Development Of Community Health Services Research Articles

Community-based rehabilitation services implemented by multidisciplinary teams among adults with stroke: a scoping review with a focus on Chinese experience

BackgroundDespite the growing interest in hospital rehabilitation services for communities, studies on existing community-based rehabilitation (CBR) services remain scarce owing to limitations in the development of community health services and regional cultural diversity. As a guaranteed measure for ensuring the quality of rehabilitation services and achieving the desired service outcomes, clear roles and responsibilities in multidisciplinary teams and effective service delivery are particularly important.ObjectiveThis scoping review aimed to determine the scope of community stroke rehabilitation programs involving existing multidisciplinary teams and to analyze the implementation content and implementers’ functional roles to provide guidance for future CBR programs.MethodsThe scoping review design followed the methodology of the Joanna Briggs Institute and was based on the normative scoping review framework proposed by Arksey and O’Malley. The comprehensive CBR framework was proposed by World Health Organization-guided data charting and analysis.ResultsOf the 22,849 identified citations, 74 studies were included, consisting of 6,809 patients with stroke and 49 primary caregivers, most of whom were from China. The most common working mode in CBR programs was a dual approach involving both healthcare professionals in medical institutions and community healthcare professionals. The number of programs in each discipline was in the following descending order: nursing, medical care, rehabilitation, psychology, nutrition, and public health. Among these, multidisciplinary teams comprising medical, nursing, and rehabilitation disciplines were the most common, with a total of 29 programs. Disciplinary members were mainly responsible for implementing their respective disciplinary content, with physicians providing guidance for the programs. More than 82.4% of the studies reported 2–4 intervention strategies. The intervention forms of rehabilitation content were the most diverse, whereas preventive interventions were more homogeneous than others. Physical function and socio-psychological measurements were the most commonly reported outcomes.ConclusionCBR services implemented by multidisciplinary teams can effectively achieve functional and emotional improvement in patients with stroke, and nurses are the most involved in implementation, especially in community settings. The results further emphasize the importance of strengthening the exploration of nurses’ maximum potential to implement CBR plans in future practice.Trial registrationThe registration information for this scoping review can be found at osf.io/pv7tg.

Demand and influencing factors of community health services among urban residents in Liaoning province

Objective To investigate the status of demand for community health services and its influencing factors among urban residents in Liaoning province for providing references to the development of community health service. Methods Using quota convenient sampling and a self-designed questionnaire, we conducted a face-to-face/telephone interviews among 1 351 adult residents (≥ 18 years) from July 1 to November 20, 2020 in 14 municipalities across Liaoning province. Descriptive statistics and logistic regression analysis were adopted in data analyses. Results Of the 1 284 residents with valid responses, 59.8% (768) reported the demand for community physical health service, higher than that (53.1%, 682) reporting the demand for community mental health service. Among the respondents, the reported demand for community physical and mental health service differed significantly by age, time of living in a community and the supply of health services in communities (P Conclusion In Liaoning province, community health service could be promoted through improving grass-roots public health system and relevant facilities and developing differentiated community service items.

Exploration and implementation on the mode of undergraduate community nursing practice, according to "National Standard of Undergraduate Teaching Quality"

According to 'National Standard of Undergraduate Teaching Quality for Nursing Science', the mode of community nursing practice was explored and implemented by the School of Nursing in Tianjin Medical University. Focus on competency, the syllabus of community nursing practice was revised. Optimizing the management system of community nursing practice, developing the team of high-quality teachers, building standardized community nursing practice bases, and improving the evaluation system of community nursing practice aimed to enhance comprehensive quality of nursing undergraduates and the quality of community nursing practice. Within the concept of big health, our school is exploring the new mode of combining community nursing practice with health management-oriented nursing personnel training, which lays an important foundation for training applied nursing talents to meet the needs on development of community health services. Key words: National Standards for Teaching Quality; Community nursing practice; Talent training; Health management

