ABSTRACT
Objective To understand the status of service contract signing conducted by primary medical and health institutions.Methods A questionnaire survey and in-depth interview methods were used to study the service contract signing at primary health care institutions.Results The contract signing rate of the institutions surveyed was 1 9.1%,and valid contract signing rate was 76%.Senior people above 65 years old accounted for 33.5% of those signers,while hypertension patients accounted for 1 9.5% and diabetes patients for 10.6%.Interviews to the general practitioners team at the primary health institutions found that main factors affecting residents′ intention to sign were drug availability, attraction for signing the services,treatment habits among others.Interviews to the staff the primary health institutions found that contracted services are facing such difficulties as medical staff shortage,lack of motivation,lack of competence among others.Interviews to leaders of the primary health institutions found that the lack of publicity and support of medical insurance also has great influence to service contract signing.Conclusions The enthusiasm of general practitioners and residents to sign up for the service remains to be improved.
ABSTRACT
Objective:To investigate the effects of sign-contract services on hypertension patient disease control and the satisfaction of medical staff. Methods:a face-to-face questionnaire survey was conducted among hypertension patients selected from 20 primary health centers in 10 provinces in China. Results:This paper collected 1 ,881 valid questionnaires, and the average age of the population was 65. 72 ± 10. 88. Respondents that received sign-contract services accounted for 53. 88%, and there was no difference between patients who signed the service contract and who did not in terms of demographics. In self-reporting of blood pressure controls, respondents who signed the service contract, aged 40~50 years old, enjoyed the free medical care, preferred to seek medical services from primary a-gencies ( i. e. community health centers and township hospitals) for minor illnesses, controlled their blood pressure better ( P<0. 05 ) . Respondents enjoyed the civil resident medical insurance, preferred to seek medical care from community health centers for minor illnesses and signed the service contract were more likely to be satisfied with their medical practitioner (P<0. 05). After adjusting for age, gender, education level, medical insurance style, patient willingness to seek medical care for minor illnesses, signing service contracts was found to be an independent factor both associated with blood pressure self-control and attitudes towards medical service providers, with the odds ratio of 3. 007 (95%CI:2. 572 -3. 517) and 1. 814 (95%CI: 1. 563 -2. 105) respectively. Conclusion: Contracts are correlated with blood pressure control and satisfaction toward medical practitioners, which means that patients who signed the service contract control their blood pressure better and are more satisfied with their medical deliverers.
ABSTRACT
Objective To investigate the correlation between serum homocysteine (Hcy) and macrophage migration inhibitory factor(MIF) with carotid atherosclerosis and between serum Hcy and MIF ,and to study whether serum Hcy influence the carotid atherosclerosis formation by MIF .Methods 258 inpatients and outpatients were performed the color ultrasound examination to ob-serve the carotid arterial vascular anatomic form ,endomembrane circumstance ,plaque and the plaque echo nature ,and the carotid in-tima-media thickness(IMT) was measured .According to the results of color ultrasound ,the cases were divided into three groups :IMT normal group(control group) ,thickening group and plaque group .According to the plaque echo characteristics ,the plaque group was redivided into two subgroups :stable plaque group and unstable plaque group .Serum Hcy and MIF levels and biochemical parameters were measured simultaneously in all cases .The differences of serum Hcy and MIF levels were compared between groups .The correlation coefficients among serum Hcy levels ,MIF levels and IMT were calculated .Results The serum Hcy and MIF levels in the control group ,thickening group and plaque group were increased in turn ,the difference among groups was statisti-cally significant(P<0 .01);which in the unstable plaque group was significantly higher than that in the stable plaque group ,the difference between them was statistically significant (P<0 .01) .The positive correlation was found among serum Hcy levels ,serum MIF levels and IMT (r=0 .584 ,0 .562 ,0 .607 ,P<0 .01) .Conclusion The serum Hcy and MIF levels are closely related with the carotid atherosclerosis degree and the plaque stability ;the serum Hcy and MIF levels are positively correlated with the carotid arte-rial IMT ;serum Hcy is positively correlated with the MIF level ,Hcy may cause the carotid atherosclerosis formation via MIF .