| Objective To survey comprehensive situation about the elderly with chronic diseases, their needs including medical care, rehabilitation, nursing care as well as caring of them in daily life, and above services supply in different levels of medical facilities and nursing homes in Henan province. By analyzing the reasons why these supplies are insufficiency compared with multiple demands of the elderly with chronic diseases. For exploring effective ways on high quality medical resources allocation in general public hospitals. Along with series policies and salary payment reform to create the methods of training and monitoring, enhance the skills and performance to the staff who works in grass-level.To ensure the senior citizens with chronic diseases could be stayed in the communities or at their own house as long as possible. The benefits are to satisfy their emotional needs and living memory awaken in their familiar environment where could make up the deficiencies from social support system. Further more, to ease the pressure on family caregivers and improve theirs experiences and their quality of life. Above can be provided foundation and reference for local government to build the system about continuous professional services in medicine, rehabilitation, nursing care even long-term care policies made to the elderly with multiple chronic diseases.Methods Multistage sampling method was used in institutions from 18 regions where was divided into 5 layers(grade 3-level hospital, grade 2-level hospital, grade 1-level hospital, community center and public nursing home) based on 2014 Henan Provincial Statistical Yearbook. With a random number table, each institution was randomly selected from each layer from 18 local areas. According to information system of national health statistics from provincial health authorities and information system of social aged care services and development from provincial civil affairs department. Relevant data were collected on 90 institutions which including general information, running conditions, human resource allocation, medical resources, etc. Then 10 elderly person with chronic diseases and 10 staff were chosen randomly from each facility. Two self-made questionnaires were used to survey, one about needs in daily of the elderly with chronic diseases, another about theirs willingness involving relevant services to staff respectively, at same time, scores of ADL and self-rated health were calculated for being selected elderly with chronic diseases. Epidata3.1 and SPSS18.0 were employed for data entry and analysis.Results1.The status of supplying services in different facilities(1) Relevant occupational department designed on aged care showed incomplete or absent completely. There was only one grade 3-level hospital had built general medicine unit, the others had not carried out standardized training for general practitioners. The development of geriatrics far away from social demands.Only 11.1% of public general hospital established aged clinic or geriatric ward. Department of nutrition, psychiatry, terminal illness care and palliative care units were serious shortage, especially in psychiatry and palliative care. 66.7% of the nursing homes had owned clinic, 83.3% nursing station were built but relevant equipment had no put there. Emergency alarm device was installed for the elderly only one nursing home(2)Almost all facility was showed deficient on professional staff allocation. They had poorer education in community centers, grade 1-level hospitals than in grade 2-3level hospitals generally. There were serious shortage in registered nurses manpower.And daily work on pharmacists majored in prescription non for guiding in medicine or prescription audit in clinic fields. Among 16 dietitians,15 were come from registered nurse and they never dealt with nutrition matching and focus on food consulting. There was no medical staff original specialized in psychiatry. The doctors of Traditional Chinese Medicine rarely did comprehensive assessment and rehabilitation conducted to the older patients. Almost facility has no purely general practitioner, and less or no multidisciplinary teams recently. Their average satisfaction about being their daily work showed 26.6% in grade 3-level hospitals, 23.7% in grade 2-level hospitals, 32.1% in 1-level hospitals, 55% in community centers and 41.5% in public nursing home. Much more staff were unwilling to involve in aged care, 49% in community centers and 53.2% in nursing homes. Influence factors including overloaded work, lower salary payment and less support from society. 15.4% staff didn’t know what is Patient Classification System and up-down give way referral, which 12.8% worked in nursing homes.(3)Busier and quieter unbalance in different level health facilities.Nearly 40% health care facilities and 83.4% nursing homes occurred financial deficiency. Reasons showed infrastructural construction more investment in big public general hospitals,and fewer patients to see a doctor in community center. All grade 3-level public general hospitals were covered by emergency network.About 90%institutions could ensure instantly calculated medical insurance and reimbursed in different places. Trust crisis between patients and staff in community centers is more popularly.Less illness history and referral to the elderly patients was recorded in services system. The referral rates from grade 1-level hospitals,grade 2 and grade 3 hospital separately showed 118.6:1,15.6:1and 16.9:1. The rate was correlated with the grade of hospitals due to no rule about patient classification system.Only 11.1% facility health management has taken to the elderly with chronic disease. Resident health documents had been built in community services centers basically but no tracking and fellow up.2.Comprehensive information about demands to the elderly with chronic diseases.The elderly 34.3% had poor health status with different level disability and dementia, and 48.5% with two or more chronic diseases. theirs caregivers were in middle age or over 60 years old, 25.7% with two or more chronic diseases. 95.75% the elderly with chronic diseases eager to obtain medical service and daily life care at theirs own house. Top 10 needs from them showed 95.29%with knowledge related to health maintain, 94.59% with timely emergency care, 80.32% with guidance on medication safety, 77.81% with rehabilitation, 68.20% with providing hospitalized services in the home, 67.35% with physical examination regularly, 63.10% with hold self-management in chronic diseases, 51.80% with assisted to see a doctor and referral, 48.91% with 24 hours hot line for health advisory, and 45.05% with training for their home caregivers. The priority choice 78.28% from the elderly showed grade 3-level hospitals when they happened urge disorder. 21.73% of the elderly preferred to nearby health care institution, 77.47% were likely to back home for rehabilitation, Be chosen into nursing homes only 3.33%. More than half were selected patients expressed the expense for medical care over their family income level. 77.22% of them were satisfied with the medical insurance and pension. But 69.54% they hoped local government could provide affordable aged care services in community and residential facility as well as 19.43% look forward to receive subsidies for caregivers cared of them at their own house.Conclusions1.Along with the population aging rapidly and empty nest popularly, co-exist about professional resources definitions,unbalance allocation and no efficient use in local area such as medicine,rehabilitation and aged care.Less or absence in relevant geriatric department involving in general practitioners, aged clinic, geriatric ward,Department of nutrition, psychiatry, terminal illness care and palliative care because of lower financial support to public hospital from government, lack of professionals specialized in aged primary care, theirs skills and knowledge couldn’t be trusted by residents.2.Theirs needs are relatively stable for the elderly with multiple chronic disease in occupational services including medicine,rehabilitation,aged care and in daily life services like washing,clothing,food etc,but philosophy, ability and technical about services from staff who works in different facility,Heavier workload, lower payment, the different social position, limited development for career which lead to the unwillingness to serve for the elderly with chronic disease, unbalance between services supplying and patients needs in care fields,contradiction can not to alleviate for long time.3.Based on the experience of developed countries and local culture, to limited expansion of public general hospital and rebuild a organic model about medical care continuously, rehabilitation and aged care to make high quality resources flow vertically, promote the skills and ability for primary care, addition financial support and payment reform,a perfect legal guarantee system providing same quality,affordable,useful services to meet individual multiple needs in community and theirs own house.The social problem would be solved to ensure four wins,which is hospital, family, society and individual with chronic disease could benefit permanently. |
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