Analysis on College Nursing Students’ Cognition for Community Health Services

Objective: To understand college nursing students’ cognition for community health services, improve junior college students’ overall quality and promote the development of community health services. Method: The independently designed questionnaire entitled College Nursing Students' Cognition for Community Health Services was issued to those students, and the data were statistically analyzed through SPSS22.0. Results: Students' cognition for community health services mainly comes from internship (practice), followed by class teaching; college nursing students' cognition for community health services is lower; junior college students' willingness to become a volunteer or internship or to work in the community is stronger than that of undergraduate and graduate students; the proportion of the undergraduate nursing students who hold the opinion that the employment in community health services is closely related to the major is lower than that of junior college students and undergraduate students. Conclusion: College nursing students’ cognition for community health services is lower as limited by cognition source; the willingness to participate in community health services varies with nursing students with different educational backgrounds. As a result, schools shall strengthen publicity of relevant community services knowledge, combine theories and practice and correctly guide nursing students on their employment attitude towards community nursing.

Survey on training for general practice backbone mentors in tertiary hospitals of Hebei province

Objective To survey on training for general practice backbone mentors in tertiary hospitals of Hebei province. Methods A questionnaire survey on training status was conducted among general practice backbone mentors in tertiary hospitals of Hebei Province. The survey items included the basic information, knowledge of general practice and its training, suggestions for mentors training and general practice discipline construction in tertiary hospitals. Results Total 208 questionnaires were distributed and 208 were retrieved with a recovery rate of 100%. Among 208 participants, all of them were over the age of 30; 202 (97.1%) had bachelor degree or above; 202 (97.1%) were attending doctors or above; 165 (79.3%) had worked for more than 10 years; 169 (81.3%) had no or little knowledge of general practice; 159 (76.4%)had not received general practice training before; 124 (59.6%) thought that general practitioners were not qualified as gatekeeper at present; and 192 (92.3%) worked in the hospitals providing standardized residency training. The training contents in general section were prioritized as clinical skills, community health service development and policy, rules for general practice standardized training, theoretical training, the present situation and countermeasure of general teaching, the doctor-patient relationship and medical ethics. The contents in training method section were prioritized as lecture series of clinical medicine, case discussion, seminar, distance education with classroom teaching. The suggestions for mentors training included: the exploration of standardized training model, perfecting continuing education system for general practice mentors, more attention to the training at community health service centers and the consummation of general practice system. The suggestions for general practice discipline construction were that more attentions should be paid by the government and the hospitals leaders, the general practice departments in tertiary hospitals should closely cooperate with community health service centers in training of qualified general practitioners. Conclusions The specialists in tertiary hospitals of Hebei province do not have enough knowledge about general practice and do not quite understand the necessity of establishment of general practice department, so the training for general practice mentors should be strengthened and improved. Properly policy and more social resources from the government and the hospitals leaders will be helpful for construction of general practice discipline in general hospital. Key words: Teacher training; Questionnaires; General practice

Effect assessment of the intervention by medical workers in the family doctor service system in Beijing

Objective To learn the awareness, attitude and behavior changes of medical workers to the family doctor service and the influential factors on their utilization of such service since the service is in place.The purpose is to provide theoretical basis to establish the family doctor service model and the incentive mechanism in line with the development of community health service in Beijing. Methods Eight community health centers were sampled randomly from three representative areas of Haidian, Xicheng and Daxing districts, which were grouped randomly as one intervention group and one control group.All the medical workers surveyed were subject to the research.The control group was managed as to the existing management mode, and the intervention group was classified and managed according to the new family doctor service model.A questionnaire survey was made to collect data from the baseline and final stages.Comparisons were made among the districts, institutions, and before-after intervention of the institutions themselves to evaluate the effects of the service model and incentive mechanism. Results The survey found a higher awareness by medical workers to such service, higher recognition and satisfaction, and lower rate of services provided by medical workers.The logistic regression analysis found the influential factors for willingness of medical workers to work as family doctors, include group difference, workload changes after signoff as family doctors, residents' acceptance of the community first visit system, recognition or not for whether a family should have a community service team, residents' acceptance, and the general comments on family doctor service(P<0.05). Conclusions Higher incentives of community doctors to embrace family doctor service, calls for the medical workers to change their perception, better incentive mechanism and greater promotion efforts for family doctors' services. Key words: Family doctor service; Intervention studies; Medical workers

Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review.

