“机构-社区-居家”养老格局下医养结合模式探索
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摘要
目的了解医养结合各服务模式的受认可情况和现存主要障碍。方法意向调查与焦点小组访谈相结合。针对上海市老年护理相关机构的关键人物(分管领导)意向调查对于养老机构设置医疗机构以及与社区卫生服务中心签约模式的认可程度,对理想"医养结合"模式的认可程度及所需支持条件等。针对样本养老机构的关键人物(分管领导),围绕对于内设老年护理院或医疗机构及与社区卫生服务中心签约合作的评价及存在问题等展开访谈。结果老年护理机构对养老机构设置老年护理院及医疗机构的认可率分别为87.60%和96.00%,对签约合作服务模式的认可率仅60.90%,养老机构不认同完全依赖签约服务。医养结合理想模式的受认可率高达76.00%。强化服务体系中各类供方机构的服务意愿和积极性是理想模式推行的重要支持条件。结论构建"机构-社区-居家"服务体系,并吸引社会力量参与。推进家庭医生与家庭病床服务,全面统筹医护人力,推进与规范医护人员多点执业。建立长期照护保险,引导服务按需利用是医养结合模式发展的必经之路。
Objective To understand the degree of acceptance and primary barricades of integrating healthcare and longterm care. Methods Intention survey and focus group interview were combined. Intention survey was conducted among key persons of aged care facilities on the degree of acceptance for contract service between community healthcare center and nursing homes,pattern of medical-nursing,also the required support conditions. An interview among key persons of nursing homes regarding the evaluation and problems of contract service with community healthcare center was conducted. ResultsThe acceptance rates of having the construction of nursing and medical institutions in endowment institution were 87.60% and 96.00%,respectively. The acceptance of the contract service mode was 60.90%,which meant that the endowment institutions disagreed on relying entirely on contract. The acceptance rate of integrating healthcare and long-term care reached 76.00%,enhancing the willingness of service and initiative was the premise of ideal pattern. Conclusion It is suggested that the service system of "institution-community-home" endowment mode be built. At the meantime,attracting the participation of social power,promoting family doctor and domestic sickbed service,overall planning the human resource and promoting the multi-sited license among medical staff,establishing the long-term care insurance and guiding service distributed according to needs were necessary for integrating healthcare and long-term care.
Objective To understand the degree of acceptance and primary barricades of integrating healthcare and longterm care. Methods Intention survey and focus group interview were combined. Intention survey was conducted among key persons of aged care facilities on the degree of acceptance for contract service between community healthcare center and nursing homes,pattern of medical-nursing,also the required support conditions. An interview among key persons of nursing homes regarding the evaluation and problems of contract service with community healthcare center was conducted. ResultsThe acceptance rates of having the construction of nursing and medical institutions in endowment institution were 87.60% and 96.00%,respectively. The acceptance of the contract service mode was 60.90%,which meant that the endowment institutions disagreed on relying entirely on contract. The acceptance rate of integrating healthcare and long-term care reached 76.00%,enhancing the willingness of service and initiative was the premise of ideal pattern. Conclusion It is suggested that the service system of "institution-community-home" endowment mode be built. At the meantime,attracting the participation of social power,promoting family doctor and domestic sickbed service,overall planning the human resource and promoting the multi-sited license among medical staff,establishing the long-term care insurance and guiding service distributed according to needs were necessary for integrating healthcare and long-term care.
引文
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[18]朱亚捷,曹晓红.新医改政策下医师多地点执业的研究和探讨[J].医院管理论坛,2011,28(7):8-10.
[19]谢宇,杨顺心,陈瑶,等.我国医师多点执业研究综述[J].中国卫生政策研究,2014,7(1):8-13.
[20]苏巧莲,冯泽永,张培林.双诊制与医师多点执业分析探讨[J].中国卫生事业管理,2010,27(12):836-838.
[21]张阳.医师多点职业:阳光下的医疗资源共享[J].医院院长论坛,2011,8(2):24-35.
[2]马彦,徐凤亮.医养融合养老服务体系探析:以苏州市为例[J].老龄科学研究,2016,4(4):72-80.
[3]睢党臣,彭庆超.“银发浪潮”下我国医养结合养老服务模式探析[J].社会保障研究(北京),2016,1(1):116-126.
[4]雷玉明,曹博,李静.公共服务型政府视野中城市社区养老合作共治模式:以南京市玄武区为例[J].华中农业大学学报(社会科学版),2013(4):113-118.
[5]袁晓航.“医养结合”机构养老模式创新研究[D].杭州:浙江大学,2013.
[6]臧少敏.“医养结合”养老服务的开展现状及模式分析:以北京市为例[J].老龄科学研究,2015,3(12):42-47.
[7]景思霞.重庆市巴南区“医养结合”养老模式与路径研究[D].重庆:重庆医科大学,2014.
[8]袁荣明.社区家庭医生责任制的体会[J].中医药管理杂志,2016,24(13):144-145.
[9]吴军,徐蕾.家庭医生在老年人健康管理中的作用[J].上海医药,2015,36(6):14-16.
[10]金国庆.家庭病床发展困境及其对策研究[D].上海:华东理工大学,2014.
[11]李林,王媛,王卫,等.社区医院开展家庭病床的SWOT分析与对策研究[J].中国全科医学,2013,16(4A):1096-1099.
[12]CARSON S S,BACH P B,BRZOZOWSKI L,et al.Outcomes after long-term acute care:an analysis of 133mechanically ventilated patients[J].Am J Respir Crit Care Med,1999,159(5):1568-1573.
[13]张涵,吴炳义,董惠玲.不同类型养老机构老年人医疗服务现状及需求调查[J].中国全科医学,2015,18(15):1786-1790.
[14]代亚丽,袁畅,赵洪军.乌鲁木齐市养老机构老年人医疗护理服务需求调查研究[J].护理管理杂志,2014,14(4):245-246.
[15]周海旺.上海人口老龄化趋势与完善养老服务模式研究[J].上海金融学院学报,2011(4):37-49.
[16]沈婉婉,鲍勇.上海市养老机构“医养结合”优化模式及对策研究[J].中华全科医学,2015,13(6):863-865,871.
[17]王元元,朱霖,牛丽娟,等.安徽省“医养结合”机构养老模式实施路径探讨[J].牡丹江医学院学报,2014,35(6):129-131.
[18]朱亚捷,曹晓红.新医改政策下医师多地点执业的研究和探讨[J].医院管理论坛,2011,28(7):8-10.
[19]谢宇,杨顺心,陈瑶,等.我国医师多点执业研究综述[J].中国卫生政策研究,2014,7(1):8-13.
[20]苏巧莲,冯泽永,张培林.双诊制与医师多点执业分析探讨[J].中国卫生事业管理,2010,27(12):836-838.
[21]张阳.医师多点职业:阳光下的医疗资源共享[J].医院院长论坛,2011,8(2):24-35.