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Objective:To investigate the current situation of medical social worker supervision in Shanghai, for reference to promote the high-quality development of medical social work.Methods:From June to July 2022, a questionnaire survey was conducted on the in-service medical social workers in all medical institutions with medical social work departments or posts in Shanghai. The questionnaire mainly included demographic information, current status of supervision implementation, and effectiveness of supervision. The data were analyzed descriptively with t test for comparison between groups and the Pearson test was for correlation analysis. Results:A total of 99 medical social workers were included in this study, 65 had received supervision, and medical institutions where 58 people located had established the supervision system. The average scores of actual and expected supervisory support received by medical social workers were 3.71 and 4.20 respectively, and the mean burnout level score was 32.91. The effect of establishing a supervision institutions on burnout was statistically significant ( P<0.05) and actual access to supervision support was negatively associated with burnout ( P<0.05). Conclusions:The overall situation of medical social work supervision in Shanghai was positive, but the demand for supervision was not fully satisfied; Supervision had a positive impact on reducing the burnout level. It is suggested that medical social work should further strengthen the cultivation of supervisory talents, promote the construction of supervisory systems, and improve the quality of supervision.
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OBJECTIVE To investigate the present equipment and management situation of narcotic drugs in primary healthcare institutions from Qiandongnan prefecture of Guizhou province. METHODS The questionnaire survey was conducted among pharmacy department heads and medical staff from primary healthcare institutions in Qiandongnan prefecture of Guizhou province. Descriptive statistical analysis was conducted on the survey results. RESULTS Of 251 healthcare institutions in this survey， 29 healthcare institutions were equipped with narcotic drugs， accounting for 11.55%. The reasons for the narcotic drugs unequipped were mainly as follows: insufficient attention， no storage conditions for narcotic drugs， complex program of narcotic drug management， small amount usage and so on. Among the 29 primary healthcare institutions equipped with narcotic drugs， all of them did not monitor patient usage， accounting for 100%； 29 healthcare institutions did not implement a return visit or follow-up every 3 months， accounting for 100%. CONCLUSIONS The health administration departments should strengthen the administration of narcotic drugs in primary healthcare institutions. At the same time， training on standardized management and clinical rational application of narcotic drugs for medical staff in primary healthcare institutions should be enhanced by the health administrative department.
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Objective @#To investigate the establishment of smoke-free environments in medical and healthcare institutions in Zhejiang Province, so as to provide the evidence for improving the implementation of the tobacco control policy in medical and healthcare institutions.@*Methods@#Health administrative sectors and public health institutions at provincial, city and county levels, secondary and tertiary medical institutions, and community health service/township health centers in Zhejiang Province were enrolled. The status of institutional establishment of smoke-free environments was investigated through concealed photography and consulting medical service guides by the assigned the third-party professional investigation company in 2021. The layout of smoke-free environments and indoor smoking were assessed according to the Criteria for Scoring Smoking-free Medical and Healthcare Institutions.@*Results@#Totally 547 medical and healthcare institutions were enrolled in this undercover investigation, including 102 health administrative sectors, 209 public health institutions, 146 secondary and tertiary medical institutions, and 90 community health service/township health centers. The gross mean scores of establishment of smoke-free environments were 83.41±12.19 among all medical and healthcare institutions, 82.02±10.73, 85.56±9.70 and 83.18±12.59 among province-, city- and county-level medical and healthcare institutions, respectively, and the gross mean scores of establishment of smoke-free environments were 82.60±12.27, 85.79±10.74, 80.89±13.85, 82.27±11.62 scores among health administrative sectors, public health institutions, secondary and tertiary medical institutions and community health service/township health centers, respectively. There were 315 institutions with no smoking signs at entrances (57.59%), 255 institutions posting no smoking signs ( 46.62% ), 245 institutions assigning two and more types of health education materials for tobacco control ( 44.79% ), 110 institutions with outdoor smoking areas ( 51.16% ), 66 secondary and tertiary medical institutions with smoking cessation clinics ( 45.20% ) and 354 institutions with carpet smoking bans in indoor places ( 64.72% ).@*Conclusions@#The overall establishment of smoke-free environments is satisfactory among medical and healthcare institutions in Zhejiang Province. Nevertheless, improving the coverage of no smoking signs and health education of tobacco control, promoting the standardized construction of smoking cessation clinics and establishing a long-action tobacco control mechanism are still needed.
