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The system of first contact in community health institutions, as the core element of hierarchical di-agnosis and treatment system, is of great importance for reforming successfully China’ health service system. The sys-tem of first contact in community health institutions implemented among labor workers in Shenzhen City plays an im-portant role in patients ’ distribution and the interested parties can accept this mandatory system. Campared with Shenzhen City, the level of services is enough to meet patients’ primary health demands in some cities which the com-munity health service develops well, and it should be thought highly of the mandatory in the process of policy imple-mentation in order to ensure the implementation effect.
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Objective To measure the costs of primary health services in the community for developing government compensation standard and prediction of budget in 201 5.Methods Literature review and panel discussions were used to build the index database.A two-round Delphi expert consultation determined the work to do and steps for community healthcare standards.60 community health centers were sampled by stratified random sampling for survey,and the work hours,workload and service volume of respective services in 2013 were measured according to the service standards of primary care.Results The community primary care consists of the categories of outpatient services,nursing care, laboratory tests and drug management,totaling 20 services and 88 working procedures.The total work hours of primary healthcare service at 60 community health centers were 2 557 187.9 hours,which is adjusted to 2 959 21 5.1 hours based on workload coefficients.Based on the income standards of employees at the community health centers investigated,and the human cost price which was recommended by the experts,the total costs of primary healthcare of the 60 centers were 245 million,248 million and 318 million respectively,and the average cost was 71.0 yuan,71.8 yuan and 92.1 yuan per visit respectively.By such standards,the government should subsidize 38.9 ~ 60.0 yuan per visit to the centers.The total expenditure of primary healthcare of all communities in Shenzhen in 201 5 was predicted to be 314 to 407 million,for which the government is expected to subsidize 1.68~2.58 billion.Conclusion The subsidies for community primary healthcare fall short as the cost per visit runs up in 2013 to 71.0 yuan per visit or more,far above the current subsidy of 32.1 yuan per person.The subsidy per visit should be made 50.0 yuan in 201 5.
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Background:Helicobacter pylori (Hp)infection is correlated with the development of chronic gastritis,peptic ulcer, mucosa-associated lymphoid tissue lymphoma and gastric cancer.Studies showed that Lactobacillus acidophilus could improve the eradication rate of Hp and reduce the occurrence of side-effects.Aims:To evaluate the efficacy of compound Lactobacillus acidophilus tablets combined with bismuth-containing quadruple therapy for the treatment of failed eradiction of Hp infection.Methods:One hundred and eighty patients with Hp-positive peptic ulcer in whom standard triple therapy failed were enrolled and then randomly assigned into experimental group and control group.Patients in experimental group received compound Lactobacillus acidophilus tablets 1 g tid for 14 days,followed by rabeprazole 10 mg bid +amoxicillin 1 000 mg bid +furazolidone 100 mg bid +bismuth 300 mg qid for 10 days.Patients in control group received rabeprazole 10 mg bid +amoxicillin 1 000 mg bid +furazolidone 100 mg bid +bismuth 300 mg qid for 10 days.13 C-urea breath test was conducted at least 4 weeks after completion of the course,Hp eradication rate and side-effects were evaluated. Results:No significant differences in PP eradication rate and ITT eradication rate were found between experimental group and control group (PP:81.2% vs.78.2%,χ2 =0.241,P =0.623;ITT:76.7% vs.75.6%,χ2 =0.031,P =0.861).Incidences of nausea and vomiting (2.4% vs.11.5%),diarrhea (0 vs.9.2%)in experimental group were significantly decreased than those in control group (P <0.05).Conclusions:Compound Lactobacillus acidophilus tablets combined with bismuth-containing quadruple therapy is efficient for Hp-positive patients with failed standard triple therapy and can reduce side-effects.
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Objective To evaluate the therapeutic efficacy and safety of endoscopic sphincterotomy (EST) combined with large balloon dilation for bile duct stones.Methods A total of 83 patients with common bile duct stones were randomly divided into 2 groups to receive standard EST (n =41,EST group) or EST plus large balloon dilation (n =42,EPLBD group),respectively.The number of endoscopic session,operation time,rates of successful complete stone retrieval,mechanical lithotripsy,and procedure related complication were compared between the two groups.Results The rate of early procedure-related complications was similar in 2 groups (9/41 vs.7/42,P ＞0.05),including perforation ( 1/41 vs.0/42,P ＞0.05),bleeding (5/41 vs.2/42,P＞0.05) and pancreatitis (3/41 vs.5/42,P＞0.05).The rate of successful complete stone removal was also similar in 2 groups (39/41 vs.41/42,P ＞ 0.05 ).However,EST group needed more procedure time (38.8 ±4.3 min vs.29.2 ±5.3 min,P ＜0.01 ) and use of mechanical lithotripsy to achieve complete stone removal (9/41 vs.2/42,P ＜ 0.05 ).Only one patient in EPLBD group ( 1/42,2.4％ ) needed a second ERCP to clear bile duct stone,while in EST group,8 patients underwent a second procedure ( 19.5％,P ＜ 0.05 ).Conclusion For endoscopic removal of common bile duct stones,EST combined with larg4e balloon dilation is as safe and effective as EST,while easier in manipulation.
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Objective To evaluate impacts of Community Health Reform Pilot in Bao'an District,Shenzhen,on the staff satisfaction in community health centers.Methods Guanlan and Xixiang Street were chosen as treatment group and Songgang Street as comparison group.Date that one year before and after community reform was retrieved from Electronic Information System both from two groups.Double Differences was employed to estimate the impacts of intervention on the staff satisfaction.Results Community Health Reform program resulted in relieving staff financial stress and occupational stress by 42.4％(P＜0.001)and 46.4％ (P＜0.001)respectively and increasing the sense of equity,the sense of achievement,job satisfaction by 67.7 ％ ( P ＜ 0.001 ),54.5 ％ ( P ＜ 0.001 ) and 14.4 ％ ( P ＜ 0.05 )respectively.Conclusion The community reform in Bao 'an district has impact on increasing job satisfaction in treatment group.
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Objective To investigate the preventive and therapeutic effects of nonsteroidal anti-inflammatory drugs ( NSAIDs) via rectum for hyperamylasemia and pancreatitis after ERCP (endoscopic retrograde cholangiopancreatography).Methods Sixty patients who underwent ERCP for various reasons were randomly divided into preventive and control groups.In addition to routine diazepam (10 mg) and anisodamine (10 mg) given intramuscularly in both groups before ERCP, 100 mg of indometacin suppositories was administered by rectum in preventive group.Serum amylase level was measured before and 6 hours and 24 hours after the procedure.Results Serum amylase levels at 6 hours after ERCP in preventive and control groups were (367.5 ± 268.7 ) U/L and (1034.2 ± 713.5 ) U/L, respectively ( P < 0.05 ), which were (324.9±142.3)U/L and (826.8 ±395.7)U/L, respectively, at 24 hours after ERCP (P<0.05).Conclusion Rectal use of NSAIDs can prevent hyperamylasemia and acute pancreatitis induced by ERCP.