.4%) registered at local health bureaux as GPs to practise medicine, and 52 left their original clinical positions and 21 of 52 moved to administration positions. Forty of them left primary-care hospitals, township hospitals, community health-care service centers or hospitals and clinics affiliated to enterprises, where they originally worked with. Eleven of them left state-owned institutions. Conclusion At present, the number of GPs registered for permit to practice medicine decreased and workforce of GPs drained out seriously appearing in unstable status. Key words: Questionnaires; Interviews; Data collection; General practitioner

Impact of community healthcare service center in emergency response to natural disaster

The Medical Healthcare Service Center,located at the Youxian District,Mianyang City of Sichuan Province,successfully rescued the people affected by the Wenchuan earthquake and the Tangjiashan barrier lake with great help from the senior hospitals.We suggest that the community healthcare service center could play an important role in emergency response system. Key words: Community health centers; Emergency mdeical services