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OBJE CTIVE To inv estigate the antibiotic use and rationality for children in community health service institutions from Beijing ，and to provide reference for promoting rational use of antibiotics in primary healthcare institutions. METHODS All the prescriptions for children from primary healthcare institutions in 2019 were extracted from prescription review system of community health service institutions in Beijing. The use of antibiotics was described according to the related indicators of the World Health Organization/International Network for Rational Use of Drug （WHO/INRUD）. The structure of antibiotics use was analyzed according to the anatomical therapeutic chemical （ATC）classification as well as the WHO AWaRe classification and diagnosis. RESULTS A total of 288 primary healthcare institutions and 10 422 prescriptions for children were included. The number of institutions in high-income areas ，middle-income areas and low-income areas were 119，80 and 89 respectively，and the number of prescriptions involved were 2 430，2 163 and 5 829 respectively，including 1 447 prescriptions involving antibiotics （13.9％）. Among 1 447 prescriptions，the rate of prescriptions involving combined use of antibiotics was 1.4％（20 pieces）；the rate of prescriptions involving antibiotics injection was 9.7％（141 pieces）；4.8％ antibiotics prescriptions were rated as unreasonable （69 pieces）. The three most commonly used antibiotics were the macrolides （40.2％），the second-generation cephalosporins （26.5％） and the third-generati on cephalosporins （23.4％）. The proportion of antibioti cs prescriptions from groups of access ，caution， reserve and not recommended were 9.1％，92.1％，0.3％，and 0， respectively. The rate of antibiotics prescriptions fortonsillitis was the highest （31.9％ ）. Among 69 irrationalantibiotics prescriptions ，main of them were irrational drug use （56 pieces，81.2％）. CONCLUSIONS The rate of antibiotics prescriptions for children in primary healthcare institutions from Beijing is lower than the standard of WHO antibiotics prescription rate （20.0％-26.8％），but the use rate of antibiotics at caution grade is too high.
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Resumo Discutimos a tentativa de organização do Hospital Proletário na capital da Paraíba nos anos 1930. Para tanto, problematizamos a cobertura do jornal A União sobre esse episódio. O envolvimento de diferentes atores - trabalhadores, associações e médicos - revela a emergência de uma nova forma de pensar e praticar as políticas de saúde. Conforme o projeto varguista de construção nacional, tais ações visavam à formação de trabalhadores saudáveis, aptos para o mercado e úteis para a nação. Apesar de seu fracasso, o projeto do hospital evidencia as diferentes concepções sobre a saúde dos trabalhadores na Era Vargas. Apropriamo-nos dos conceitos de "interdependência sanitária", "medicina social", "cidadania regulada" e "trabalhismo".
Abstract We discuss the attempt to establish the Hospital Proletário in the capital of the state of Paraíba in the 1930s. To this end, we problematized the coverage in the newspaper A União on this episode. The involvement of different actors - workers, associations and physicians - reveals the emergence of a new way of thinking and implementing healthcare policies. According to the Vargas government's national construction plan, actions like this were intended to ensure healthy workers - ready for the market and useful for the country. Despite its failure, the hospital project provided evidence of the different concepts of worker health during the Vargas Era. We identified the concepts of "health interdependence," "social medicine," "regulated citizenship" and the "labor movement."
