某山区农村“空巢”老人健康与卫生服务保障模式研究
|
摘要
随着生活和住房条件的改善,家庭结构的小型化,以及大量年轻人外出求学和工作,导致我国“空巢”老人数量逐渐增多。“空巢”老人作为我国社会变化过程中产生的弱势群体,他们的身心健康状况不容乐观。本研究拟通过对某山区农村“空巢”与非“空巢”老人健康与卫生服务利用的对比研究,评价该地区农村“空巢”老人的健康与卫生服务利用公平性,并深入分析影响“空巢”老人卫生服务利用的因素;通过对该地区乡镇卫生院的现况调查,找出该地区乡镇卫生院在“空巢”老人卫生服务中存在的不足;借鉴西方国家居家卫生服务实践,进一步探讨居家卫生服务对“空巢”老人的健康保障作用,在此基础上建立该地区农村“空巢“老人居家卫生服务模型。研究结果将对改善该地区农村“空巢”老人的健康状况、提高其卫生服务利用水平产生深远的影响,也将为全国范围内农村相应体系的建立提供借鉴。
我们采用个人基本情况调查表、社会支持评定量表、自报健康状况与卫生服务利用情况调查表、36条目简明健康量表、UCLA孤独量表、老年抑郁量表、生活满意度指数Z、日常生活活动能力调查表对湖北省远安县550位“空巢”和630位非“空巢”老人进行问卷调查,包括社会人口经济学特征、参加医疗保险情况、健康相关行为、自报健康状况、慢性病患病情况、生命质量、孤独水平、抑郁水平、两周就诊情况和年住院情况、卫生服务需要未满足情况、卫生服务需要未满足原因、生活自理能力、日常生活活动能力和生活满意度等。与非“空巢”老人相比,“空巢”老人的月收入水平较低、与子女关系较差、社会支持水平较低、参加医疗保险的人所占比例较低、吸烟率较高、自报健康状况较差、慢性病患病率较高、生命质量生理和心理维度得分都较低、孤独和抑郁水平较高、两周就诊率较低、卫生服务需要未满足率较高、生活满意度较低。“空巢”老人的生活自理能力和日常生活活动能力受损者均占一定比例,阻碍其卫生服务利用的因素主要包括服务的可及性、社会态度、服务质量和费用四个方面。
我们对湖北省远安县的6所乡镇卫生院的相关知情人进行问卷调查和当面访谈,了解这6所乡镇卫生院卫生服务的基本情况,包括各类人员的类别、性别和学历构成、近五年的日均门诊量和住院量、科室设置、服务内容等。结果显示这6所乡镇卫生院人力配置规模不均,其卫生人力总量高于2003年全国平均水平;卫生人员性别构成均衡;多数卫生人员学历水平偏低;卫技人员的专业结构相对合理,但是缺少精通老年医学的医生和护士;没有开通就医热线;病人不能通过电话联系到医生;很少为病人提供上门服务;没有开设心理咨询服务及疾病康复服务;从2002年——2006年日平均门诊量和住院量都逐年下降。该县乡镇卫生院如果不进行适当改革,不突出自己的优势和特色,不仅不利于“空巢”老人的健康保障,也不利于其自身的长远发展。
通过专家研讨会和概念建模的方式,建立了“空巢”老人卫生服务的目标模型、乡镇卫生院卫生服务的问题模型和老年居家卫生服务模型。结果显示:“空巢”老人卫生服务的目标是实现“空巢”老人的健康老龄化和积极老龄化,途径是为他们提供连续的、全方位的、没有灰色带的、能够提高他们独立生活能力的综合性服务;乡镇卫生院在“空巢”老人卫生服务中存在的问题主要包括卫生工作人员的态度、工作程序和内容、资源三个方面;老年居家卫生服务模型主要包括四个微观系统领域:自我管理支持、决策支持、递送系统设计和临床信息系统,服务内容包括初级卫生保健服务和社会服务两部分,服务方式为上门服务,充分利用乡镇的资源和政策,注重医患间的生产性交互,对于提高老年卫生服务质量很有帮助。
这些结果提示,与非“空巢”老人相比,“空巢”老人存在着健康与卫生服务利用的相对不公平性,而卫生服务可及性差是阻碍其卫生服务利用的原因之一,相对于乡镇卫生院,居家卫生服务对于提高“空巢”老人卫生服务可及性、提高其独立生活能力、改善其生活质量具有很强的针对性。
Life and housing condition improved, family structure miniaturized, and a lot of yong man studing and working outside, the number of empty nest elders in our country is increasing. The empty nest elders, as the weak population in the progress of social changing, their physical and mental health was not optimistic. According the survey of the health and health care utilization between the empty nest and not empty nest elders in the rural area of a mountainous county, to estimate the equity of health and health care utilization of the empty nest elders, and to furtherly analyze the factors influencing the health care utilization of the empty nest elders. Investigating the current conditions of the Township Hospitals in the area, to find their deficiencies in serving the the empty nest elders. Using western contries' practice in home health care for reference, to further discuss the function of home health care in serving the empty nest elders, and to build the home health care modle serving the empty nest elders in the area. The study will be benefit to improve the rural empty nest elders' health, increase their health care utilization. It will also provide reference for the home health care system building in the rural area of the whole country.
A set of questionnaires, including general information questionnaire, Social Support Rate Scale, self report health and health care utilization questionnaire, 6-Item Short-Form Health Survey, UCLA Loneliness Scale, Geriatric Depression Scale, Life satisfaction Index Z and activities of daily living questionnaire, were sent to a randomized sample of 550 empty nest elders and 630 not empty nest elders in Yuan'an County, Hubei Provence. We investigated their social, demographic and economic characters, insurance status, health related behaviors, self report health, chronic health conditions, quality of life, loneliness, depression, two-week visits and one-year hospital admissions, unmet health care needs and the reasons, self-care ability, ability of daily life and life satisfaction, et al.. Compared with the not empty nest elders, the empty nest elders showed lower income, worse relationships with children, less social support, lower insurance coverage, higher prevalence of smoking consumption, worse self report health, higher prevalence of chronic diseases, lower physical and mental scores from SF-36, higher loneliness and depression level, lower two-week visit rate, higher health care need unmet rate and lower life satisfaction. There were quite a proportion of empty nest elders without self-care ability and ability of daily life. Among the empty nest old persons with unmet health care, the barriers fell into four groups: access, social attitudes, services, and cost.
Questionaire investigation and interview were carried out among the people knowing the inside story in six Township Hospitals of Yuan'an County, Hubei Provence. The general information, including the classification, gender and education constitution ratio of all persons, daily outpatient and inpatient visits in the recent five years, section office setting and service, was investigated. The results showed that the human resource sizes in the six Township Hospitals were not equal; the total human resource was higher than the countrywide mean level in 2003; the gender constitution ratio of the health care staff was balanced; majority of the health care staff had lower education; the specialty structure of health technical staff was relatively rational; there was no doctors and nurses mastering geratology; and there was no health hotline, so patients can not contact with doctors by phone; the Township Hospitals seldomely provided home services; there was no psychology consulting and rehabilitation services; the daily outpatient and inpatient visits from 2002 to 2006 were decreacing year by year. Unless there was reform, and advantage and character of theirselves was emphasized in the Township Hospitals, it will not benefit the health of the empty nest elders and its own development.
