Theoretical Construction and Clinical Application of Doctor-patient Shared Decision-making / 中国医学伦理学

On the basis of combing and reflecting on the literature related to doctor-patient shared decision-making, this paper proposed the necessity of discussing the ethical basis of shared decision-making from a theoretical perspective, and attempted to analyze the suitability of Aristotle’s "friendship" ideology as its ethics’ basis. At the practical level, starting from Ropohl’s technical ethics, it was recommended to establish a shared decision-making responsibility sharing system, providing methodological guidelines for the clinical application of shared decision-making.

Discussion on the effect of medical insurance payment system reform on promoting the construction of medical alliance / 中华医院管理杂志

The reform of medical insurance payment system could promote the transformation of medical services from price medical care to value medical care, which is very important to promote the construction of medical alliance. The authors discussed the reform of medical insurance payment system to promote the construction of medical alliance, and the order of medical alliance covering medical services and seeking medical treatment.For medical service providers, the reform of medical insurance payment system helped to promote the construction of closer medical alliance, guided the sinking of high-quality resources, helped to form a smooth referral mechanism, and strengthened the supervision and assessment of medical behavior. For the demanders of medical services, the differentiated medical insurance reimbursement proportion policy within the medical alliancewas more conducive to attracting the first consultation at the grass-roots level. At the same time, patients had a wider choice of medical treatment and more freedom of choice. In view of the problems existing in practice, the authors suggested that a variety of medical insurance payment and performance systems with value-based medical care as the core should be implemented to deepen the development of medical alliance, the medical insurance system and municipal subsidies should jointly undertake the salary subsidies for sinking medical personnel, and integrate the grass-roots fragmented health care business with the help of medical insurance payment tools, and promote the coverage expansion of the medical insurance reform of the medical alliance based on policy guidance.

Investigation and analysis of patients′ subjective feelings of medical reform effect under the background of the China Healthcare Improvement Initiative / 中华医院管理杂志

Objective:To explore the change trend of patients′ recognition of the medical reform effect and medical staff′s occupation and its relationship with medical experience, since the implementation of the China Healthcare Improvement Initiative(CHII), so as to provide reference for exploring the breakthrough point of consolidating the reform effect.Methods:Four indicators of the third-party assessment of patients were selected, which were " I think the medical reform has benefited patients" , " I think the doctor-patient relationship is improving in the past three years" , " I think medical personnel deserve social respect and recognition" , and " I am willing to let my children join the medical profession" . Descriptive and trend analysis were carried out on the survey results, and correlation analysis was carried out between the survey results and patients′ medical experience.Results:Compared with the baseline evaluation results(76.9% and 69.9%for outpatients, 87.3% and 85.6%for inpatients), the patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship in the fifth evaluation(86.2% and 89.1%for outpatients, 91.4% and 92.6%for inpatients)were significantly improved. The proportion of patients who thought the medical staff was worthy of respect and willing to let their children work in the hospital in the fifth evaluation(97.4%, 79.1%for outpatients, 98.7%, 85.1%for inpatients)were higher than the baseline evaluation results(92.3%, 71.0%for outpatients, 98.1%, 81.6%for inpatients). The above indicators were positively correlated with the patient′s medical experience.Conclusions:Since the implementation of CHII, patients′ recognition of the sense of medical reform and the improvement of doctor-patient relationship has been continuously improved, and patients′ respect and recognition of professional identity of medical personnel is at a high level and continues to improve. Improving medical experience has a positive effect on the improvement of patients′ sense of medical reform.