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Humans , History, 20th Century , Hospitals/history , Social Class , Brazil , Charities/historyABSTRACT
Objective@#To evaluate the new compensation mechanism for primary healthcare institutions in Zhejiang province, in terms of fairness, performance, incentive mechanism and sustainability in pilot areas.@*Methods@#Evaluation indicators were constructed based on stakeholder theory, fairness theory, expectation theory and sustainable development theory.Focus group interviews were conducted with stakeholders and quantitative data were collected through questionnaires. Meanwhile, the financial compensation, income and expenditure and work equivalent data were collected from such institutions of the four pilot areas, with quantitative data subject to descriptive analysis.@*Results@#This study found the reform used reasonable proportion of funds allocated(the proportion of basic salary for employees was lower than 50%)and adjustment factors(1.0-1.8)of different primary healthcare institutions to guarantee the fairness of the reform; the increase of work equivalents(the per capita work equivalents of medical staff in pilot counties had increased from 38.435 million in the previous year to 42.590 million work equivalents)reflected the performance outcomes of the reform. The incentive and sustainability of the reforms were the weak parts. These were mainly due to the fact that the internal distribution system of primary healthcare institutions failed to make corresponding reforms.@*Conclusions@#The reform of the compensation mechanism based on the equivalent method has changed medical staff′s perception of the distribution of funds. The principle of" more pay for more work" and the use of information technology to capture work equivalents have improved the enthusiasm of primary medical staff and the operational efficiency of these institutions, thus, making reform generally scientific and reasonable.
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Background: Tobacco smoking is a pandemic affecting populations and contributing to global morbidity and mortality. It is well known that the second hand smoke is equally hazardous like first hand smoke. Cigarette and other tobacco products act 2003 is an effort put forth by Government of India in order to curb this menace and protect people from ill effects of second hand smoke.Methods: The present study was conducted to assess the compliance to smoke free act in tertiary healthcare institutes in Shimla city, Himachal Pradesh. A total of 57 public places and 8 shops in five Tertiary healthcare institutes were evaluated for various provisions of the act. Compliance to different sections of the act was assessed using a structured observational checklist.Results: Signage indicating ban on smoking was seen at 71.9% places. Active smoking was absent at 77.2% places. About 25% shops around the institutes were found selling tobacco products. Signage displaying ban on sale within 100 m of educational institution and sale to minors was not observed at any shop. Tobacco product vendor was seen around 80% of educational buildings. Tobacco free institution signage was seen at 60% of educational premises.Conclusions: The study highlights that the level of compliance did not meet the standards laid down for a smoke free city. Timely and periodic assessment of the compliance must be conducted by the administrative authorities of the institutes for ensuring the adherence and strict implementation of the provisions of the act.
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Objective To probe into the status of " Internet +maternal and children healthcare"services provided by municipal maternal and child healthcare institutions, and to analyze existing problems, provide reference for the development of " Internet+maternal and children healthcare" for MCH institutions and other medical institutions. Methods From June to August 2018, the National General Information Platform on Women and Children Health was engaged, to launch a questionnaire survey on the status of" Internet+maternal and children healthcare" application at municipal MCH institutions across the country. Results The top three handy services for the public provided by municipal MCH institutions using the" Internet+" technology for the clients were hospital information inquiry, appointment registration and medical test result queries, accounting for 49.1% , 44.2% and 35.8% respectively. The proportion of" Internet+" specific service for women and children from high to low were portable device remote monitoring ( 16.1% ), antenatal examination/physical examination of children/vaccination reminder (13.3% ), online school for pregnant women(10.2% ), follow-up management services(9.8% ) and self-service measurements such as body height, weight, and blood pressure(3.5% ).The top three services for doctors were patient test result checkup, inquiry of patients′ basic information, and inquiry of patients′treatment, accounting for 19.3% , 17.5% and 13.0% respectively.In terms of service provision of the top one service for nurses was specimen code scan(17.5% ).In terms of the 18 handy services accessible, 5 specific services for women and children, 9 services for doctors, 4 services for nurses, the proportion declined in turn from the eastern, central and western areas in the country.The top three roadblocks to be resolved right away in the " Internet+maternal and children healthcare" service, were the lack of supervision system, that of professional technical management personnel and that of standard specifications, accounting for 63.5% , 57.5% and 49.1% respectively. Conclusions The " Internet+maternal and children healthcare"in municipal MCH institutions in China stays at an initial development stage, and there is a great development difference between the eastern, central and western regions of China. Relevant measures must be taken to reduce the development gap between municipal MCH institutions among these regions, and to solve the roadblocks curbing the development of " Internet + maternal and children healthcare" in municipal MCH institutions in China.
