The Current Situation And Countermeasures Of Supply And Demand Of Medical Services In Community Health Institutions Under The Mode Of Home Care

Objective:To understand the current services of community health services providing for the elderly,the needs of the elderly for community health services,and the constraints of service supply and demand.Methods:Questionnaire surveys and interviews were used to survey the elderly living in communities over the age of 60 and to understand their current status,evaluation,and service needs of community health services.The interviews were mainly targeted at the relevant person in charge of the community health service organization.It aimed at understand the current situation of services provided by service organizations for the elderly and the model for community to provide medical care services for elderly people living in homes.Results:Community health service utilization:About 40%of the elderly went to at least 1-2 times to community health service institutions or more.It mainly based on prescribing,disease diagnosis and physical examination,and rehabilitation training,Chinese medicine health care and other relatively small proportion.Of the elderly people who went to community health institutions after illness,more than 90%of the elderly could walk or ride within 30 minutes.Among the elderly who went to the community after getting sick,the number of people who chose to stay in the hospital was small.As for the evaluation of community health service organizations,the reasons why older people did not choose to visit a community health service was the doctors' level,followed by not having the necessary inspection equipment and fewer types of drugs.15%of the elderly said that their community had a day care center,and more than 80%of the elderly said they did not know or were not clear.Multivariate analysis showed that the number of chronic diseases(P<0.05)was the main influencing factor for evaluating the service satisfaction of community health institutions in the elderly.The regression analysis results showed that older people whose income level was lower(P=0.0009,OR=2.12),whose medical cost accounted for a higher proportion of total income(P=0.018,OR=0.5)and who lived together with the spouse of the children(P=0.01,OR=1.76)were more likely to rely on community health service agencies to solve their medical needs.The elderly in the 70-79 age group and the elderly with more than three chronic diseases have the highest utilization rates in community health service organizations.In terms of service demand,the elderly want community health service providers to provide regular physical examination(81.10%),disease diagnosis and treatment(59.36%),preventive health care(57.94%),rehabilitation care(44.23%),delivery of medicines(40.36%)The demand for family beds(30.81%),generation of fried Chinese medicine(28.36%)and psychological counseling(26.09%)are relatively small.As for the ways in which health service providers provide services,it tends to be higher for doctors regularly visiting(53.31%)and directly to the community(52.84%).31.38%of the elderly people hope that they can be served by professional caregivers.29.49%of the elderly people want to provide geriatric disease community lectures.26.09%of the elderly people want the community to have a 24-hour family doctor.Older people most agreed with caregivers trained by community health service organizations(58.880%),followed by trained family members(27.22%),and social agencies had the lowest proportion of caregivers(2.65).The level of daily care center fees that seniors can accept is mostly below 2,000 yuan.The acceptance rate of on-site service charges,the acceptance of hospitalization in community health service institutions,and the acceptance level of health care services for traditional Chinese medicine,etc.,are acceptable to more than half of the population,but they are influenced by factors such as education level and household income.Conclusion:It is feasible for community health service agencies to provide maintenance services for home-based caregivers,at the same time,it is also constrained by many factors.There is a need for more policy support and tilt at the national level.More attention is paid to community health service agencies providing elderly care services.Standards are formulated and appropriate rights are delegated,including nursing personnel training and certification,service standard fees,etc.At the same time,the construction of long-term care insurance system should be expedited.At the community level,it is necessary to strengthen community service capacity building,provide diversified nursing services,and explore appropriate technologies for community care and necessary Chinese medicine services to meet the maintenance needs of the elderly at home.