Synergy of Centralized Drug Volume-based Purchasing and Medical Insurance Negotiation Policy / 中国药房

OBJECTIVE：To investigate the s ynergy between centralized drug volume-based purchasing （called“volume- based purchasing”for short ）and medical insurance negotiation policy. METHODS ：From the aspects of economic and social benefits ， the synergy of volume-based purchasing and medical insurance negotiation was analyzed by using the methods of literature analysis，policy interpretation and interview. The corresponding suggestions were put forward for the problems of the supply and use of drugs. RESULTS & CONCLUSIONS ：The synergy of volume-based purchasing and medical insurance negotiation in terms of economic benefits include medical insurance fund management optimization to improve fund utilization efficiency improvement ； medical insurance fund payment optimization to reduce transaction cost ；network promotion of medical security information platform to reduce the cost of information exchange. The synergy of volume-based purchasing and medical insurance negotiation in terms of social benefits includes relevant index assessment of drug quality evaluation to improve drug quality evaluation system ； medical service level improvement to form compound medical insurance payment mode under total budget management ；enterprise supervision driven by market to reduce the pressure of government supervision. The relevant departments should continue to strengthen the comprehensive management of medical institutions to reduce the phenomenon of irrational drug use ；strengthen policy convergence ，avoid the poor implementation of medical insurance drug adjustment policy ，so that the policy dividend of volume-based purchasing and medical insurance negotiation can benefit the people more through system reform ，optimal allocation of funds ，etc.

Analysis of typical practical problems and countermeasures of supply chain management mode in public hospitals / 药学实践杂志

Objective to analyze the differences and changes before and after the introduction of supply processing distribution (SPD) supply chain management mode in a public hospital, analyze the typical problems existing in the clinical practice and development of SPD mode, and explore the countermeasures to improve the SPD supply chain management. Methods the changes of 20 management functions before and after the introduction of SPD supply chain management mode were compared. The advantages and disadvantages of SPD management mode were analyzed. The improvement measures and countermeasures were proposed. Results among the 20 management functions, 11 of them were reduced, 5 of them were equal, and 4 of them were increased. The overall efficiency of hospital management was improved. Because the external medicine supplier has not been included in the hospital rules, regulations system and process. The role positioning was not clear. There were defects in institutional and continuous guarantee. Conclusion SPD supply chain management mode can be improved and innovated to promote the supply channel reform of drugs and medical consumables, and improve the fine management level of drugs and medical consumables.

Implementación de la metodología indagatoria-mayéutica en la educación médica en Chile / Implementation of the inquiry-maieutic methodology in the medical education in Chile

La indagación científica se entiende como un "proceso en el cual se plantean preguntas acerca del mundo natural, se generan hipótesis, se diseña una investigación, y se colectan, analizan datos con el objeto de encontrar una solución al problema" (Windschitl, 2003: 113). La educación médica en Chile presenta un enfoque médico hegemónico que aún arrastra falencias en torno a un modelo mecanicista, segmentado y desigual. Esta manifestación se perpetúa a través de la educación desde el ciclo preescolar hasta la enseñanza secundaria. Acerca de este tópico la A. de Cs. de Chile expresó en 2005la Academia de Ciencias, durante el 2005 señaló que: "Ha girado tradicionalmente en torno de una enseñanza desagregada o disciplinaria del saber científico, una instrucción enciclopedista, un aprendizaje memorístico de conocimientos atomizados, datos fragmentarios e informaciones puntuales, con una comprensión de la ciencia descontextualizada del mundo cotidiano y de las necesidades de la vida social"

Generación de un acuerdo Marco para una Nueva Política Educativa Médica Chilena / Generation of a Framework Agreement for a New Policy Chilean Medical Education

Desde el origen de la República, Chile ha probado diversos modelos educativos con el fin de responder a los requerimientos y necesidades de una población en un avanzada transición epidemiológica y demográfica y que requerirá un nuevo tipo de profesional que responda de forma versátil y adaptada a una sociedad en constante cambio, donde la migración, la adquisición de enfermedades foráneas y el acelerado proceso de envejecimiento y de industrialización de la sociedad llevarán a un incremento explosivo de las enfermedades neurodegenerativas, los cánceres y la emergencia de nuevas enfermedades de origen parasitaria, virales y bacterianas a las cuales la población no se encontraba adaptada

Since the origin of the Republic, Chile has tested different educational models in order to respond to the requirements and needs of a population in an advanced epidemiological and demographic transition and that will require a new type of professional who respond in a versatile way and adapted to a society constantly changing, where migration, acquisition foreign diseases and the accelerated process of aging and industrialization of society will lead to an explosive increase in diseases neurodegenerative drugs, cancers and the emergency of new diseases of parasitic, viral and bacteria to which the population was not adapted