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OBJECTIVE： To explore the current situation of service ability and pharmaceutical service construction of primary healthcare institutions in Jiangsu province. METHODS： Questionnaire survey was conducted among primary healthcare institutions of 13 prefecture level cities in Jiangsu province， involving basic service information （such as serving mode， medical departments）， resource allocation （such as hardware， human resource） and pharmaceutical care construction （such as the leaders of the drug procurement， pharmaceutical departments allocation， mediation safety management）. The current situation of service ability and pharmaceutical service construction was evaluated in primary healthcare institutions of Jiangsu province. RESULTS： A total of 579 primary healthcare institutions in Jiangsu province were investigated and 579 questionnaires were collected （some items in the questionnaires were not answered）. Outpatient service （543/555，97.8％） was the main mode of service provided by primary healthcare institutions in Jiangsu province， followed by emergency call （321/555，57.8％） and hospitalization （292/555，52.6％）； the frequently established department in primary healthcare institutions was the medical department for all （452/568，79.6％）， preventive healthcare department（401/568，70.6％）， internal medicine department （365/568，64.3％）； 16.1％ （93/533）of the primary healthcare institutions had no beds； 36.4％ （211/579）of the institutions had no chief physician； 20.9％ （111/532）of the primary healthcare institutions medicine procurement were managed by pharmacists； 42.5％ （212/499）of the institutions had no pharmaceutical departments； physicians were responsible for patients' medication safety in 43.9％ （236/537） of the primary healthcare institutions and pharmacists were responsible for patients' medication safety in only 16.2％ （87/537）of the institutions. CONCLUSIONS： Primary healthcare institutions in Jiangsu province have made some achievements in service capability building. Human resources， equipment and facilities， pharmaceutical care construction and other aspects still need to be improved.
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Objective To assess the technical efficiency and subsystem technical efficiency of the healthcare institutions in China,including that of management system and medical system.Methods Panel data of 31 provinces' healthcare institutions were selected,and Network DEA was adopted to assess such input indicators as managerial staff and health technical personnel,and such output indicators as medical revenue and number of medical visits.Results The technical efficiency of healthcare institutions is as lower as an efficiency mean of 0.853 in five year.Provinces of Zhejiang,Shandong,Henan,Guangdong and Tibet have maintained a higher level.The healthcare system breaks down into two independent subsystems of the management subsystem and medical subsystem.The mean of the former one is 0.937,higher than 0.783 of the latter.The number of medical revenue and that of patients in the non-effective provinces were relatively inadequate.Conclusions Healthcare resources allocation in China needs to be optimized.It is imperative to adjust the input-output ratio,improve medical service quality via scientific management.
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Bring your own device (BYOD) has become popular as it empowers medical practitioners to use their own devices for communication,mobile rounds,real-time EMR query,selflearning and auxiliary diagnosis.Based on implementation experiences of BYOD at home and overseas healthcare institutions,this paper recommended domestic institutions on BYOD planning and deployment as follows:restructuring of their wireless networks and access control;better device supervision;open BYOD portal;and protection of both staff privacy and data security.This effort provides insights for BYOD development in China's healthcare institutions.
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Objective To learn the main problems of performance salary system in primary healthcare institutions after the implement of recent performance salary system guiding opinion in Zhejiang Province.Methods Purposive sampling method was used to separately select 2 counties from high,average and poor economic level regions in Zhejiang Province. Questionnaire survey was conducted among 100 leaders of 84 primary healthcare institutions which the number of staffs is larger than 20.The survey contents included demographic characteristics and the assessment of performance appraisal and performance salary system,which embraced workload,the change of work income and enthusiasm,the incentive function, component ratio and existing problem of performance salary system.Results The average income general increased, however,the staffs working enthusiasm should be further improved.Some problems still exist,such as the public health funds were brought into the total performance salary,and the gross payroll levels were low as well as the performance salary was lack of increasing mechanism.The TCM was the prior development business and contribute most to the revenue and expenditure surplus of primary healthcare institutions.Conclusion The performance salary system should be further improved and the operating effect evaluation in phases and stages should be developed.The decoction pieces should be selled without added profit,and the service ability of primary traditional Chinese medicine should be further strengthened.
