The Future of Community Health Services

The authors welcome a constructive debate on the future of community-centred health services. Therefore, we have written this piece in response to an article published by Cunningham in the previous edition of the Australian Health Review (Cunningham, Australian Health Review 2012; 36: 121–124), which was a very limited analysis and misleading critique of our previous contribution to this journal (Rosen et al. Australian Health Review 2010; 34: 106–115). The focus here is necessarily brief and does not stand in for a detailed analysis of the evidence base. The aim instead, is to draw attention back to the broader political, economic and social dimensions of how the retreat from community health services has affected clinical care. We also outline a response to a longstanding assumption, or belief, that ‘too many hospital beds are not enough’ and may never be enough. How we understand the problem of resource allocation in healthcare shapes the remedies that are considered realistic. We explain that the reasons for the systematic underdevelopment of community health services are complex, historical, and largely relate to political and economic factors, but they are still amenable to change. What is known about the topic? There is a growing evidence base and consensus of expert opinion supporting the gradual shift in health service delivery away from hospital-based models of care to community-centred ones. Wherever possible, speciality community health services should be co-located with primary health care in communal shopping and transport hubs so that patients have access to ‘one-stop-shops’ providing both primary healthcare and community treatment, and support services. It is important that these speciality community health services retain their integrity and control of their budgets, but also that they maintain functional integration with their respective hospital-based services. What does this paper add? In response to a recently published vigorous but narrowly targeted critique of community-based models of care, we explore the wider context of the debate about the appropriate balance between hospital and community health services. We pay particular attention to the current debate in mental health services. What are the implications for practitioners? Clinicians need to understand the historical, political and economic factors that have influenced the underdevelopment of community-centred health services, so as to avoid unhelpful conflicts between specialists and those working in different care settings. Rear-guard attempts to restore the dominance of hospital-centric services are unsustainable in terms of ethics and economic reality. Policy-makers and health planners should instead aim to rebalance resources in the health sector so that people in all age groups and regions have equitable access to the full range of human health and support services across the continuum of care.

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Current status of antenatal care of pregnant women—8 provinces in China, 2018

BMC Public Health ◽

10.1186/s12889-021-11154-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wenling Hu ◽

Huanqing Hu ◽

Wei Zhao ◽

Aiqun Huang ◽

Qi Yang ◽

...

Keyword(s):

Health Services ◽

Antenatal Care ◽

Pregnant Women ◽

Community Health ◽

First Trimester ◽

Community Health Services ◽

Current Status ◽

Categorical Variables ◽

Chi Square ◽

Prenatal Care Visit

Abstract Background Antenatal care (ANC) played a crucial role in ensuring maternal and child safety and reducing the risk of complications, disability, and death in mothers and their infants. The objective of this study was to evaluate the current status of ANC emphasizing the number, timing, and content of examinations on a national scale. Methods The data was collected from maternal and newborn’s health monitoring system at 8 provinces in China. After ethical approval, all pregnant women registered in the system at their first prenatal care visit, we included 49,084 pregnant women who had delivered between January 1, 2018 and December 31, 2018. Descriptive statistics of all study variables were calculated proportions and chi-square for categorical variables. Results Of the 49,084 women included in this study, the mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% women received ANC examinations at least five times, 39.93% of the women received ANC examinations at least eight times and 16.66% of the women received ANC examinations at least 11 times. The proportion of first ANC examination in first trimester was 61.87%. The percentage of normative ANC examinations and the percentage of qualified ANC examinations were 30.98 and 8.03% respectively. Only 49.40% of the total women received all six kinds of examination items in first ANC examination: 91.47% received a blood test, 91.62% received a urine test, 81.56% received a liver function examination, 80.52% received a renal function examination, 79.07% received a blood glucose test, and 86.66% received a HIV/HBV/syphilis tests. 50.85% women received the first ANC examination in maternal and child health care (MCH) institutions, 14.07% in a general hospital, 18.83% in a township hospital, 13.15% in a community health services center, and 3.08% in an unspecified place. The proportion of women who received each of the ANC examination items in community health services center was the highest, but that in the MCH institutions was the lowest. Conclusions There is a big difference between the results of this study and the data in official reports, this study found the current status of antenatal care is not optimal in China, findings from this study suggest that the systematization, continuity and quality of ANC examinations need to be improved.

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A Concept of Community Health Services

New England Journal of Medicine ◽

10.1056/nejm195808142590705 ◽

1958 ◽

Vol 259 (7) ◽

pp. 327-330

Author(s):

Samuel B. Kirkwood

Keyword(s):

Health Services ◽

Community Health ◽

Community Health Services

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Patient experience surveys for children’s community health services: A scoping review

Journal of Child Health Care ◽

10.1177/13674935211005874 ◽

2021 ◽

pp. 136749352110058

Author(s):

Helen J Nelson ◽

Catherine Pienaar ◽

Anne M Williams ◽

Ailsa Munns ◽

Katie McKenzie ◽

...

Keyword(s):

Health Care ◽

Health Services ◽

Community Health ◽

Patient Experience ◽

Scoping Review ◽

Emotional Support ◽

Community Health Services ◽

Experience Of Care ◽

Healthcare Experience

Patient experience surveys have a user focus and measure the quality of person-centered health care for hospital inpatients and consumers of community health services, providing a governance process to evaluate the quality of care and to action improvement. Experience of care has been described as effective communication, respect and dignity, and emotional support. Measurement criteria for these domains are not standardized, leading to inconsistent reporting of patient experience. The objective of this scoping review was to synthesize evidence for measuring experience of care in children’s community health services using the Joanna Briggs Institute framework for scoping review method. Three parent-reported surveys met the inclusion criteria, and 50 survey items were assessed by expert reviewers for fit to domains of healthcare experience. Conceptual domains of parent experience in children’s community health services included respect and dignity, effective communication, and emotional support. A gap was identified, in that few items in identified surveys measured emotional support. This contribution will promote consistent reporting of healthcare experience, informing policy and practice for person-centered health care.

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