Depuis l'origine de la République, le Chili a testé différents modèles éducatifs afin de répondre aux les besoins et les besoins d'une population une transition épidémiologique et démographique avancée et qui nécessitera un nouveau type de professionnel qui répondre de manière polyvalente et adaptée à une société en constante évolution, où la migration, l'acquisition maladies étrangères et le processus accéléré de vieillissement et industrialisation de la société conduira à une augmentation explosive des maladies médicaments neurodégénératifs, les cancers et l'urgence nouvelles maladies parasitaires, virales et bactéries auxquelles la population n'était pas Adapté

Impacts of the new medical reform on the equity of women's gynecological examination service utilization: Taking Shaanxi Province as an example / 西安交通大学学报(医学版)

Objective: To study the impacts of the new medical reform on the utilization equity of gynecological examination services for women in economically underdeveloped regions of western China. Methods: Based on the data of the 4th and 5th National Health Service Survey in Shaanxi Province, we used concentration index and decomposition of concentration index to explore the inequality of women's gynecological examination service utilization and its sources; we also used horizontal inequity index to analyze the horizontal equity of the women's gynecological examination service utilization. Results: The concentration index of gynecological examination rate of the women surveyed in 2008 and 2013 was 0.0882 and 0.0640, respectively. The horizontal inequity index was 0.0894 and 0.0463, respectively. The factors that contributed most to the inequality of the women's gynecological examination service utilization were the economic level and contribution which accounted for 54.49% and 61.86%, respectively. Conclusion: The implementation of basic public health and major public health services in the new medical reform policy has increased women's gynecological examinations rate and plays a positive role in improving the equity in utilization of women's gynecological examination services.

Research on the Work Status Quo and Countermeasures of Pharmacists in Public Hospitals of Chongqing under the Backgro und of“New Medical Reform ” / 中国药房

OBJECTIVE： To investigate the current status of pharmacists in public hospitals from Chongqing after the comprehensive reform of public hospitals， to put forward countermeasures and suggestions. METHODS： In questionnaire survey， pharmacists were selected from 33 public hospitals of secondary grade and above in Chongqing as survey objects. The current status of pharmacists in public hospitals of Chongqing from Sept. to Aug. 2018 was collected and surveyed in respects of the basic situation of pharmacists， the impact of medical reform policies， acceptance and professional development requirements of pharmacists. RESULTS： Totally 33 medical institutions included 13 third-grade hospitals and 20 secondary hospitals. A total of 838 questionnaires were distributed and 702 questionnaires were effectively recovered with effective recovery rate of 83.8％. According to the survey results， the majority of pharmacists in public hospitals of Chongqing were 25-35 years old （50.6％）； 8 （1.1％） had doctor’s degree， 86 （12.3％） had master’s degree， and 25.9％ had junior college and technical secondary schools. The number of master’s and doctor’s degrees in third-grade hospitals was higher than that of secondary hospitals， but there were still junior college and technical secondary school degrees in third-grade hospitals. Pharmacists were mainly referred to as middle and junior titles， 217 of which were middle-level titles （30.9％）， and 434 were primary titles（61.8％）； the majors were mainly pharmacy （64％）， followed by traditional Chinese pharmacology （18.7％）. Most of the working years were within 10 years （54.9％）. There were 274 people （39.0％） with an annual income of less than 50 000 yuan， 342 people （48.7％） with an annual income of 50 000- 100 000 yuan and only 86 people （12.3％） with an annual income of more than 100 000 yuan. After the implementation of new medical reform， 430 people （61.3％） thought that the workload had increased significantly or slightly， 99 people （14.1％） thought that the scope of work was significantly expanded， and 433 people thought that the annual income after medical reform was slightly reduced or significantly reduced （61.7％）； 253 people （36.0％） believed that hospital leaders did not pay attention to and did not pay much attention to pharmacists； 294 （41.9％） believed that medical staffs relatively accepted or highly accepted pharmacists. The reasons why pharmaceutical staffs thought that they were not valued mainly included five aspects， including that patients did not understand them； clinical medical staff did not agree with them； leaders did not pay attention to them； corresponding systems and regulations lacked； professional quality lacked. The main work content of pharmacists was mainly based on drug dispensing， and there were fewer people carrying out clinical pharmaceutical care， pharmacy management， pharmaceutical administration and quality control， preparation， pharmaceutical research. The jobs that they hoped to engage in were clinical pharmaceutical care， drug dispensing， pharmaceutical administration and quality monitoring， etc. Pharmacists believed that drug dispensing and delivery， reviewing medical orders， medication education guidance， consultation and medication counseling， drug management were important skills. The pharmaceutical staffs were good at skills， such as medical order review， medication education guidance， drug management. CONCLUSIONS： At present， the pharmacists in public hospitals of Chongqing have some problems， such as low education level， few clinical pharmaceutical professionals， low overall income and not recognized. It is suggested to protect the role and position of pharmacists in the medical treatment process from the perspective of introducing highly educated personnel of clinical pharmacy， improving the professional and educational structure of pharmacists， changing the pharmaceutical care mode， and improving their own ability and treatment.