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Success of the reform of the primary healthcare system is marked by whether a new management framework and working mechanism can be established.In recent years,Yushu city keeps on track the public welfare nature of these primary healthcare institutions to move forward their reform.The paper covered the worthwhile reform attempts,such as implementation of the essential medicines system,appropriation reimbursement mechanism of sustainable development,and reforms on the personnel management system and benefits distribution system.Such reforms have met the needs of primary healthcare and public health services of the city dwellers in their best interests.
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Objective:To study the status quo of National Essential Medicine System ( NEMS) in village clinics of a province in western China. Methods:Individual in-depth interview was carried out with village doctors and their managers of a province in western China, to understand the subsidies of zero-markup rate, compensations for general medical fees, and status quo of NEMS assessment mechanism and its impacts on prescribing behavior of village doc-tors. Results:In the surveyed area, the intervention of NEMS has not achieved the desired objectives: the prescri-bing behavior of village doctors has not changed significantly;general medical fee system has failed to achieve reason-able compensations;and the assessment mechanism done by village doctor managers has been a mere formality. Con-clusions and Suggestions:To ensure the feasibility, effectiveness and sustainability of the intervention, the area poli-cymakers should take into full consideration the special nature of village doctors.
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In this paper, a systematical and retrospective review was made on how the drug purchasing system of Chinese healthcare institutions has evolved from decentralized purchasing to centralized purchasing based on four stages as budding stage, initial stage, adjustment stage and deepening stage. In each stage, the working characteris-tics, achievements and problems have been analyzed. Targeting at the problems and challenges confronted with cur-rent drug purchasing, recommendations was made to reform and improve public hospitals’ centralized purchasing sys-tem, such as persisting centralized purchasing online at provincial level, sticking to “four favorable” principles, breaking through the mechanism of compensating medical cost with drug-selling profits, promoting coordinated inter-action reforms in healthcare insurances, distribution and pricing, strengthening comprehensive services and supervi-sion, etc.
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Considerando a inserção da clínica psicanalítica no âmbito da saúde pública, o artigo problematiza os desdobramentos da não relação psicanálise-instituição, apontando para uma aproximação possível entre os dois campos. A partir das formulações freudianas sobre os desdobramentos, no coletivo, do caráter de exceção e do laço necessário entre pulsão e civilização, o trabalho propõe uma interlocução necessária entre psicanálise e instituição;assim, a especificidade do discurso analítico e as elaborações lacanianas sobre o gozo, bem como o lugar de ideal da instituição poderiam, numa perspectiva inclusiva, se somarem ao tratamento dos sintomas atuais.
Considering the practice of psychoanalytic clinic in public healthcare context, this article debates the repercussions of the non-relation between psychoanalysis and institution and tries to identify possibilities of approximation between these two fields. Based on freudian conceptualizations about the collective reverberations of the exception character and the required bound between civilization and drive, this work proposes a necessary dialogue between psychoanalysis and institution. In this inclusive perspective, the specificities of psychoanalytical discourse and Lacanian theorization about jouissance could articulate with the institutional expectations to contribute to contemporary symptoms treatment.
Considérant linsertion de la clinique psychanalytique dans le domaine de la santé publique, larticle met en question les dédoublements de labsence du rapport psychanalyse-institution, faisant le point pour lapproche possible entre ces deux champs. A partir des formulations freudiennes sur les dédoublements, dans le collectif, du caractère dexception et du lien nécessaire entre pulsion et civilization, le travail propose une interlocution essentielle entre psychanalyse et institution; la spécificité du discours analytique et les formulations de Lacan sur la jouissance, ainsi que le lieu idéal de linstitution pourraient, par le biais de linclusion, sajouter au traitement des symptomes actuels.