Using workshop and conceptual modeling methods, it was built that the goal model in care of empty nest elders, health care problem model of the Township Hospitals and home health care model for elders. The results showed that, the goal in care of empty nest elders, realizing their health and active aging, will come true through total, continuous, no grey-zone comprehensive services which increase the empty nest elders' independency; the problems in care of the empty nest elders of the Township Hospitals were categorised into three main themes: attitudes among staff, processes of care and resources for care; home health care model for elders mainly included four microsystem domains: self-management support, decision support, delivery system design and clinical information system; the services included primary health care service and social service, which were provided in the patients' home; at the same time, to improve the quality of health care, it was essential to fully utilize the resources and policies in the town and attach importance to the productive interactions between practice team and patients.
The results suggested that compared with the not empty nest elders, the empty nest elders were unequal in health and health care utilization; the inaccessibility to health care was one of the barriers; compared with Township Hospitals, home health care can do better in improving the empty nest elders' accessibility to health care, increasing their independent living ability and improving their quality of life.
我们采用个人基本情况调查表、社会支持评定量表、自报健康状况与卫生服务利用情况调查表、36条目简明健康量表、UCLA孤独量表、老年抑郁量表、生活满意度指数Z、日常生活活动能力调查表对湖北省远安县550位“空巢”和630位非“空巢”老人进行问卷调查,包括社会人口经济学特征、参加医疗保险情况、健康相关行为、自报健康状况、慢性病患病情况、生命质量、孤独水平、抑郁水平、两周就诊情况和年住院情况、卫生服务需要未满足情况、卫生服务需要未满足原因、生活自理能力、日常生活活动能力和生活满意度等。与非“空巢”老人相比,“空巢”老人的月收入水平较低、与子女关系较差、社会支持水平较低、参加医疗保险的人所占比例较低、吸烟率较高、自报健康状况较差、慢性病患病率较高、生命质量生理和心理维度得分都较低、孤独和抑郁水平较高、两周就诊率较低、卫生服务需要未满足率较高、生活满意度较低。“空巢”老人的生活自理能力和日常生活活动能力受损者均占一定比例,阻碍其卫生服务利用的因素主要包括服务的可及性、社会态度、服务质量和费用四个方面。
我们对湖北省远安县的6所乡镇卫生院的相关知情人进行问卷调查和当面访谈,了解这6所乡镇卫生院卫生服务的基本情况,包括各类人员的类别、性别和学历构成、近五年的日均门诊量和住院量、科室设置、服务内容等。结果显示这6所乡镇卫生院人力配置规模不均,其卫生人力总量高于2003年全国平均水平;卫生人员性别构成均衡;多数卫生人员学历水平偏低;卫技人员的专业结构相对合理,但是缺少精通老年医学的医生和护士;没有开通就医热线;病人不能通过电话联系到医生;很少为病人提供上门服务;没有开设心理咨询服务及疾病康复服务;从2002年——2006年日平均门诊量和住院量都逐年下降。该县乡镇卫生院如果不进行适当改革,不突出自己的优势和特色,不仅不利于“空巢”老人的健康保障,也不利于其自身的长远发展。
通过专家研讨会和概念建模的方式,建立了“空巢”老人卫生服务的目标模型、乡镇卫生院卫生服务的问题模型和老年居家卫生服务模型。结果显示:“空巢”老人卫生服务的目标是实现“空巢”老人的健康老龄化和积极老龄化,途径是为他们提供连续的、全方位的、没有灰色带的、能够提高他们独立生活能力的综合性服务;乡镇卫生院在“空巢”老人卫生服务中存在的问题主要包括卫生工作人员的态度、工作程序和内容、资源三个方面;老年居家卫生服务模型主要包括四个微观系统领域:自我管理支持、决策支持、递送系统设计和临床信息系统,服务内容包括初级卫生保健服务和社会服务两部分,服务方式为上门服务,充分利用乡镇的资源和政策,注重医患间的生产性交互,对于提高老年卫生服务质量很有帮助。
这些结果提示,与非“空巢”老人相比,“空巢”老人存在着健康与卫生服务利用的相对不公平性,而卫生服务可及性差是阻碍其卫生服务利用的原因之一,相对于乡镇卫生院,居家卫生服务对于提高“空巢”老人卫生服务可及性、提高其独立生活能力、改善其生活质量具有很强的针对性。
Life and housing condition improved, family structure miniaturized, and a lot of yong man studing and working outside, the number of empty nest elders in our country is increasing. The empty nest elders, as the weak population in the progress of social changing, their physical and mental health was not optimistic. According the survey of the health and health care utilization between the empty nest and not empty nest elders in the rural area of a mountainous county, to estimate the equity of health and health care utilization of the empty nest elders, and to furtherly analyze the factors influencing the health care utilization of the empty nest elders. Investigating the current conditions of the Township Hospitals in the area, to find their deficiencies in serving the the empty nest elders. Using western contries' practice in home health care for reference, to further discuss the function of home health care in serving the empty nest elders, and to build the home health care modle serving the empty nest elders in the area. The study will be benefit to improve the rural empty nest elders' health, increase their health care utilization. It will also provide reference for the home health care system building in the rural area of the whole country.
A set of questionnaires, including general information questionnaire, Social Support Rate Scale, self report health and health care utilization questionnaire, 6-Item Short-Form Health Survey, UCLA Loneliness Scale, Geriatric Depression Scale, Life satisfaction Index Z and activities of daily living questionnaire, were sent to a randomized sample of 550 empty nest elders and 630 not empty nest elders in Yuan'an County, Hubei Provence. We investigated their social, demographic and economic characters, insurance status, health related behaviors, self report health, chronic health conditions, quality of life, loneliness, depression, two-week visits and one-year hospital admissions, unmet health care needs and the reasons, self-care ability, ability of daily life and life satisfaction, et al.. Compared with the not empty nest elders, the empty nest elders showed lower income, worse relationships with children, less social support, lower insurance coverage, higher prevalence of smoking consumption, worse self report health, higher prevalence of chronic diseases, lower physical and mental scores from SF-36, higher loneliness and depression level, lower two-week visit rate, higher health care need unmet rate and lower life satisfaction. There were quite a proportion of empty nest elders without self-care ability and ability of daily life. Among the empty nest old persons with unmet health care, the barriers fell into four groups: access, social attitudes, services, and cost.
Questionaire investigation and interview were carried out among the people knowing the inside story in six Township Hospitals of Yuan'an County, Hubei Provence. The general information, including the classification, gender and education constitution ratio of all persons, daily outpatient and inpatient visits in the recent five years, section office setting and service, was investigated. The results showed that the human resource sizes in the six Township Hospitals were not equal; the total human resource was higher than the countrywide mean level in 2003; the gender constitution ratio of the health care staff was balanced; majority of the health care staff had lower education; the specialty structure of health technical staff was relatively rational; there was no doctors and nurses mastering geratology; and there was no health hotline, so patients can not contact with doctors by phone; the Township Hospitals seldomely provided home services; there was no psychology consulting and rehabilitation services; the daily outpatient and inpatient visits from 2002 to 2006 were decreacing year by year. Unless there was reform, and advantage and character of theirselves was emphasized in the Township Hospitals, it will not benefit the health of the empty nest elders and its own development.
Using workshop and conceptual modeling methods, it was built that the goal model in care of empty nest elders, health care problem model of the Township Hospitals and home health care model for elders. The results showed that, the goal in care of empty nest elders, realizing their health and active aging, will come true through total, continuous, no grey-zone comprehensive services which increase the empty nest elders' independency; the problems in care of the empty nest elders of the Township Hospitals were categorised into three main themes: attitudes among staff, processes of care and resources for care; home health care model for elders mainly included four microsystem domains: self-management support, decision support, delivery system design and clinical information system; the services included primary health care service and social service, which were provided in the patients' home; at the same time, to improve the quality of health care, it was essential to fully utilize the resources and policies in the town and attach importance to the productive interactions between practice team and patients.
