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1.
Article in Chinese | WPRIM | ID: wpr-934579

ABSTRACT

Objective:To evaluate the barrier-free level of village clinics of a city in the aging era, for references in improving the barrier-free medical environment for the elderlies.Methods:The village dectors of 156 village clinics in 12 counties of a city were selected as the objects of a questionnaire survey from Dec.2020 to Jan.2021, with 6 evaluation indexes established, each set with 1-10 points. This questionnaires was used to survey the barrier-free construction levels of village clinics. The data were statistically analyzed by rank sum ratio and quadrant graph model.Results:The barrier-free buildings of such clinics scored 32.86 points in average. Among the six indexes, the barrier-free access and doors(7.21 points) scored the highest, and the barrier-free parking space(4.71points) and toilets(3.28 points) scored the lowest. All the counties of the city fell into four categories, including 2 counties with high degree of aging-high level of accessibility, 4 counties with low degree of aging-high level of accessibility, 4 counties with low degree of aging-low level of accessibility, and 2 counties with high degree of aging-low level of accessibility, according to the quadrant graph model built based on the aging degrees and the barrier-free levels of village clinics.Conclusions:The barrier-free level of the village clinics in a city needs to be further improved, and the barrier-free transformation of parking space and toilets should also be strengthened in the future. The government should take different measures in view of conditions of each county to improve the accessibility of village clinics and facilitate the health care-seeking of elderlies.

2.
Article in Chinese | WPRIM | ID: wpr-912845

ABSTRACT

Objective:To evaluate and analyze the patient experience of residents contracted with primary medical institutions, for providing a basis for improving quality of contracted family doctor services.Methods:Using the Chinese version of the primary care assessment tools(PCAT), a household survey was conducted on 1 400 contracted residents in 9 community health service centers and 9 township health centers in a city from May to June 2020, and their medical experience in primary medical institutions was statistically analyzed. At the same time, interviews were conducted with institutional managers and family doctors. Descriptive statistics and one-way ANOVA were used for data analysis.Results:1 333 valid questionnaires were collected, and the effective recovery rate was 95.2%.The total PCAT scoring was 25.17. Seven dimensions of first contact, continuous, coordination, comprehensiveness, patient and family centered, community-oriented and cultural competence scored in average 3.57, 3.68, 3.54, 3.40, 3.72, 3.67 and 3.59 respectively.372 people(47.1%) had not been referred by the contracted institution before going to the superior hospital or specialized hospital. There were significant differences in the scores of four core dimensions in different types of institutions, age, education level, occupation and income( P<0.001). Conclusions:Given the initial progress of contracted family doctor services in the city, there is still room for improvement. It is suggested to further improve the comprehensiveness, coordinationand accessibility of services, and promote the high-quality development of contracted family doctor services.

3.
Article in Chinese | WPRIM | ID: wpr-912833

ABSTRACT

Objective:To explore the current status of medical preventive integration at primary medical institutions, analyze the problems of medical prevention integration, and put forward optimization suggestions.Methods:From June to July 2020, 169 primary medical institutions in a city were selected as the survey objects to conduct a questionnaire survey on the basic information of institutions and the evaluation indicators of medical preventive integration. The evaluation index system of medical preventive integration was divided into a factual survey and a sensory survey. In addition, 32 relevant personnel were interviewed on the current situation of medical preventive integration at primary medical institutions. The reliability and validity of the data were tested and analyzed, while descriptive analysis and classification extraction analysis were carried out.Results:The reliability and validity analysis proved the data reliability. The factual survey extracted three common factors, namely organization management, performance appraisal distribution and information management. The sensory survey extracted two common factors, namely working mode and personnel training. In terms of organization, management and working methods, the degree of medical preventive integration was low. Among them, 53.8% of the institutions had formulated the medical preventive integration norms, and only 41.4% of them had shared residents′ health information in time.Conclusions:The degree of medical preventive integration of primary medical institutions in the city still need to be improved. In the future, we should strengthen the top-level design, establish the norms and cooperation mechanism of medical preventive integration, improve the awareness of medical preventive integration of medical personnel, improve the information level, and to build a new service model integrating disease prevention, medical treatment and health management.