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Public Health , Psychoanalytic TherapyABSTRACT
La adquisición de tecnologías en salud es un proceso complejo enfocado al mejoramiento en la calidad y la eficiencia en la prestación de los servicios de salud a través de la adquisición de tecnología efectiva. Dentro de los procesos de adquisición de tecnologías en salud se destacan la evaluación técnica y clínica. El objetivo de la evaluación de tecnologías en salud es recolectar, analizar y sintetizar información y conocimiento para contribuir a mejorar la toma de decisiones en la práctica médica y en las políticas de salud. Este artículo ofrece un procedimiento de adquisición de tecnología biomédica con énfasis en la evaluación técnica y clínica basado en metodologías de evaluación de tecnologías en salud. También ofrece una estructura detallada sobre los conceptos técnicos y clínicos que servirán de base para la toma de decisiones en procesos de adquisición dentro del ambiente prestador de salud. De igual manera, pretende impulsar en los departamentos de ingeniería clínica la implementación de procesos metodológicos de amplia aceptación y efectividad que tienen como objetivo primordial la adquisición de tecnologías en salud basados en la evidencia. Asimismo, se promueve la participación activa del personal asistencial y técnico con el fin de enfocar el proceso a un ambiente multidisciplinario y obtener retroalimentación específica sobre las tecnologías en salud en áreas de uso a través de usuarios representativos.
The acquisition of healthcare technologies is a complex process focused in the improvement of quality and efficiency in delivering health services through the acquisition of technology in an effective manner. Within the acquisition processes of healthcare technologies, the technical and clinical evaluation highlights. The objective of the health technology assessment is to collect, analyze and synthesize information and knowledge to help improve decision-making in medical practice and health policies. This article provides a procedure for healthcare technologies acquisition with emphasis in technical and clinical evaluation based on health technology assessment methodologies. This presents a detailed structure on technical and clinical concepts that serve as a basis for decision-making procurement processes within healthcare environment. Likewise, it is expected to motivate in clinical engineering departments, the implementation of broad acceptance and effective methodological process that have as its primary objective the acquisition of healthcare technologies based on evidence. It also promotes the active participation of clinical and technical staff in order to approach the process to a multidisciplinary environment and obtain feedback on specific areas of the healthcare technologies trough representative users.
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Since the inception of the National Tuberculosis Control Program in 1962, the incidence of tuberculosis and its associated mortality has declined dramatically due to effective anti-tuberculosis drugs and a systematic control program. The prevalence of radiographically active tuberculosis has fallen from 5.1% in 1965 to 1.0 in 1995.However, tuberculosis is still a major problem, as the mortality rate is still higher compared to other developed countries. Furthermore, tuberculosis is currently re-emerging in HIV/AIDS epidemic countries.In order to lower the tuberculosis death rate to the levels of developed countries, the tuberculosis control efforts in private healthcare institutions and the national tuberculosis control program in the public sector, need to work together more effectively adn efficiently.In this paper, the quthor reviewed te current situation regarding tuberculosis management in private healthcare institutions of Korea based on the literature and the National Health Insurance Claim data, and the future tasks of tuberculosis management are suggested.
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Delivery of Health Care , Developed Countries , Incidence , Korea , Mortality , National Health Programs , Prevalence , Public Sector , TuberculosisABSTRACT
Since the inception of the National Tuberculosis Control Program in 1962, the incidence of tuberculosis and its associated mortality has declined dramatically due to effective anti-tuberculosis drugs and a systematic control program. The prevalence of radiographically active tuberculosis has fallen from 5.1% in 1965 to 1.0 in 1995.However, tuberculosis is still a major problem, as the mortality rate is still higher compared to other developed countries. Furthermore, tuberculosis is currently re-emerging in HIV/AIDS epidemic countries.In order to lower the tuberculosis death rate to the levels of developed countries, the tuberculosis control efforts in private healthcare institutions and the national tuberculosis control program in the public sector, need to work together more effectively adn efficiently.In this paper, the quthor reviewed te current situation regarding tuberculosis management in private healthcare institutions of Korea based on the literature and the National Health Insurance Claim data, and the future tasks of tuberculosis management are suggested.