The results suggested that compared with the not empty nest elders, the empty nest elders were unequal in health and health care utilization; the inaccessibility to health care was one of the barriers; compared with Township Hospitals, home health care can do better in improving the empty nest elders' accessibility to health care, increasing their independent living ability and improving their quality of life.
引文
[1]黄润龙.我国空巢老人家庭状态.人口与经济,2005,(2):57-62.
[2]肖汉仕.我国家庭空巢现象的成因及发展趋势.人口研究,1995,19(5):13-16.
[3]代爱英,顺滠,曹杰.空巢老人健康状况和社区卫生服务需求调查分析.中华全科医师杂志,2004,3(5):311.
[4]李德明,陈天勇,李贵芸.空巢老人心理健康状况研究.中国老年学杂志,2003,23(7):405-407.
[5]Long MV,Martin P.Personality,relationship closeness,and loneliness of oldest old adults and their children.J Gerontol B Psychol Sci Soc Sci,2000,55(5):311-319.
[6]Pillay AL.Midlife depression and the "empty nest" syndrome in Indian women.Psychol Rep,1988,63(2):591-594.
[7]Denes Z.Loneliness in old age.ZFA,1980,35(6):475-480.
[8]王静,张亮,冯占春,牛宏俐,张翔.农村乡镇卫生院服务质量评价体系研究.中华医院管理杂志,2007,23(2):83-84.
[9]乐虹,唐圣舂.西部地区乡村卫生服务提供调查报告.中国卫生经济,2006,25(5):20-22.
[10]Shepperd S,Iliffe S.Hospital at home.BMJ,1996,312(7036):923-924.
[11]Iliffe S.Hospital at home:from red to amber?.Data that will reassure advocates-but without satisfying the sceptics.BMJ,1998,316(7147):1761-1762.
[12]Arno PS,Bonuck KA,Padgug R.The economic impact of high-technology home care.Hastings Cent Rep,1994,24(5 Suppl):S15-19.
[13]Shaughnessy PW,Schlenker RE,Hittle DF.Home health care outcomes under capitated and fee-for-service payment.Health Care Financ Rev,1994,16(1):187-222.
[14]Kane RL,Finch M,Chen Q,Blewett L,Burns R,Moskowitz M.Post-hospital home health care for Medicare patients.Health Care Financ Rev,1994,16(1):131-153.
[15]Montalto M.Patients' and carers' satisfaction with hospital-in-the-home care.Int J Qual Health Care,1996,8(3):243-251.
[16]Burton LC,Left B,Harper M,Ghoshtagore I,Steinwachs DA,Greenough WB 3rd,Burton JR.Acceptability to patients of a home hospital.J Am Geriatr Soc,1998,46(5):605-609.
[17]Evans RL,Bishop DS,Haselkorn JK.Factors predicting satisfactory home care after stroke.Arch Phys Med Rehabil,1991,72(2):144-147.
[18]Shaughnessy PW, Kramer AM. The increased needs of patients in nursing homes and patients receiving home health care. N Engl J Med, 1990, 322(1): 21-27.
[19] Welch HG, Wennberg DE, Welch WP. The use of Medicare home health care services. N Engl J Med, 1996, 335(5): 324-329.
[20] Cohen MA, Tumlinson A. Understanding the state variation in Medicare home health care. The impact of Medicaid program characteristics, state policy, and provider attributes. Med Care, 1997, 35(6): 618-633.
[21] Johansson L. Promoting home-based elder care: some Swedish experiences. Journal of Cross-Cultural Gerontology, 1993, 8: 391-406.
[22]Fulop NJ, Hood S, Parsons S. Does the National Health Service want hospital-at-home? J R Soc Med, 1997, 90(4): 212-215.
[23] 肖水源. 社会支持评定量表. 中国心理卫生杂志,1993(增刊), 42-46.
[24] Stewart M. The Medical Outcomes Study 36-item short-form health survey (SF-36). Aust J Physiother, 2007, 53(3): 208.
[25]McHorney CA.Measuring and monitoring general health status in elderly persons: practical and methodological issues in using the SF-36 Health Survey. Gerontologist, 1996, 36(5): 571-583.
[26] Russell D, Peplau LA, Cutrona CE.The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol, 1980, 39(3): 472-480
[27]Chau J, Martin CR, Thompson DR, Chang AM, Woo J. Factor structure of the Chinese version of the Geriatric Depression Scale. Psychol Health Med, 2006, 11(1): 48-59.
[28] Wood V, Wylie ML, Sheafor B. An analysis of a short self-report measure of life satisfaction: correlation with rater judgments. J Gerontol, 1969, 24(4): 465-469.
[29]Borg C, Hallberg IR, Blomqvist K. Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspects. J Clin Nurs, 2006, 15(5): 607-618.
[30]SPSS, Inc.: SPSS: Version 10.0 for Windows. Chicago: SPSS, Inc.; 1999.
[31 ] http://www.hbnmpx.gov.cn/pages/news_detail.asp?id=2567
[32] http://www.dh.gov.hk/english/pub_rec/pub_rec_ar/pdf/0001/ch_0115. pdf
[33] http://www.chinapop.gov.cn/rkxx/ztbd/t20070124_144759019.html
[34]Chalise HN, Saito T, Takahashi M, Kai I. Relationship specialization amongst sources and receivers of social support and its correlations with loneliness and subjective well-being: a cross sectional study of Nepalese older adults. Arch Gerontol Geriatr, 2007, 44(3):299-314.
[35]Coventry WL,Gillespie NA,Heath AC,Martin NG.Perceived social support in a large community sample--age and sex differences.Soc Psychiatry Psychiatr Epidemiol,2004,39(8):625-636.
[36]http://www.hbnycyh.com/ReadNews.asp?NewsID=1118
[37]张燕,唐根富,朱敏贞.空巢家庭存在的问题及其对策.卫生软科学,2005,19(4):285-286.
[38]Jylha M.Old age and loneliness:cross-sectional and longitudinal analyses in the Tampere Longitudinal Study on Aging.Can J Aging,2004,23(2):157-168.
[39]Fogelholm M,Valve R,Absetz P,Heinonen H,Uutela A,Patja K,Karisto A,Konttinen R,Makela T,Nissinen A,Jallinoja P,Nummela O,Talja M.Rural-urban differences in health and health behaviour:a baseline description of a community health-promotion programme for the elderly.Scand J Public Health,2006,34(6):632-640.
[40]Campbell VA,Crews JE,Moriarty DG,Zack MM,Blackman DK.Surveillance for sensory impairment,activity limitation,and health-related quality of life among older adults--United States,1993-1997.MMWR CDC Surveill Summ,1999,48(8):131-156.
[41]Gonzalez Vazquez T,Bonilla Fernandez P,Jauregui Ortiz B,Yamanis TJ,Salgado de Snyder VN.Well-being and family support among elderly rural Mexicans in the context of migration to the United States.J Aging Health,2007,19(2):334-355.
[42]Lam CW,Boey KW.The psychological well-being of the Chinese elderly living in old urban areas of Hong Kong:a social perspective.Aging Ment Health,2005,9(2):162-166.