4.
Article in Chinese | WPRIM | ID: wpr-912828

ABSTRACT

Objective:To understand the willingness of contracted residents to renew the family doctor contract service in Shandong Province, and to explore its influencing factors.Methods:From July to August 2020, 1 500 contracted residents in 3cities of Shandong Province were investigated by questionnaire survey.Descriptive statistical analysis, Mann-Whitney U test and binary logistic regression model were used to analyze the contracted residents′ cognition, utilization, satisfaction evaluation and renewal intention of family doctor contract service. Results:1 445 valid questionnaires were obtained, of which 682(47.2%)were willing to renew their contracts.The results of binary logistic regression analysis showed that marital status, educational level, time to see a doctor in contracted institutions, optimism about the development prospect of contracted service policy, whether the proportion of medical insurance reimbursement increased after signing the contract, whether follow-up work was carried out on time, satisfaction with family doctor service attitude and satisfaction with the effect of disease treatment were factors affecting the willingness of contracted residents to renew the contract.Conclusions:The contracted residents in Shandong Province have a high willingness to renew their contracts. On the basis of consolidating and improving the policy cognition and confidence of the contracted residents, we should actively optimize and improve the contracted service quality, ensure the sense of service access of contracted residents, and continuously and effectively realize the comprehensive promotion of the contracted services of family doctors.

5.
Article in Chinese | WPRIM | ID: wpr-912753

ABSTRACT

Objective:To analyze the cognition and willingness of family physicians on contracted service, and to explore the implementation obstacles and feasible strategies of implementing contracted service of family physicians from the perspective of suppliers.Methods:From July to October 2020, 850 family physicians in community health service centers or township health centers in three cities of Shandong Province were investigated by questionnaire survey and key person interview. Descriptive analysis and binary logistic regression model were used to analyze the willingness of family physicians to provide contracted service. Through questionnaire survey and key person interview, the implementation obstacles and service optimization strategies of family physicians were discussed.Results:791 valid questionnaires were obtained, of which 688(87.0%) approved the implementation of family physician contract service, and 679(85.8%) expressed willingness to provide family physician contract service. Marital status, recognition of service policy, satisfaction of service operation effect, optimistic degree of service development prospect and residents′ first choice of illness were the factors influencing family physician′s service willingness.Conclusions:We should effectively improve the family doctor′s service intention and promote the efficient and orderly implementation of family doctor′s contract service policy through enriching policy supporting measures, innovating the application of " Internet plus" , increasing personnel training, optimizing performance appraisal work and creating favorable public opinion environment.

6.
Article in Chinese | WPRIM | ID: wpr-912698

ABSTRACT

Objective:To analyze the grid management strategy of medical alliances in Rizhao city, Shandong province, and to provide references for improvement of this policy.Methods:In August 2020, semi-structured interviews were conducted with 31 managers of three medical alliances in Rizhao city, regarding the objectives, specific measures, problems and influencing factors of the grid layout of the medical alliances. The grounded theory was used to sort out the interview data, along with the Mazmanian-Sabatier model for further analysis.Results:The analysis resulted in 8 main categories and 19 sub-categories, including theoretical and technical support, target group characteristics, policy causality theory, current status of policy directives, inter-agency relations, socioeconomic conditions and technology, public attitudes, and media campaigns. On this basis, a theoretical framework for the implementation of the grid layout of medical alliance was formed based on the Mazmanian-Sabatier model.Conclusions:The socio-economic conditions and technologies for implementing the grid-based management of medical alliances in Rizhao city were relatively mature, enjoying strong public support and good social response. But on the other hand, there were still such problems as unclear policies, imperfect mechanisms for synergy of interests among different subjects, and incomplete supporting policies. In the future, it is expected to form a policy implementation synergy, introduce supporting policies and strengthen primary teams building, in order to ensure the orderly promotion and long-term implementation of the policy.

7.
Article in Chinese | WPRIM | ID: wpr-934528

ABSTRACT

Objective:To describe the content and analyze the constitutive dimensions of the psychological contracts with residents contracted for family physician services.Methods:Based on a collection of policy documents on family doctor contracting services issued by central government ministries and relevant departments in Shandong province as well as 27 signed family doctor agreements in nine counties (cities, districts) of Shandong province, semi-structured interviews were made to 48 residents in both September 2019-January 2020 period and May-June 2020 period, regarding the verbal promises of family doctors and the needs of these contracted residents. Then the documented and non-documented commitments of the family doctors were extracted in the content analysis method, and a credibility test was made using the Myers reliability test formula.Results:A total of 639 written commitments of family doctors were obtained, covering 5 types of responsibilities and 20 commitments, and the credibility coefficient was 0.88. 322 codes of non-documented commitments were obtained, 4 commitments were added on the basis of documented commitments, and the credibility coefficient was 0.90. The psychological contracts were sorted out in such five areas as technical quality responsibility, cost control responsibility, convenient access responsibility, communication responsibility, and empathic responsibility, by matching the residents′ medical service needs obtained from the interviews, while the first three categories and the last two categories were classified as transactional and relational psychological contracts, respectively, with 10 items of technical quality responsibility accounting for the highest percentage (41.67%).Conclusions:The documented and non-documented commitments of family doctors differed in content and structure. The psychological contract signed by residents was mainly transactional, and residents had higher expectations for family doctors to provide high-quality, convenient and economical services.