Innovation and Practice of Prescription Comment in Medical Institutions of Chongqing under the Background of"New Medical Reform" / 中国药房

OBJECTIVE:To explore new method of prescription comment in medical institutions of Chongqing under the background of"New Medical Reform",and to provide reference for prescription comment innovation and promoting rational drug use in clinic. METHODS:Through analyzing policy background of prescription comment innovation and practice,referring to experience of other regions,the achievements and problems were analyzed by developing centralized prescription comment and prescription comment information construction in municipal and regional (county-level) medical institutions of Chongqing. The countermeasures suggestion was put forward. RESULTS&CONCLUSIONS:The prescriptions of 16 municipal medical institutions were commented centrally,involving more than 300 medical records and 1600 prescriptions or medical orders. The prescriptions of 135 regional (county-level) medical institutions were commented centrally,involving more than 3100 medical records and 12100 prescriptions or medical orders."Chongqing Medical Institution Prescription Comment Key Technology Monitoring System"was established. Above measures innovated centralized prescription comment mode,improved the quality of prescription comment and promoted prescription comment informatization. There were still problems as incomplete coverage of the system,inspection to become a mere formality. It is suggested to strengthen internal quality control of medical institutions by establishing rational drug use scoring management system,developing clinical pharmacist ward round and prescription checking in advance;establish and improve third-party external comment and supervision mechanism;improve the knowledge of prescriptions comment staff in all directions so as to further standardize prescriptions and promote rational drug use in medical institutions.

Drug supply chain management mode for hospital-enterprise cooperation in new medical reform / 医学研究生学报

In order to comply with canceling the drug price addition policy in the new medical reform program, meet the requirements of meticulous management and intensified medication safety, and improve the efficiency of pharmacies, the hospital pharmaceutical supply chain must be rebuilt by modern logistics and information technologies. This article compared three models of current hospital pharmaceutical chain and considered the supply chain management model of cooperating with the third party as the most effective one in the aspects of cost, efficiency,quality control management and so on. System deployment and implementation Methods of this model were further elaborated from the aspects of Hospital Information System(HIS) reform, management strategy, system architecture and security.

Design and application of internet combined with chronic disease management system / 医疗卫生装备

Objective To design an internet-based chronic disease management system to facilitate the administration to master the prevention, occurrence, therapy and rehabilitation of the chronic disease as well as the population to obtain medical service by large-scale hospitals. Methods The system was developed with internet, App by J2ME technique and cloud desktop and then popularized for application, which was composed of the terminals of patient, doctor and administration.Oracle 11g database was used to establish data center for data storage and sharing. Results The system contributed to implementing the mode of the first diagnosis in the primary hospital,bi-directional transfer and graded medical service,integrated the doctors,medical technologies and equipment from tertiary level 3 hospitals into health service centers in primary communities,and provided big data support for the decision of the administrations.Conclusion The system meets the requirements of the medical reform,and has to be deepened further. [Chinese Medical Equipment Journal,2018,39 (5):55-58]