[43]Carvalho-Bos SS,Riemersma-van der Lek RF,Waterhouse J,Reilly T,Van Someren EJ.Strong association of the rest-activity rhythm with well-being in demented elderly women.Am J Geriatr Psychiatry,2007,15(2):92-100.
[44]Li TC,Lee YD,Lin CC,Amidon RL.Quality of life of primary caregivers of elderly with cerebrovascular disease or diabetes hospitalized for acute care:assessment of well-being and functioning using the SF-36 health questionnaire.Qual Life Res,2004,13(6):1081-1088.
[45]Doll HA,Petersen SE,Stewart-Brown SL.Eating disorders and emotional and physical well-being:associations between student self-reports of eating disorders and quality of life as measured by the SF-36.Qual Life Res,2005,14(3):705-717.
[46]Paul C,Ayis S,Ebrahim S.Psychological distress,loneliness and disability in old age.Psychol Health Med,2006,11(2):221-232.
[47]Routasalo PE, Savikko N, Tilvis RS, Strandberg TE, Pitkala KH. Social contacts and their relationship to loneliness among aged people - a population-based study. Gerontology, 200 6,52(3): 181-187.
[48]Jakobsson U, Hallberg IR. Loneliness, fear, and quality of life among elderly in Sweden: a gender perspective. Aging Clin Exp Res. 2005; 17(6):494-501.
[49]Haustein KO. Smoking and poverty. Eur J Cardiovasc Prev Rehabil, 2006, 13(3): 312-318.
[50]Lauder W, Mummery K, Jones M, Caperchione C. A comparison of health behaviours in lonely and non-lonely populations. Psychol Health Med, 2006, 11(2): 233-245.
[51] Green BH, Copeland JR, Dewey ME, Sharma V, Saunders PA, Davidson IA, Sullivan C, McWilliam C. Risk factors for depression in elderly people: a prospective study. Acta Psychiatr Scand, 1992, 86(3): 213-217.
[52]Haag S, Senf W, Hauser W, Tagay S, Grandt D, Heuft G, Gerken G, Talley NJ, Holtmann G. Impairment of health-related quality of life in functional dyspepsia and chronic liver disease: the influence of depression and anxiety. Aliment Pharmacol Ther, 2008, 27(7): 561-571.
[53]Xavier FM, Ferraz MP, Marc N, Escosteguy NU, Moriguchi EH. Elderly people's definition of quality of life. Rev Bras Psiquiatr, 2003, 25(1): 31-39.
[54]Brenes GA. Anxiety, depression, and quality of life in primary care patients. Prim Care Companion J Clin Psychiatry, 2007, 9(6): 437-443.
[55]Jakobsson U, Hallberg IR. Loneliness, fear, and quality of life among elderly in Sweden: a gender perspective. Aging Clin Exp Res, 2005, 17(6): 494-501.
[56]Lorant V, Croux C, Weich S, Deliege D, Mackenbach J, Ansseau M.epression and socio-economic risk factors: 7-year longitudinal population study.r J Psychiatry, 2007, 190:293-298.
[57]Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging, 2006, 21(1): 140-151.
[58]Urbina Torija JR, Flores Mayor JM, Garcia Salazar MP, Torres Buisan L, Torrubias Fernandez RM. Depressive symptoms in the elderly. Prevalence and associated factors. Gac Sanit, 2007. 21(1): 37-42.
[59]Demura S, Sato S. Relationships between depression, lifestyle and quality of life in the community dwelling elderly: a comparison between gender and age groups. J Physiol Anthropol Appl Human Sci, 2003, 22(3): 159-166.
[60]Tomaka J, Thompson S, Palacios R. The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. J Aging Health, 2006,18(3): 359-384.
[61]Murata C, Kondo K, Hirai H, Ichida Y, Ojima T. Association between depression and socio-economic status among community-dwelling elderly in Japan: The Aichi Gerontological Evaluation Study (AGES). Health Place, 2008, 14(3): 406-414.
[62]Chalise HN, Saito T, Kai I. Correlates of loneliness among older Newar adults in Nepal. Nippon Koshu Eisei Zasshi, 2007, 54(7): 427-433.
[63]Niti M, Ng TP, Kua EH, Ho RC, Tan CH. Depression and chronic medical illnesses in Asian older adults: the role of subjective health and functional status. Int J Geriatr Psychiatry, 2007, 22(11): 1087-1094.
[64] 卢祖洵. 社会医学. 北京：科学出版社,2003, 149.
[65]Ahs AM, Westerling R. Health care utilization among persons who are unemployed or outside the labour force. Health Policy, 2006, 78: 178-193.
[66] Sproston KA, Pitson LB, Walker E. The use of primary care services by the Chinese population living in England: examining inequalities. Ethn Health, 2001, 6: 189-196.
[67]Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev, 2000, 57 Suppl 1: 108-145.
[68]Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care, 2002, 40: 52-59.
[69]Frisbie WP, Cho Y, Hummer RA. Immigration and the health of Asian and Pacific Islander adults in the United States. Am J Epidemiol, 2001, 153: 372-380.
[70] Li PL, Logan S, Yee L, Ng S. Barriers to meeting the mental health needs of the Chinese community. J Public Health Med, 1999, 21: 74-80.
[71 ] Hoffman-Goetz L, Breen NL, Meissner H. The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States. Ethn Dis, 1998, 8: 43-51.
[72] Lee MC. Knowledge, barriers, and motivators related to cervical cancer screening among Korean-American women. A focus group approach. Cancer Nurs, 2000, 23: 168-175.
[73] Ma GX. Barriers to the use of health services by Chinese Americans. J Allied Health, 2000, 29: 64-70.
[74] Davis SK, Liu Y, Gibbons GH. Disparities in trends of hospitalization for potentially preventable chronic conditions among African Americans during the 1990s: implications and benchmarks. Am J Public Health, 2003, 93: 447-455.
[75] Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Soc Work, 1998, 23: 136-145.
[76]Tang TS, Solomon LJ, McCracken LM. Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older. Prev Med, 2000, 31:575-583.
[77] Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep, 2001, 116: 404-416.
[78]LaVeist TA. Disentangling race and socioeconomic status: a key to understanding health inequalities. J Urban Health, 2005, 82(2 Suppl 3): iii26-34.
[79] Christensen B. Payment and attendance at general practice preventive health examinations. Fam Med, 1995, 27: 531-534.
[80]Carr-Hill RA, Rice N, Roland M. Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices. BMJ, 1996,312: 1008-1012.
[81] Field KS, Briggs DJ. Socio-economic and locational determinants of accessibility and utilization of primary health-care. Health Soc Care Community, 2001, 9: 294-308.
[82] Iron K, Goel V. Sex differences in the factors related to hospital utilization: results from the 1990 Ontario Health Survey. J Womens Health, 1998, 7: 359-369.
[83]Saarento O, Rasanen S, Nieminen P, Hakko H, Isohanni M. Sex differences in the contact rates and utilization of psychiatric services. A three-year follow-up study in northern Finland. Eur Psychiatry, 2000, 15: 205-212.
[84] Baker D, Mead N, Campbell S. Inequalities in morbidity and consulting behaviour for socially vulnerable groups. Br J Gen Pract, 2002, 52: 124-130.
[85]Joia LC, Ruiz T, Donalisio MR. Life satisfaction among elderly population in the city of Botucatu, Southern Brazil. Rev Saude Publica, 2007, 41(1): 131-138.
[86]Shkolnik T, Weiner C, Malik L, Festinger Y. The effect of Jewish religiosity of elderly Israelis on their life satisfaction, health, function and activity. J Cross Cult Gerontol, 2001, 16(3): 201-219.