8.
Article in Chinese | WPRIM | ID: wpr-934526

ABSTRACT

Objective:To analyze problems found in the implementation of the appointment registration system at public hospitals in China under the new situation, and provide a reference for the improvement and development of the system.Methods:Documents on appointment registration system published before December 31, 2020 were collected through the databases of CNKI, Wanfang, VIP and other official websites such as the National Health Commission. The Smith-Model was used as the main analysis framework in a systematical sorting and analysis of the implementation of the appointment registration system of public hospitals, in such means as qualitative interviews with relevant managers, doctors and residents and PEST analysis method.Results:The appointment registration system of public hospitals was highly idealized in its design, but there existed policy deficiencies in system standards, implementation effectiveness and supporting systems; and there were various problems in policy cognition, acceptance and implementation with its implementation agencies and target groups. Environmental factors such as politics, laws, economy, social culture and technology also posed negative effects on the implementation of policies.Conclusions:There were still some problems in the implementation of the appointment registration system in public hospitals, such as imperfect system standards, different implementation efforts in different regions, imperfect incentive and economic compensation mechanisms, and it was difficult to change residents' traditional ideas.Targeted strategies and measures should be taken regarding the policy makers, health administrative departments, business institutions, patients and environmental factors to ensure the continuous and effective implementation of the system in the future.

9.
Article in Chinese | WPRIM | ID: wpr-798670

ABSTRACT

Objective@#To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform.@*Methods@#Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity.@*Results@#29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken.@*Conclusions@#The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic.

10.
Article in Chinese | WPRIM | ID: wpr-798669

ABSTRACT

Objective@#To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform.@*Methods@#A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index.@*Results@#The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability.@*Conclusions@#In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.

11.
Article in Chinese | WPRIM | ID: wpr-798668

ABSTRACT

Objective@#To define the connotation of village doctors′ vulnerability.@*Methods@#On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015.@*Results@#Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%.@*Conclusions@#The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors.

12.
Article in Chinese | WPRIM | ID: wpr-872382

ABSTRACT

Objective:Based on the perspective of status-seeking, to clarify the status quo of rural doctors′ subjective social status, and put forward countermeasures and suggestions to improve the subjective social status of rural doctors.Methods:By investigating 1 395 rural doctors in both 2015 and 2017 to clarify the status quo of rural doctors′ subjective social status through descriptive analysis, we compared the subjective social status of rural doctors with different characteristics by using differential analysis.Results:The overall subjective social status scoring of rural doctors was 3.17±0.48, including decision participation scoring(3.30±0.82), income scoring(2.19±0.80), social relationship scoring(4.05±0.61), career reputation scoring(3.09±0.84), career promotion scoring(2.38±0.67), and career value scoring(4.04±0.63). Rural doctors with middle or above academic titles, high-performance levels, as well as those comparable to doctors in township hospitals and self-employed clinics were found with higher subjective social status.Conclusions:Rural doctors held their subjective social status to be at an intermediate level, with higher ratings for interpersonal relationships and professional values and lower ratings for salary and training mechanisms. Positive feedback on the status-seeking behavior of rural doctors is recommended to improve village clinic services and reshape the image of rural doctors.

13.
Article in Chinese | WPRIM | ID: wpr-872285

ABSTRACT

The healthcare plus aging care is a new type of aging care model that integrates medical services and aging care services. China has successively issued a series of policies, encouraging the localities to proactively explore such a model. The authors refer to the four dimensions of exchange and communication, policy resources, policy executor preferences and organizational structure in the Edwards policy execution model, for analyzing the implementation of such a policy. The study found such constraints for the policy as follows: unclear policy implementation standards, inadequate policy resources of manpower, financial and material resources, differences in preferences among local governments, general hospitals, primary medical institutions, and pension institutions, as well as decentralized and restricted organizational structures. At present, the policy of healthcare plus aging care remains in the stage of exploration and trial. The government should continue to define and revise the policy to ensure the smooth progress and long-term implementation of the policy of healthcare plus aging care.