Status survey of job satisfaction of nurses at public hospitals and recommendations / 中华医院管理杂志

Objective To analyze the status and influencing factors of job satisfaction of nurses at public hospitals, providing references for the teambuilding strategy of nurses. Methods Questionnaire survey method was used, in October 2017, to study job satisfaction of 1,047 nurses at 13 public general hospitals, for a countermeasure study. Results Job satisfaction of the nurses was found at a medium level. Specifically, their overall job satisfaction score was 3. 68, and the satisfaction scores of the following dimensions from high to low were: on-the-job training (3. 91), hierarchical nurse use (3. 79), performance appraisal (3. 68), promotion evaluation (3. 67), and remuneration (3. 62) respectively. Contents of the five dimensions are strongly related to the overall job satisfaction (r＞0. 6). Job satisfaction scores of nurses with their differences in positions, annual income, and hospital level were significantly different (P＜ 0. 05). The three main influencing factors for talent turnover rate are remuneration, workplace pressure and work environment. Conclusions Higher remuneration, improved hierarchical management system, and greater attention to nursing care at secondary hospitals are very important for effectively improving the job satisfaction of nurses and ensuring the health care industry.

Practice and Review of Party Building in Public Hospitals in the New Era / 中国医院管理

As the medical and health system reform proceeds,the party building works in Chinese public hospitals are facing with a new situation and a range of new problems.How to correctly tackle and resolve these problems and further improve and innovate the works of Party building has become an important issue for the hospitals' reform and development.The paper sums up the experience and practices of carrying out Party building works in Peking Union Medical College Hospital,and provides reference and inspiration for strengthening the Party building works in public hospitals in the new era.

Ethical Dilemmas and Countermeasures of China's Primary Medical System under the Background of New Healthcare Reform / 中国医学伦理学

Since the implementation of the new healthcare reform,it has achieved some success.However,many problems still exist in the process of primary medical reform,and there are many ethical dilemmas.The un-balanced allocation of medical resources reflects the relationship between government and market,the difficult pro-motion of " three medicine" reflects the sectoral conflicts of interest,the difficult implementation of the grading di-agnosis and treatment system reflects the different demands of stakeholders in health care system.As a result,the whole function of China's medical and health system has not been fully played.Based on the ethical perspective,this paper put forward that taking the scientific definition of government and market responsibility as a framework,it should construct an investment system of health resource allocation taking equity as a value orientation; taking ethi-cal responsibility as the framework,it should promote the cooperation consensus of the linkage reform of medical treatment,medical insurance and medical departments; and taking ethical community as the constraint,it should balance the interests of all parties and promote the implementation of the policy of grading treatment system.

Ethical Reflection on Interventional Therapy in Patients with Coronary Heart Disease under the Background of the Medical Conjoined in the New Medical Reform / 中国医学伦理学

Due to the development of economy,the mature of technology,and the improvement of institution,the under-treatment and over-treatment of percutaneous coronary intervention (PCI) gradually tends to be balanced in our country.However,these two phenomena still exist in some regions,even in the same hospital.Under the background of the medical conjoined in the new medical reform,it should play its positive role through strengthening the guidanceof medical ethics and the abiding the principle of optimization,in order to apply PCI scientifically and rationally,benefit patients more,and improve the medical quality.

"Investigation and Study on Patients'Satisfaction about""Sanming Medical Reform""" / 中国药房