[87]Zhang AY, Yu LC. Life satisfaction among Chinese elderly in Beijing. Cross Cult Gerontol, 1998, 13(2): 109-125.
[88]http://210.72.21.20/chinese/PI-c/225082.htm
[89]吴铁坚,等.乡镇卫生院发展的障碍与对策.中国初级卫生保健,1990,4(8):21.
[90]周东海.农村卫生人力资源发展与加强初级卫生保健.中国农村卫生事业管理,1995,(15):7.
[91]王光荣,徐华,江明,龚幼龙,梅人朗.456名乡镇卫生院医生综合素质评定.中国卫生资源,2003,6(2):72-74.
[92]蒋飞,马进,宋建平,王春明,马一,李兴洲,夏芹.乡村医生基本专业素质的循证研究.中国初级卫生保健,2003,17(6):17-20.
[93]弥曼,景富春.乡村卫生队伍整体素质亟待提高.现代中医药,2003,(5):66-67.
[94]Stock RD,Reece D,Cesario L.Developing a comprehensive interdisciplinary senior healthcare practice.Stock RD,Reece D,Cesario L.J Am Geriatr Soc,2004,52(12):2128-2133.
[95]Boult C,Kane RL,Pacala JT,Wagner EH.Innovative healthcare for chronically ill older persons:results of a national survey.Am J Manag Care,1999,5(9):1162-1172.
[96]Liu LJ,Sun X,Zhang CL,Guo Q.Health-care utilization among empty-nesters in the rural area of a mountainous county in China.Public Health Rep,2007,122(3):407-413.
[97]Liu LJ,Guo Q.Loneliness and health-related quality of life for the empty nest elderly in the rural area of a mountainous county in China.Qual Life Res,2007,16(8):1275-1280.
[98]Henriksen E,Rosenqvist U.Understanding and practice:a 7-year follow-up study on implementation of a cardiac rehabilitation program.Qual Health Res,2002,12(5):671-684.
[99]Bowling A.Research methods in health investigation,health and health services.Trowbridge:Open University Press,Redwood Books,1997.
[100]Patton MQ.Qualitative evaluation and research methods,second ed..Sage Publication,1990.
[101]Henriksen E,Selander G,Rosenqvist U.Health Policy.Can we bridge the gap between goals and practice through a common vision? A study of politicians and managers'understanding of the provisions of elderly care services,2003,65(2):129-137.
[102]Fraser SW,Greenhalgh T.Coping with complexity:educating for capability.BMJ,2001,323(7316):799-803.
[103]Elkan R,Kendrick D,Dewey M,Hewitt M,Robinson J,Blair M,Williams D,Brummell K.Effectiveness of home based support for older people:systematic review and meta-analysis.BMJ,2001,323(7315):719-725.
[104]Stuck AE,Siu AL,Wieland GD,Adams J,Rubenstein LZ.Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet, 1993, 342(8878): 1032-1036.
[105] Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127(12): 1097-102.
[106]Borgenicht K, Carty E, Feigenbaum LZ. Community resources for frail older patients. West J Med, 1997, 167(4): 291-294.
[107]Olof Hedman N, Johansson R, Rosenqvist U. Clustering and inertia: structural integration of home care in Swedish elderly care. Int J Integr Care, 2007, 7: e32.
[108]Bentur N, King Y, Brodsky J, Mualem A, Gindin Y. Home hospitalization in the Israeli health system, RR-329-98; JDC-Brookdale Institute, Jerusalem, 1998.
[109] Shepperd S, Harwood D, Jenkinson C, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. BMJ, 1998, 316(7147): 1786-1791.
[110] Shepperd S, Harwood D, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis. BMJ, 1998, 316(7147): 1791-1976.
[111]Richards SH, Coast J, Gunnell DJ, Peters TJ, Pounsford J, Darlow MA. Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ, 1998, 316(7147): 1796-1801.
[112] Coast J, Richards SH, Peters TJ, Gunnell DJ, Darlow MA, Pounsford J. Hospital at home or acute hospital care? A cost minimisation analysis. BMJ, 1998, 316(7147): 1802180-6.
[113]Stessman J, Ginsberg G, Hammerman-Rozenberg R, Friedman R, Ronen D, Israeli A, Cohen A. Decreased hospital utilization by older adults attributable to a home hospitalization program. J Am Geriatr Soc, 1996, 44(5): 591-598.
[114]Kornowski R, Zeeli D, Averbuch M, Finkelstein A, Schwartz D, Moshkovitz M, Weinreb B, Hershkovitz R, Eyal D, Miller M, et al. Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure. Am Heart J, 1995, 129(4): 762-766.
[115]Hughes SL, Cummings J, Weaver F, Manheim L, Braun B, Conrad K. A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill. Health Serv Res, 1992, 26(6): 801-817.
[116]Gladman J, Whynes D, Lincoln N. Cost comparison of domiciliary and hospital-based stroke rehabilitation. DOMINO Study Group. Age Ageing, 1994, 23(3): 241-245.
[117]Hensher M, Fulop N, Hood S, Ujah S. Does hospital-at-home make economic sense? Early discharge versus standard care for orthopaedic patients. J R Soc Med, 1996, 89(10): 548-551.
[118] Brazil K, Bolton C, Ulrichsen D, Knott C. Substituting home care for hospitalization: the role of a quick response service for the elderly. J Community Health, 1998, 23(1): 29-43.
[119] Melin AL, Hakansson S, Bygren LO. The cost-effectiveness of rehabilitation in the home: a study of Swedish elderly. Am J Public Health, 1993, 83(3): 356-362.
[120] Brown MG. Cost-effectiveness: the case of home health care physician services in New Brunswick, Canada. J Ambul Care Manage, 1995, 18(1): 13-28.
[121]Hedrick SC, Koepsell TD, Inui T. Meta-analysis of home-care effects on mortality and nursing-home placement. Med Care, 1989, 27(11): 1015-1026.
[122] Hughes SL, Ulasevich A, Weaver FM, Henderson W, Manheim L, Kubal JD, Bonarigo F. Impact of home care on hospital days: a meta analysis. Health Serv Res, 1997, 32(4): 415-432.
[123] Fleishman JA. Utilization of home care among people with HIV infection. Health Serv Res, 1997,32(2): 155-175.
[124] Kenny GM. Understanding the effect of PPS on Medicare home health use. Inquiry, 1991,28: 129-19.
[125]Nixon M. Hospital without walls. Canadian Family Physician, 1991, 57: 1709-1917.
[126]Stessman J, Hammerman-Rozenberg R, Cohen A. Home hospitalization in the spectrum of community geriatric care. Disabil Rehabil, 1997, 19(4): 134-141.
[127] Mauser E, Miller NA. A profile of home health users in 1992. Health Care Financ Rev, 1994, 16(1): 17-33.
[128] Meyer GS, Gibbons RV. House calls to the elderly—a vanishing practice among physicians. N Engl J Med, 1997, 337(25): 1815-1820.
[129]Campion EW. Can house calls survive? N Engl J Med, 1997, 337(25): 1840-1841.
[130]Soundappan A, Goodwin T, Greengold R, Siegler EL. How to get the most benefit from a changing home health care system. Geriatrics, 1997, 52(10): 83-86.
[131]Coleman B. New Directions for the State Long-Term Care System. 2nd ed. Public Policy Institute, 1998, AARP No. 9808.
[132]Normand C. Can an economic case be made for investing in health?. No, but it's the wrong question.Normand C. BMJ, 1998, 316(7147): 1762.
