| Object ives:(1) To explore the understanding of health workers on the mode of continuity of care and the patients’ demand of implementing the mode of continuity of care, then analyze the difficulties of its application on the elders with chronic illness.(2) To investigate the situation and demands of the nursing services for both urban and rural elderly people with chronic diseases in China.(3) To establish a service platform so as to provide clues of establishing the new care mode for the elderly patients.Methods:A cross-sectional study was carried out between July2010and February2011by questionnaire survey and semi-structured interviews.(1) Semi-structured interviews: in order to explore the understanding of health workers on the mode of continuity of care and the patients’demand of implementing the mode of continuity of care, a convenience sample of15health workers and elderly patients in urban and rural areas in Tianjin were interviewed in terms of the outline from July2010to February2011.(2) During October2010to February2011. another convenience and stratified sample of1902urban and rural elders with chronic illness from29provinces had been enrolled and investigated by the questionnaire made by researchers themselves so as to understand the situation and demands of the nursing services for the elderly patients in China.Results:1. Results of interviews:(1)Health workers were commonly lack of the knowledge of continuity of care:(2)There were mainly three aspects of difficulties in each process of implementing continuity of care in China.2. Results of investigations:(1) Utilization and degree of satisfaction of nursing services for elders with chronic illnesses:the choice of comprehensive hospitals (provincial hospitals and hospitals in cities), frequency to see a doctor and home care in the past year, and degree of satisfaction of the nursing services among the participants in cities were all higher than those in villages (χ2=150.151, P=0.000; F=3.723,P=0.024;χ2=19.471, P=0.000;F=11.405,P=0.000; χ2=95.175,P=0.000);(2) Demands of nursing services for elders with chronic illnesses:①The demands of psychological counseling and hospice care for the participants in cities and towns were higher than those in villages (χ2=13.205,P=0.001;χ2=39.308, P=0.000);②The demands of essential nursing care (including care of common chronic illnesses, periodic physical examinations, lectures of health care knowledge, dietary guidance, physical exercise guidance, guidance of correct application of drugs and disease counseling) for the participants in towns were higher than those in cities and villages (χ2=10.757, P=0.005;χ2=7.094,P=0.029; χ2=12.680. P=0.002;χ2=7.397,P=0.025; χ2=15.139,P=0.001; χ2=15.130,P=0.001;χ2=-10.245,P=0.006);③And the demands of pain management care for the participants in towns and villages were higher than those in cities (χ2=32.837,P=0.000).(3)The majority of the elders (72.1%) in the survey will choose community for subsequent recovery after discharge.(4) The patients’ physical, psychological health and economic status might be the influential factors.Conclusions:1. At present, continuity of care has not yet developed in China, and there were still some difficulties in implementing continuity of care in China.2. Endowment in community has become an inevitable trend and a key point in the procedure of continuity of care in China. Meanwhile, there are still lots of problems in our community health care services, so it remind relevant staffs that some measures should be taken to solve such situations.3. The service platform which was proposed in the study can help solve some social endowment problems in some degree and promote establishing the comprehensive elderly nursing service system eventually. |
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