OBJECTIVE:To provide the scientific evidence and reference for improving medical reform. METHODS:Based on background ofSanming Medical Reform,self-designed questionnaires were used to investigate the cognition and satisfaction of local patients. The results of investigation were analyzed statistically. RESULTS:A total of 275 paper questionnaires were sent out and all were collected;345 electronic questionnaires were sent out by Wechat and all collected. Among 620 questionnaires,372 valid questionnaires were collected with effective rate of 60.00%. More patients(31.45%)thought the cost of treatment decreased, and less (22.31%) thought the cost increased. The proportion of high-income people who thought cost reduced was significantly higher than the proportion of low-income people (P=0.018). 27.42% of patients believed shortage of drugs,and tertiary hospi-tals were more prone to drug shortage than other medical institutions(P=0.062). The patients'satisfaction with medical staff and healthcare reform were both high(86.56% and 79.03%),but the satisfaction of rural patients was lower than that of urban patients (P=0.051). Understanding of patients onSanming Medical Reformwas in low level. Only 20.70% of the patients fully under-stood or generally understood ofSanming Medical Reform. The patients who thought the skills of medical staff were improved (40.32%)were more than those who thought the skills of medical staff were reduced(5.91%). CONCLUSIONS:Most patients are satisfied withSanming Medical Reform,and agree the achievements;but some problems are not solved,such as the shortage of some drugs,lack of grass-roots medical personnel,not understand medical policy.

"Analysis of the Utilization of Essential Medicines in a Community Health Service Center in Foshan before and after the""New Medical Reform""" / 中国药房

OBJECTIVE:To provide reference for the further promotion ofNew Medical Reformand the further implementa-tion and improvement of National Essential Medicine System. METHODS:By systematic sampling,1728 outpatient prescriptions were randomly selected from a community health service center in Foshan during 2012 to 2015,and then analyzed and compared statistically in respects of the amount of drugs,rational drug use indexes,prescription cost,main disease composition,treatment cost. The change rules and characteristics of all the above mentioned information were all studied. RESULTS:The average number of medicines per prescription and the number of essential medicines decreased year by year,Comparied with 2012,the proportion of antimicrobial agents,the proportion of two or more antimicrobial agents,the proportion of injection prescription and the propor-tion of transfusion prescription were significantly reduced,the cost of medical treatment of patients decreased significantly;medi-cine cost and medicare reimbursement amount had increased to different extents,there was statistical significance(P<0.05). Multi-ple linear regression analysis(stepwise)showed that the cost of medical treatment was closely related to rationality of prescriptions. Respiratory diseases,cardiovascular and cerebrovascular diseases,gastrointestinal diseases were the top 3 of the major diseases, the proportion of prescriptions for respiratory diseases,gastrointestinal diseases decreased year by year,while that for cardiovascu-lar and cerebrovascular diseases increased year by year. CONCLUSIONS:The promotion ofNew Medical Reformand the imple-mentation of National Essential Medicine System play a positive role in promoting rational drug use and the quality of medical ser-vice in community health service center. However,there are still many problems in the community health service centers,such as too many medicines each prescription,the lack of diagnosis and treatment ability,the defects of medicine selection and administra-tion.

Practice and Problem Analysis of Hierarchical Diagnosis and Treatment in China Under the Background of New Medical Reform / 中国医院管理

Hierarchical diagnosis and treatment is the top priority of health care reform,it will provide a solid institutional foundation and institutional protection for the construction of healthy China and the basic health care system.The paper summarizes the present practice of the hierarchical diagnosis and treatment in China,and analyzes the existing problems,on this basis puts forward corresponding countermeasures and suggestions as the references for the construction of hierarchical diagnosis and treatment and deepening reform.

The management of medical consumables in the cost control of hospital / 中国医学装备

Objective: To strengthen the management of medical consumable of hospital, and adapt the public welfare characteristic of hospital, and control the use of medical consumable, and reduce burden of patients, and decrease expenditure of medical healthcare insurance fund so as to establish economic base for realizing the redeveloping of hospital. Methods: Hospital must strengthen internal management, and improve the existed problem in the link of "receive-use-repurchase" of consumables management. Besides, hospital should especially strengthen the management of medical consumables. Results: As above measures, hospital has formulated countermeasures for fortifying the management of medical consumables, and strengthened supervision of purchasing. Besides, hospital has carried out performance assessment of cost from consciousness, and carried out informatization and intelligentialize of materials management system from details. And the management of consumables has be implemented in plan, out-put and in-put of warehouse, application and use management. Conclusion: The strengthening of medical consumable management of hospital can reduce the total cost of medical consumables of patients in treatment and its proportion in the operating cost of hospital. And it can alleviate burden of patients, and it also can reduce the expenditure of medical healthcare insurance fund and operating cost of hospital.