In 2009 China introduced a new round of healthcare reform to strengthen primary care networks through the development of Community Health Services (CHS). This study aimed to measure the degree of overall job satisfaction and also satisfaction dimensions and then find common causes of dissatisfaction among Community Health Workers (CHWs) in urban China by conducting a systematic review of relevant studies on CHWs' job satisfaction. Web of Science, PubMed, Google scholar, Wanfangdata and CNKI were searched. Publications about job satisfaction of CHWs were screened and assessed. Finally 18 Chinese articles and 4 English articles were included. Quantitative and qualitative data were extracted for nine themes concerning job satisfaction. Narrative synthesis was employed to analyze the data. CHWs were generally neither satisfied nor dissatisfied with their work after 2009. Financial rewards and opportunities for professional development were the most important determinants of job dissatisfaction. Workers were generally satisfied with interpersonal relationships in the workplace. The expanded public health services package and human-resources related regulations, e.g. the professional rank promotion system, government-controlled staffing policy (i.e. staff-quota system) and government-controlled budgetary planning (i.e. the Separation of Revenue and Expenditure), were policies that had an effect on job satisfaction. Financial rewards and professional development were the two main predictors of job satisfaction. To improve CHS in China, policy-makers (especially the central government) need to consider the impact of current policies on job satisfaction in order to reduce job dissatisfaction.

General evaluation of prevention and health care services of community health centers in Shandong province

Objective To comprehensively evaluate prevention and health care services of community health centers in Shandong province since the ongoing health reform and provide policy basis for development of community health services. Methods To study with rank sum ratio method and important quadrant models. Results Seventy-eight percent of community health centers were appraised asaverage. Overall satisfaction of residents for preventive and health services was 2.66 points.Preventive and health services of community health centers are expected to improve. Conclusion Overall prevention and health services of CHS centers were found less than satisfactory.Prevention and health services of CHS centers in regions a and B were poor, which deserves attention of the government health authorities.The government is expected to take actions to promote development of CHS centers for prevention and health care service. Key words: Health reform; Community health service; Prevention and health care; General evaluation

Health workforce equity in urban community health service of China.

ObjectivesTo reveal the equity of health workforce distribution in urban community health service (CHS), and to provide evidence for further development of community health service in China.MethodsA community-based, cross-sectional study was conducted in China from September to December 2011. In the study, 190 CHS centers were selected from 10 provinces of China via stratified multistage cluster sampling. Human resources profiles and basic characteristics of each CHS centers were collected. Lorenz curves and Gini Coefficient were used to measure the inequality in the distribution of health workforce in community health service centers by population size and geographical area. Wilcoxon rank test for paired samples was used to analyze the differences in equity between different health indicators.ResultsOn average, there were 7.37 health workers, including 3.25 doctors and 2.32 nurses per 10,000 population ratio. Significant differences were found in all indicators across the samples, while Beijing, Shandong and Zhejiang ranked the highest among these provinces. The Gini coefficients for health workers, doctors and nurses per 10,000 population ratio were 0.39, 0.44, and 0.48, respectively. The equity of doctors per 10,000 population ratio (G = 0.39) was better than that of doctors per square kilometer (G = 0.44) (P = 0.005). Among the total 6,573 health workers, 1,755(26.7%) had undergraduate degree or above, 2,722(41.4%)had junior college degree and 215(3.3%) had high school education. Significant inequity was found in the distribution of workers with undergraduate degree or above (G = 0.52), which was worse than that of health works per 10000 population (P<0.001).ConclusionsHealth workforce inequity was found in this study, especially in quality and geographic distribution. These findings suggest a need for more innovative policies to improve health equity in Chinese urban CHS centers.