14.
Article in Chinese | WPRIM | ID: wpr-872277

ABSTRACT

Family physicians contracted service is an important choice to deepen the reform of China′s healthcare reform and achieve the strategic goal of " health for all" . In order to effectively promote the contracted service, the central government has successively issued a number of policy documents, which are echoed by the localities in their proactive explorations, achieving remarkable results. But there are also multiple roadblocks hindering the contracted service to progress. This article referred to the three-circle theory and studied policy implementation from the three dimensions of policy value, policy resources, and policy impetus. A thorough analysis of the problems in the implementation process revealed such main problems as insufficient family physicians, inadequacy of supporting policies and low level of policy acceptance among the young healthy age groups. The follow-up work will promote the long-term implementation of the family physicians contracted service policy by enriching the family physicians team, enriching supporting policies, and focusing on promotions to key age groups.

15.
Article in Chinese | WPRIM | ID: wpr-872244

ABSTRACT

Objective:By investigating the demand of " Internet-based health education" for urban and rural residents, to identify the main functions of " Internet-based health education" platform and the priority order that platform design should follow, in an effort to help promote the accurate dissemination of health education.Methods:Since April 2019, a stratified random sampling method was used to collect urban and rural residents in 3 counties and cities of a city. The survey mainly investigated the importance of the preliminary function and the specific demand of residents for " Internet-based health education" . With data collected and based on Kano model, the Better-Worse coefficient was used for quantitative analysis.Results:There are 14 main functions of the function item identification and discovery platform; among them, privacy, and without product placement are regarded requisites of the platform, while simple and stable operation among others rank the expected functions. in addition, artistic interface, fun experience, etc. were seen as the undifferentiated functions.Conclusions:The platform design for " Internet-based health education" should follow the priority order of privacy, without product placement, simple and stable operation, information authority, low attrition, comprehensive functions, perfect supervision, free service and high popularity.

16.
Article in Chinese | WPRIM | ID: wpr-872216

ABSTRACT

Objective:To investigate the cognition and willingness of nursing staff to Internet plus nursing service, and analyze the related factors that affect their participation in Internet plus nursing service.Methods:From April to May 2019, 150 nurses from three hospitals in Weifang were investigated by questionnaire and key person interview. Descriptive analysis and binary logistic regression analysis were used to analyze the intention of nursing staff to participate in Internet plus nursing service. The interview mode was used to analyze the appropriate mode of Internet plus nursing service from the perspective of nursing staff.Results:142 valid questionnaires were obtained, of which 137(96.5%)indicated willingness to provide Internet plus nursing services, and 135(95.1%) realized the necessity of the service. Education, marriage, nurses′judgment on the necessity of the service and their own subjective judgment of their competence were the factors affecting nurses′ participation in the Internet plus nursing service.Conclusions:Multiple factors affect the choice of nursing staff′s behavior in Internet plus nursing service.From the perspective of nursing staff, the Internet plus nursing service mode needs joint efforts from many aspects.

17.
Article in Chinese | WPRIM | ID: wpr-872210

ABSTRACT

Objective:To define the connotation of village doctors′ vulnerability.Methods:On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015.Results:Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%.Conclusions:The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors.

18.
Article in Chinese | WPRIM | ID: wpr-872209

ABSTRACT

Objective:To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform.Methods:Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity.Results:29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken.Conclusions:The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic.

19.
Article in Chinese | WPRIM | ID: wpr-872201

ABSTRACT

Objective:To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform.Methods:A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index.Results:The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability.Conclusions:In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.

20.
Article in Chinese | WPRIM | ID: wpr-735129

ABSTRACT

Objective To analyze the motives and tactics of township health centers ( THC) to participate in the countywide medical communities of Shandong province. Methods Such tools as the new institutionalism, rational choice and social network theories, as well as the constituent ratios and Pearson correlation coefficient of data were used in a survey in August 2018 with managers of 264 THCs in Shandong. It aimed to learn from the respondents their motives, tactics, and behaviors to participate in such communities. Results Theoretical analysis of the results found that their participation was bound by both institutional environment and technical environment. For example, compliance tactics, accompanied by efficiency, was adopted to cope with stress from institutional environment. Exploratory tactics, accompanied by legitimacy, was adopted to cope with stress from technical environment. The figures showed 87. 5% of 264 THCs investigated participated in such communities, and their main motives were in turn to follow government requests (86. 1% ) and to seek development opportunities (69. 7% ). The critical criteria of partner selection were in turn technological level (83. 5% ) and matching of resources (77. 9% ). Of 231 THCs which participated in the communities, 95. 2% joined in countywide medical communities, and 28. 6% participated in other forms of medical alliances. Conclusions THCs showed high organizational convergence in their participation, and adopted diversified strategies of participation in medical alliance.

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