[133]Ashton CM, Kuykendall DH, Johnson ML, Wray NP, Wu L. The association between the quality of inpatient care and early readmission. Ann Intern Med, 1995, 122(6): 415-421.
[2]肖汉仕.我国家庭空巢现象的成因及发展趋势.人口研究,1995,19(5):13-16.
[3]代爱英,顺滠,曹杰.空巢老人健康状况和社区卫生服务需求调查分析.中华全科医师杂志,2004,3(5):311.
[4]李德明,陈天勇,李贵芸.空巢老人心理健康状况研究.中国老年学杂志,2003,23(7):405-407.
[5]Long MV,Martin P.Personality,relationship closeness,and loneliness of oldest old adults and their children.J Gerontol B Psychol Sci Soc Sci,2000,55(5):311-319.
[6]Pillay AL.Midlife depression and the "empty nest" syndrome in Indian women.Psychol Rep,1988,63(2):591-594.
[7]Denes Z.Loneliness in old age.ZFA,1980,35(6):475-480.
[8]王静,张亮,冯占春,牛宏俐,张翔.农村乡镇卫生院服务质量评价体系研究.中华医院管理杂志,2007,23(2):83-84.
[9]乐虹,唐圣舂.西部地区乡村卫生服务提供调查报告.中国卫生经济,2006,25(5):20-22.
[10]Shepperd S,Iliffe S.Hospital at home.BMJ,1996,312(7036):923-924.
[11]Iliffe S.Hospital at home:from red to amber?.Data that will reassure advocates-but without satisfying the sceptics.BMJ,1998,316(7147):1761-1762.
[12]Arno PS,Bonuck KA,Padgug R.The economic impact of high-technology home care.Hastings Cent Rep,1994,24(5 Suppl):S15-19.
[13]Shaughnessy PW,Schlenker RE,Hittle DF.Home health care outcomes under capitated and fee-for-service payment.Health Care Financ Rev,1994,16(1):187-222.
[14]Kane RL,Finch M,Chen Q,Blewett L,Burns R,Moskowitz M.Post-hospital home health care for Medicare patients.Health Care Financ Rev,1994,16(1):131-153.
[15]Montalto M.Patients' and carers' satisfaction with hospital-in-the-home care.Int J Qual Health Care,1996,8(3):243-251.
[16]Burton LC,Left B,Harper M,Ghoshtagore I,Steinwachs DA,Greenough WB 3rd,Burton JR.Acceptability to patients of a home hospital.J Am Geriatr Soc,1998,46(5):605-609.
[17]Evans RL,Bishop DS,Haselkorn JK.Factors predicting satisfactory home care after stroke.Arch Phys Med Rehabil,1991,72(2):144-147.
[18]Shaughnessy PW, Kramer AM. The increased needs of patients in nursing homes and patients receiving home health care. N Engl J Med, 1990, 322(1): 21-27.
[19] Welch HG, Wennberg DE, Welch WP. The use of Medicare home health care services. N Engl J Med, 1996, 335(5): 324-329.
[20] Cohen MA, Tumlinson A. Understanding the state variation in Medicare home health care. The impact of Medicaid program characteristics, state policy, and provider attributes. Med Care, 1997, 35(6): 618-633.
[21] Johansson L. Promoting home-based elder care: some Swedish experiences. Journal of Cross-Cultural Gerontology, 1993, 8: 391-406.
[22]Fulop NJ, Hood S, Parsons S. Does the National Health Service want hospital-at-home? J R Soc Med, 1997, 90(4): 212-215.
[23] 肖水源. 社会支持评定量表. 中国心理卫生杂志,1993(增刊), 42-46.
[24] Stewart M. The Medical Outcomes Study 36-item short-form health survey (SF-36). Aust J Physiother, 2007, 53(3): 208.
[25]McHorney CA.Measuring and monitoring general health status in elderly persons: practical and methodological issues in using the SF-36 Health Survey. Gerontologist, 1996, 36(5): 571-583.
[26] Russell D, Peplau LA, Cutrona CE.The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. J Pers Soc Psychol, 1980, 39(3): 472-480
[27]Chau J, Martin CR, Thompson DR, Chang AM, Woo J. Factor structure of the Chinese version of the Geriatric Depression Scale. Psychol Health Med, 2006, 11(1): 48-59.
[28] Wood V, Wylie ML, Sheafor B. An analysis of a short self-report measure of life satisfaction: correlation with rater judgments. J Gerontol, 1969, 24(4): 465-469.
[29]Borg C, Hallberg IR, Blomqvist K. Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspects. J Clin Nurs, 2006, 15(5): 607-618.
[30]SPSS, Inc.: SPSS: Version 10.0 for Windows. Chicago: SPSS, Inc.; 1999.
[31 ] http://www.hbnmpx.gov.cn/pages/news_detail.asp?id=2567
[32] http://www.dh.gov.hk/english/pub_rec/pub_rec_ar/pdf/0001/ch_0115. pdf
[33] http://www.chinapop.gov.cn/rkxx/ztbd/t20070124_144759019.html
[34]Chalise HN, Saito T, Takahashi M, Kai I. Relationship specialization amongst sources and receivers of social support and its correlations with loneliness and subjective well-being: a cross sectional study of Nepalese older adults. Arch Gerontol Geriatr, 2007, 44(3):299-314.
[35]Coventry WL,Gillespie NA,Heath AC,Martin NG.Perceived social support in a large community sample--age and sex differences.Soc Psychiatry Psychiatr Epidemiol,2004,39(8):625-636.
[36]http://www.hbnycyh.com/ReadNews.asp?NewsID=1118
[37]张燕,唐根富,朱敏贞.空巢家庭存在的问题及其对策.卫生软科学,2005,19(4):285-286.
[38]Jylha M.Old age and loneliness:cross-sectional and longitudinal analyses in the Tampere Longitudinal Study on Aging.Can J Aging,2004,23(2):157-168.
[39]Fogelholm M,Valve R,Absetz P,Heinonen H,Uutela A,Patja K,Karisto A,Konttinen R,Makela T,Nissinen A,Jallinoja P,Nummela O,Talja M.Rural-urban differences in health and health behaviour:a baseline description of a community health-promotion programme for the elderly.Scand J Public Health,2006,34(6):632-640.
[40]Campbell VA,Crews JE,Moriarty DG,Zack MM,Blackman DK.Surveillance for sensory impairment,activity limitation,and health-related quality of life among older adults--United States,1993-1997.MMWR CDC Surveill Summ,1999,48(8):131-156.
[41]Gonzalez Vazquez T,Bonilla Fernandez P,Jauregui Ortiz B,Yamanis TJ,Salgado de Snyder VN.Well-being and family support among elderly rural Mexicans in the context of migration to the United States.J Aging Health,2007,19(2):334-355.
[42]Lam CW,Boey KW.The psychological well-being of the Chinese elderly living in old urban areas of Hong Kong:a social perspective.Aging Ment Health,2005,9(2):162-166.
[43]Carvalho-Bos SS,Riemersma-van der Lek RF,Waterhouse J,Reilly T,Van Someren EJ.Strong association of the rest-activity rhythm with well-being in demented elderly women.Am J Geriatr Psychiatry,2007,15(2):92-100.
[44]Li TC,Lee YD,Lin CC,Amidon RL.Quality of life of primary caregivers of elderly with cerebrovascular disease or diabetes hospitalized for acute care:assessment of well-being and functioning using the SF-36 health questionnaire.Qual Life Res,2004,13(6):1081-1088.