Do Patients Choose Community Health Services (CHS) for First Treatment in China? Results from a Community Health Survey in Urban Areas

In recent years, the government has paid more attention to the development of community health service (CHS) in urban areas in China. Therefore, determining if it plays important roles and establishing methods to evaluate the effects of CHS are critical emphases in research. This study measured the effects of CHS through the choices of patients and their evaluation of CHS, and aimed to contribute to the development of primary health services. Face-to-face interviews were performed using the questionnaire with a random sample of 865 patients in CHS institutions from five provinces in China. Pearson's Chi square tests and binary logistic regression were used to analyze influencing factors that are associated with the patients' choices and evaluations. A total of 62.2% of the patients would choose CHS for their first treatment. Patient choice was mainly affected by the following: (1) social demographic factors of the patients, namely, age, educational level, medical insurance, and survey areas; (2) evaluation of CHS by the patients: convenience, reasonable charges, and attitude of the doctors. In addition, the patients showed more satisfaction with convenience, waiting time, and communication with doctors, and less satisfaction with the medical charges, drug costs, and medical equipment of CHS. Through the results, we suggest that the government should provide more regard to the convenience, reasonable charges, and the attitude of the doctors as important factors to attract the patients to CHS. The government should also exert efforts to reduce the medical charges (especially the drug costs) for CHS.

Community health service capacity in China: a survey in three municipalities

China is reforming its health care system. It aims to strengthen primary health care through building community health facilities and assigning a 'gate-keeper' role to primary care providers. However, it remains unknown whether community health facilities are able to fulfil such a mission. This study evaluated the service capacity of a selected sample of community health facilities and the competency of primary care practitioners employed by those facilities. Three municipalities from the east, middle and west of China were purposely selected. A questionnaire was undertaken in 45 randomly selected community health facilities in the three municipalities and 700 primary care practitioners responded to the survey. The survey investigated the capacity of the community health facilities in providing diagnostic services and the competency of the primary care providers in handling common health problems. The most common reasons for doctor-patient encounters were common cold and chronic diseases. The capacity of the community health facilities in providing diagnostic services was limited. Although the majority of respondents believed that they could correctly identify common symptoms, many were unable to perform some essential physical examinations. The community health facilities are not able to fulfil their designated mission because of the limited diagnostic capacity and poor competency of the primary care practitioners. Priorities should be given to capacity building for the development of community health services in the future.

Research in influencing factors of job satisfaction degree among community nurses in Qiqihar city

Objective To understand the influencing factors of job satisfaction degree among community nurses in Qiqihar city.Methods Using stratified systematic cluster sampling method,we conducted self-administered questionnaire,results were subsequently analyzed.Results Logistic regression analysis was introduced,influencing factors of job satisfaction degree included work location,age,marital status,professional title,properties of jobs,monthly income and work length.Conclusions The government should pay attention to community health care services,gasp the situation of job satisfaction degree of community nurses timely,take innovative measures,improve job satisfaction degree of community nurses,stabilize community nursing teams and promote the development of community health services. Key words: Community nurses; Job satisfaction degree; Influencing factor

What should the government do regarding health policy-making to develop community health care in Shanghai?

What should the government do regarding health policy-making to develop community health care in Shanghai?

A Survey of Factors Associated with the Utilization of Community Health Centers for Managing Hypertensive Patients in Chengdu, China

BackgroundFor decades the development of community health services has been emphasized in China to cope with the growing burden of chronic diseases by providing basic medical services. This survey aims at investigating factors associated with the use of Community Health Centers (CHCs) for the management of hypertensive patients in Chengdu, China.MethodsWe used a systematic sampling method to select 2,030 patients with hypertension or diabetes registered in 29 CHCs in Chengdu in 2007. Researchers interviewed patients who consented to participate at their home. This paper reports findings from the survey of 1,716 hypertensive patients with completed questionnaires. Univariate analyses and multiple logistic regression analyses were conducted to explore factors influencing the use of CHCs for the management of hypertensive patients.Results81.4% of hypertensive patients regularly used CHCs for hypertension monitoring and treatment in Chengdu. Univariate analyses indicated that use of CHCs was associated with the education level, occupation, types of medical insurance, Body Mass Index(BMI), patients' knowledge on hypertension, awareness of CHCs functions, satisfaction of the service of CHCs. Multiple regression analyses found that use of CHCs was positively associated with the following factors: the Urban Resident Basic Medical Insurance(URBMI), knowledge on blood pressure, awareness of the sites in CHCs to measure blood pressure, awareness of having to take life-long antihypertensive medicine once the treatment started, awareness of the health records registration in CHCs, regular follow up, improved convenience of seeing doctor. Patients with professional job were less likely to use the services of CHCs.ConclusionsThe use of CHCs for hypertension management could be increased by improving residents' knowledge on the monitoring and treatment of hypertension, and the awareness of CHCs functions. The CHCs could play an important role in providing medical care to low-income, unemployed and other disadvantaged patients with hypertension.

