Palti Hava, Gofin Rosa, Adler Bella
Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem.
Harefuah. 2004 Mar;143(3):184-8, 247.
Preventive services for prenatal and child health care were established 85 years ago by Henrietta Szold, president of the Women's Zionist Organization of America. A network of 1200 Mother and Child-Care clinics (known as "Tipat Halav") has developed as a result of this initiative. Preventive services are provided by the Ministry of Health, municipalities and recently, by all four Health Maintenance Organizations (HMO's) in Israel.
To assess the utilization and satisfaction of preventive health services during infancy.
The sample consisted of Jewish and Arab women who gave birth during March 2000. A total of 667 Jewish and 211 Arab mothers were interviewed after their infants reached the age of 15-19 months. The response rate was 92% and 88% respectively.
It was found that 96% of the Jewish women and 100% of the Arab women utilized "Tipat Halav" services. Preventive services were provided mainly by the Ministry of Health and municipalities, while HMO's provided service to 15% of the Jewish infants and 19% of the Arab infants. Nine percent of the infants were not, examined by a physician within the framework of the preventive service, but all infants had health supervision by a nurse. Overall, 25% of the Jewish infants and 32% of the Arab infants had 11 or more visits with the nurse. It was observed that mothers with a higher educational level and those with many children began the process of health supervision at a later stage and visited the clinic less frequently. The number of visits to all health services combined, from birth to 15-19 months, was 26 for Jewish and 28 for Arab infants, indicating over-utilization and dependence. However, the performance of hearing and vision tests was inadequate. Referral to orthopedics was 41% for Jewish and 11% for Arab infants. The level of satisfaction with the service was high, with scores mostly above 3.0 out of a maximum of a total of 4.0 points.
The preventive services provided by the different agencies do not differ significantly except in the case of private physicians and voluntary organizations in East Jerusalem, which do not comply with the recommended routines.
Our recommendations include raising the compliance and performance of screening tests and defining the policy of referral to orthopedic services. Furthermore, the clinics should provide more outreach to high-risk families in order to optimize their utilization of services and compliance.
85年前，美国犹太复国主义妇女组织主席亨丽埃塔·绍尔德创立了产前和儿童保健预防服务。作为这一倡议的成果，一个由1200家母婴保健诊所（称为“蒂帕特·哈拉夫”）组成的网络得以发展。预防服务由以色列卫生部、各市政当局提供，最近，以色列所有四家健康维护组织（HMO）也开始提供此类服务。
评估婴儿期预防保健服务的利用情况和满意度。
样本包括2000年3月分娩的犹太和阿拉伯妇女。在其婴儿达到15 - 19个月大时，共对667名犹太母亲和211名阿拉伯母亲进行了访谈。回复率分别为92%和88%。
发现96%的犹太妇女和100%的阿拉伯妇女利用了“蒂帕特·哈拉夫”服务。预防服务主要由卫生部和市政当局提供，而健康维护组织为15%的犹太婴儿和19%的阿拉伯婴儿提供服务。9%的婴儿在预防服务框架内未接受医生检查，但所有婴儿都有护士进行健康监督。总体而言，25%的犹太婴儿和32%的阿拉伯婴儿接受护士探访达11次或更多。观察到教育水平较高和子女较多的母亲在较晚阶段开始健康监督过程，且去诊所的频率较低。从出生到15 - 19个月，犹太婴儿和阿拉伯婴儿接受所有健康服务的总探访次数分别为26次和28次，表明存在过度利用和依赖情况。然而，听力和视力测试的执行情况不佳。犹太婴儿转诊至骨科的比例为41%，阿拉伯婴儿为11%。对服务的满意度较高，评分大多在满分4.0分中的3.0分以上。
除东耶路撒冷的私人医生和志愿组织未遵守推荐程序外，不同机构提供的预防服务差异不显著。
我们的建议包括提高筛查测试的合规性和执行情况，明确转诊至骨科服务的政策。此外，诊所应加强对高危家庭的宣传，以优化他们对服务的利用和合规情况。