[45]Doll HA,Petersen SE,Stewart-Brown SL.Eating disorders and emotional and physical well-being:associations between student self-reports of eating disorders and quality of life as measured by the SF-36.Qual Life Res,2005,14(3):705-717.
[46]Paul C,Ayis S,Ebrahim S.Psychological distress,loneliness and disability in old age.Psychol Health Med,2006,11(2):221-232.
[47]Routasalo PE, Savikko N, Tilvis RS, Strandberg TE, Pitkala KH. Social contacts and their relationship to loneliness among aged people - a population-based study. Gerontology, 200 6,52(3): 181-187.
[48]Jakobsson U, Hallberg IR. Loneliness, fear, and quality of life among elderly in Sweden: a gender perspective. Aging Clin Exp Res. 2005; 17(6):494-501.
[49]Haustein KO. Smoking and poverty. Eur J Cardiovasc Prev Rehabil, 2006, 13(3): 312-318.
[50]Lauder W, Mummery K, Jones M, Caperchione C. A comparison of health behaviours in lonely and non-lonely populations. Psychol Health Med, 2006, 11(2): 233-245.
[51] Green BH, Copeland JR, Dewey ME, Sharma V, Saunders PA, Davidson IA, Sullivan C, McWilliam C. Risk factors for depression in elderly people: a prospective study. Acta Psychiatr Scand, 1992, 86(3): 213-217.
[52]Haag S, Senf W, Hauser W, Tagay S, Grandt D, Heuft G, Gerken G, Talley NJ, Holtmann G. Impairment of health-related quality of life in functional dyspepsia and chronic liver disease: the influence of depression and anxiety. Aliment Pharmacol Ther, 2008, 27(7): 561-571.
[53]Xavier FM, Ferraz MP, Marc N, Escosteguy NU, Moriguchi EH. Elderly people's definition of quality of life. Rev Bras Psiquiatr, 2003, 25(1): 31-39.
[54]Brenes GA. Anxiety, depression, and quality of life in primary care patients. Prim Care Companion J Clin Psychiatry, 2007, 9(6): 437-443.
[55]Jakobsson U, Hallberg IR. Loneliness, fear, and quality of life among elderly in Sweden: a gender perspective. Aging Clin Exp Res, 2005, 17(6): 494-501.
[56]Lorant V, Croux C, Weich S, Deliege D, Mackenbach J, Ansseau M.epression and socio-economic risk factors: 7-year longitudinal population study.r J Psychiatry, 2007, 190:293-298.
[57]Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging, 2006, 21(1): 140-151.
[58]Urbina Torija JR, Flores Mayor JM, Garcia Salazar MP, Torres Buisan L, Torrubias Fernandez RM. Depressive symptoms in the elderly. Prevalence and associated factors. Gac Sanit, 2007. 21(1): 37-42.
[59]Demura S, Sato S. Relationships between depression, lifestyle and quality of life in the community dwelling elderly: a comparison between gender and age groups. J Physiol Anthropol Appl Human Sci, 2003, 22(3): 159-166.
[60]Tomaka J, Thompson S, Palacios R. The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. J Aging Health, 2006,18(3): 359-384.
[61]Murata C, Kondo K, Hirai H, Ichida Y, Ojima T. Association between depression and socio-economic status among community-dwelling elderly in Japan: The Aichi Gerontological Evaluation Study (AGES). Health Place, 2008, 14(3): 406-414.
[62]Chalise HN, Saito T, Kai I. Correlates of loneliness among older Newar adults in Nepal. Nippon Koshu Eisei Zasshi, 2007, 54(7): 427-433.
[63]Niti M, Ng TP, Kua EH, Ho RC, Tan CH. Depression and chronic medical illnesses in Asian older adults: the role of subjective health and functional status. Int J Geriatr Psychiatry, 2007, 22(11): 1087-1094.
[64] 卢祖洵. 社会医学. 北京：科学出版社,2003, 149.
[65]Ahs AM, Westerling R. Health care utilization among persons who are unemployed or outside the labour force. Health Policy, 2006, 78: 178-193.
[66] Sproston KA, Pitson LB, Walker E. The use of primary care services by the Chinese population living in England: examining inequalities. Ethn Health, 2001, 6: 189-196.
[67]Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev, 2000, 57 Suppl 1: 108-145.
[68]Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care, 2002, 40: 52-59.
[69]Frisbie WP, Cho Y, Hummer RA. Immigration and the health of Asian and Pacific Islander adults in the United States. Am J Epidemiol, 2001, 153: 372-380.
[70] Li PL, Logan S, Yee L, Ng S. Barriers to meeting the mental health needs of the Chinese community. J Public Health Med, 1999, 21: 74-80.
[71 ] Hoffman-Goetz L, Breen NL, Meissner H. The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States. Ethn Dis, 1998, 8: 43-51.
[72] Lee MC. Knowledge, barriers, and motivators related to cervical cancer screening among Korean-American women. A focus group approach. Cancer Nurs, 2000, 23: 168-175.
[73] Ma GX. Barriers to the use of health services by Chinese Americans. J Allied Health, 2000, 29: 64-70.
[74] Davis SK, Liu Y, Gibbons GH. Disparities in trends of hospitalization for potentially preventable chronic conditions among African Americans during the 1990s: implications and benchmarks. Am J Public Health, 2003, 93: 447-455.
[75] Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Soc Work, 1998, 23: 136-145.
[76]Tang TS, Solomon LJ, McCracken LM. Cultural barriers to mammography, clinical breast exam, and breast self-exam among Chinese-American women 60 and older. Prev Med, 2000, 31:575-583.
[77] Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep, 2001, 116: 404-416.
[78]LaVeist TA. Disentangling race and socioeconomic status: a key to understanding health inequalities. J Urban Health, 2005, 82(2 Suppl 3): iii26-34.
[79] Christensen B. Payment and attendance at general practice preventive health examinations. Fam Med, 1995, 27: 531-534.
[80]Carr-Hill RA, Rice N, Roland M. Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices. BMJ, 1996,312: 1008-1012.
[81] Field KS, Briggs DJ. Socio-economic and locational determinants of accessibility and utilization of primary health-care. Health Soc Care Community, 2001, 9: 294-308.
[82] Iron K, Goel V. Sex differences in the factors related to hospital utilization: results from the 1990 Ontario Health Survey. J Womens Health, 1998, 7: 359-369.
[83]Saarento O, Rasanen S, Nieminen P, Hakko H, Isohanni M. Sex differences in the contact rates and utilization of psychiatric services. A three-year follow-up study in northern Finland. Eur Psychiatry, 2000, 15: 205-212.
[84] Baker D, Mead N, Campbell S. Inequalities in morbidity and consulting behaviour for socially vulnerable groups. Br J Gen Pract, 2002, 52: 124-130.
[85]Joia LC, Ruiz T, Donalisio MR. Life satisfaction among elderly population in the city of Botucatu, Southern Brazil. Rev Saude Publica, 2007, 41(1): 131-138.
[86]Shkolnik T, Weiner C, Malik L, Festinger Y. The effect of Jewish religiosity of elderly Israelis on their life satisfaction, health, function and activity. J Cross Cult Gerontol, 2001, 16(3): 201-219.
[87]Zhang AY, Yu LC. Life satisfaction among Chinese elderly in Beijing. Cross Cult Gerontol, 1998, 13(2): 109-125.