E0296 Community-hospital classification management model results

Background Hypertension is a common disease that seriously endangers the health of populations, frequently-occurring disease, is one of stroke, coronary heart disease the major risk factors. At present, China in...

Analysis of factors influencing the outpatient workload at Chinese health centres.

BackgroundAlthough the community health service system is now established in China, the utilisation of the community health service institutions is low due to the lack of a gate-keeping role of the primary health service providers and referrals among the three-tiered health service institutions. In addition to this, patients who can afford to pay, often seek best services in big hospitals to guarantee the quality of care. Thus, the need of guiding the patients to the community health services and increasing the utilisation of the community health service institutions is becoming an urgent problem, which hinders the future development of community health services. This study focuses on the question of how to increase the utilisation of Chinese community health centres (HCs).MethodsA cross-sectional Base-line Survey of Chinese City Community Health Service System Building using the multi-staged cluster sampling was conducted to collect data from all HCs in 28 key contact cities. Relevant indicators of totally 1790 HCs were analysed. The statistical methods included ANONVA and logistic regression.Results and ConclusionsThe analysis suggested several key factors for increasing the outpatient workload (OW) at the HCs: establishing an adequate referral system among the different levels of the health system; enhancing the qualification of health personnel and increasing the compensation by the health insurance for services provided at HCs. Other key factors with a positive effect on the OW included: the government ownership of the HCs, the scale of the institutions, the medical equipment used, the mix of health services provided, and the women in childbearing age in the residence.

Community Care for People with Learning Disabilities: Specialist Learning Disabilities Health Services Following Resettlement

Health services for people with learning disabilities have changed considerably in the recent past, with the resettlement of individuals from institutions and a focus on community care. However, there is little available information on national averages of specialist learning disabilities health service provision in National Health Service (NHS) Trusts which have completed their resettlement programmes. A survey of specialist health services to people with learning disabilities was undertaken by means of two postal questionnaires to NHS Trusts in England and Wales which provide learning disabilities services. Thirty NHS Trusts had completed their resettlement programmes and their specialist learning disabilities services were analysed in detail and comparisons made with the NHS Trusts which still retained placements in an institution. These comparisons showed that NHS Trusts which had completed the resettlement process had significantly fewer long‐stay placements and employed significantly fewer learning disabilities psychiatrists than did other NHS Trusts. However, similar numbers of other learning disabilities health professionals were employed by the two groups of NHS Trusts to work with people with learning disabilities in the community. This suggests that when institutions close, the development of community health services has not been accompanied by the increase in resources that one might have expected.

An evaluative study of a community health service development

This paper describes a research study designed to evaluate a community health service development in one health authority in rural England. The study compared two types of primary care teams working towards the same objectives. Surveys of patients and staff in the health authority were conducted about a range of issues, defined by the original aims of the scheme. Measures were made of care received by people over 75 years of age, consumer satisfaction, staff experiences of the multi-disciplinary team, job satisfaction and liaison with social services personnel. Few differences existed between the two forms of care on all of these measures. This paper contains a discussion of the findings alongside an examination of the implications for future health service developments, particularly flagship enterprises such as nursing development units. The importance of well established baseline measurements is emphasized by both the research findings and the discussion.

Development of community health services for the Arab village population in Israel.

With the proclamation of the State of Israel in 1948 the war began between Israel and her neighbours and the health services for the entire population were at a minimum. Among the Arab population where such services did exist, the personnel - doctors, nurses, teachers - fled; those in Jerusalem went to Jordan and in the North, Haifa was the point of departure for Lebanon and other countries (Mizrahi 1981, Ron 1981).

Progress in development of community health services and facilities.

Progress in development of community health services and facilities.