[88]http://210.72.21.20/chinese/PI-c/225082.htm
[89]吴铁坚,等.乡镇卫生院发展的障碍与对策.中国初级卫生保健,1990,4(8):21.
[90]周东海.农村卫生人力资源发展与加强初级卫生保健.中国农村卫生事业管理,1995,(15):7.
[91]王光荣,徐华,江明,龚幼龙,梅人朗.456名乡镇卫生院医生综合素质评定.中国卫生资源,2003,6(2):72-74.
[92]蒋飞,马进,宋建平,王春明,马一,李兴洲,夏芹.乡村医生基本专业素质的循证研究.中国初级卫生保健,2003,17(6):17-20.
[93]弥曼,景富春.乡村卫生队伍整体素质亟待提高.现代中医药,2003,(5):66-67.
[94]Stock RD,Reece D,Cesario L.Developing a comprehensive interdisciplinary senior healthcare practice.Stock RD,Reece D,Cesario L.J Am Geriatr Soc,2004,52(12):2128-2133.
[95]Boult C,Kane RL,Pacala JT,Wagner EH.Innovative healthcare for chronically ill older persons:results of a national survey.Am J Manag Care,1999,5(9):1162-1172.
[96]Liu LJ,Sun X,Zhang CL,Guo Q.Health-care utilization among empty-nesters in the rural area of a mountainous county in China.Public Health Rep,2007,122(3):407-413.
[97]Liu LJ,Guo Q.Loneliness and health-related quality of life for the empty nest elderly in the rural area of a mountainous county in China.Qual Life Res,2007,16(8):1275-1280.
[98]Henriksen E,Rosenqvist U.Understanding and practice:a 7-year follow-up study on implementation of a cardiac rehabilitation program.Qual Health Res,2002,12(5):671-684.
[99]Bowling A.Research methods in health investigation,health and health services.Trowbridge:Open University Press,Redwood Books,1997.
[100]Patton MQ.Qualitative evaluation and research methods,second ed..Sage Publication,1990.
[101]Henriksen E,Selander G,Rosenqvist U.Health Policy.Can we bridge the gap between goals and practice through a common vision? A study of politicians and managers'understanding of the provisions of elderly care services,2003,65(2):129-137.
[102]Fraser SW,Greenhalgh T.Coping with complexity:educating for capability.BMJ,2001,323(7316):799-803.
[103]Elkan R,Kendrick D,Dewey M,Hewitt M,Robinson J,Blair M,Williams D,Brummell K.Effectiveness of home based support for older people:systematic review and meta-analysis.BMJ,2001,323(7315):719-725.
[104]Stuck AE,Siu AL,Wieland GD,Adams J,Rubenstein LZ.Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet, 1993, 342(8878): 1032-1036.
[105] Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127(12): 1097-102.
[106]Borgenicht K, Carty E, Feigenbaum LZ. Community resources for frail older patients. West J Med, 1997, 167(4): 291-294.
[107]Olof Hedman N, Johansson R, Rosenqvist U. Clustering and inertia: structural integration of home care in Swedish elderly care. Int J Integr Care, 2007, 7: e32.
[108]Bentur N, King Y, Brodsky J, Mualem A, Gindin Y. Home hospitalization in the Israeli health system, RR-329-98; JDC-Brookdale Institute, Jerusalem, 1998.
[109] Shepperd S, Harwood D, Jenkinson C, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes. BMJ, 1998, 316(7147): 1786-1791.
[110] Shepperd S, Harwood D, Gray A, Vessey M, Morgan P. Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis. BMJ, 1998, 316(7147): 1791-1976.
[111]Richards SH, Coast J, Gunnell DJ, Peters TJ, Pounsford J, Darlow MA. Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care. BMJ, 1998, 316(7147): 1796-1801.
[112] Coast J, Richards SH, Peters TJ, Gunnell DJ, Darlow MA, Pounsford J. Hospital at home or acute hospital care? A cost minimisation analysis. BMJ, 1998, 316(7147): 1802180-6.
[113]Stessman J, Ginsberg G, Hammerman-Rozenberg R, Friedman R, Ronen D, Israeli A, Cohen A. Decreased hospital utilization by older adults attributable to a home hospitalization program. J Am Geriatr Soc, 1996, 44(5): 591-598.
[114]Kornowski R, Zeeli D, Averbuch M, Finkelstein A, Schwartz D, Moshkovitz M, Weinreb B, Hershkovitz R, Eyal D, Miller M, et al. Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure. Am Heart J, 1995, 129(4): 762-766.
[115]Hughes SL, Cummings J, Weaver F, Manheim L, Braun B, Conrad K. A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill. Health Serv Res, 1992, 26(6): 801-817.
[116]Gladman J, Whynes D, Lincoln N. Cost comparison of domiciliary and hospital-based stroke rehabilitation. DOMINO Study Group. Age Ageing, 1994, 23(3): 241-245.
[117]Hensher M, Fulop N, Hood S, Ujah S. Does hospital-at-home make economic sense? Early discharge versus standard care for orthopaedic patients. J R Soc Med, 1996, 89(10): 548-551.
[118] Brazil K, Bolton C, Ulrichsen D, Knott C. Substituting home care for hospitalization: the role of a quick response service for the elderly. J Community Health, 1998, 23(1): 29-43.
[119] Melin AL, Hakansson S, Bygren LO. The cost-effectiveness of rehabilitation in the home: a study of Swedish elderly. Am J Public Health, 1993, 83(3): 356-362.
[120] Brown MG. Cost-effectiveness: the case of home health care physician services in New Brunswick, Canada. J Ambul Care Manage, 1995, 18(1): 13-28.
[121]Hedrick SC, Koepsell TD, Inui T. Meta-analysis of home-care effects on mortality and nursing-home placement. Med Care, 1989, 27(11): 1015-1026.
[122] Hughes SL, Ulasevich A, Weaver FM, Henderson W, Manheim L, Kubal JD, Bonarigo F. Impact of home care on hospital days: a meta analysis. Health Serv Res, 1997, 32(4): 415-432.
[123] Fleishman JA. Utilization of home care among people with HIV infection. Health Serv Res, 1997,32(2): 155-175.
[124] Kenny GM. Understanding the effect of PPS on Medicare home health use. Inquiry, 1991,28: 129-19.
[125]Nixon M. Hospital without walls. Canadian Family Physician, 1991, 57: 1709-1917.
[126]Stessman J, Hammerman-Rozenberg R, Cohen A. Home hospitalization in the spectrum of community geriatric care. Disabil Rehabil, 1997, 19(4): 134-141.
[127] Mauser E, Miller NA. A profile of home health users in 1992. Health Care Financ Rev, 1994, 16(1): 17-33.
[128] Meyer GS, Gibbons RV. House calls to the elderly—a vanishing practice among physicians. N Engl J Med, 1997, 337(25): 1815-1820.
[129]Campion EW. Can house calls survive? N Engl J Med, 1997, 337(25): 1840-1841.
[130]Soundappan A, Goodwin T, Greengold R, Siegler EL. How to get the most benefit from a changing home health care system. Geriatrics, 1997, 52(10): 83-86.
[131]Coleman B. New Directions for the State Long-Term Care System. 2nd ed. Public Policy Institute, 1998, AARP No. 9808.
[132]Normand C. Can an economic case be made for investing in health?. No, but it's the wrong question.Normand C. BMJ, 1998, 316(7147): 1762.
[133]Ashton CM, Kuykendall DH, Johnson ML, Wray NP, Wu L. The association between the quality of inpatient care and early readmission. Ann Intern Med, 1995, 122(6): 415-421.