THE IMPACT OF SUPPLY CHAIN MANAGEMENT PRACTICES ON PRODUCTIVITY

The purpose of the study is to test the impact of supply chain management practices on productivity of the organisation. Additionally, investigated the relationship between supply chain management practices and organisational productivity. The type of research used is descriptive in nature.. The study was conducted on the basis of various factors like risk management, process, delivery and planning and how organisational productivity can be improved through these factors of supply chain management practices. The paper revealed that there is a relationship between supply chain management practices and organisational productivity. It also revealed that there is an impact of supply chain management practices on organisational productivity. As far as the researcher is aware,this paper is rst to investigate the impact of supply chain management practices on organisational productivity with factors like quality management, inventory management and transportation and the researcher has done the study on different factors like risk management, planning, process and delivery

Can Drug Price Controls Help Patients Get a Better Deal? A SWOT Analysis

@#Introduction: Due to the increasing rate of drug prices and overall healthcare inflation, stakeholders from the pharmaceutical industry and non-governmental organisations (NGOs) are voicing their concerns about the possible reciprocal effects in the long run. Drug price controls (DPCs) regulation is crucial to ensure affordability and indirectly reduce congestion in public healthcare facilities. This study aims to identify the SWOT analysis of the DPCs in Malaysia and how it will impact the drug supply chain. Methods: The study adopted a subjective environmental scanning method and a SWOT analysis tool to examine the Malaysian pharmaceutical DPCs in the healthcare supply chain (HSC) ecosystem through both intrinsic and extrinsic perspectives. Results: The immediate effect of DPCs would be beneficial, especially to the patients and the government. Balancing the right amount of control and liberalization of the market is seen to be the biggest factor contributing to the policy’s effect on the drug supply chain. The main concern would be the long-term effect as mixed results are coming from a group of countries that had implemented a similar policy. Conclusion: Notwithstanding the qualitative methodology of the paper, the findings could provide a better understanding of the price of drugs in Malaysia’s HSC and serve as a foundation for future studies. This paper proposes a new way to diversify the DPCs economy by entering the HSC chain industry.

El Problema de la Recogida de Productos Defectuosos en el Mercado: Enfoques Académicos y Legales / The Product Recall Problem: Academic and Legal Approaches / O Problema da Recolha de Produtos Defeitos no Mercado: Abordagens Acadêmicas e Jurídicas

Resumen Introducción: el estudio de las campañas de retiro de productos defectuosos del mercado {recalls} es un tema vigente y complejo en el contexto de la gestión de la calidad en cadenas de suministro para garantizar la seguridad y la protección de los consumidores. Objetivo: identificar los principales enfoques académicos y legales utilizados a nivel nacional e internacional para el diseño y ejecución de estrategias de retiro de productos. Materiales y métodos: se aplicó un enfoque exploratorio de la investigación, a través de una revisión de literatura y análisis bibliométrico con Vosviewer, considerando los artículos publicados en el periodo entre 1999 y 2019, en las bases de datos Taylor and Francis, EBSCO, Science Direct, Scopus, Springer Link, IEEE, Google académico y Proquest. Resultados: se evidenció un crecimiento en el número de recalls en los últimos 20 años, especialmente en la industria de juguetes (161 %), sector automotriz (140%), productos de belleza (70 %) y suministros eléctricos (64 %). Las principales metodologías para el estudio de los recalls son de naturaleza cualitativa. Conclusiones: son requeridos nuevos aportes académicos orientados al desarrollo de modelos y metodologías que permitan involucrar a todos los miembros de la cadena de suministro en el diseño y ejecución de estrategias coordinadas para disminuir los riesgos de ocurrencia de productos defectuosos o inseguros en el mercado.

Abstract Introduction: the recall study is a current and complex issue of supply chain quality management to ensure the safety and protection of consumers. Objective: identify the main national and international academic and legal approaches used to design and perform product recall strategies. Materials and Methods: an exploratory research approach was applied, through a literature review and bibliometric analysis with the Vosviewer software, by considering the articles published between 1999 and 2019 in the databases Taylor and Francis, EBSCO, Science Direct, Scopus databases, Springer Link, IEEE, Google Scholar, and Proquest. Results: there was an increase in the number of recalls in the last 20 years, especially in the toy industry (161 %), the automotive sector (140 %), beauty products (70 %) and electrical supplies (64 %). The main methodologies for studying product recalls are qualitative ones. Conclusions: new academic contributions are required for developing models and methodologies that allow all the supply chain members to be involved in designing and performing coordinated strategies to reduce the risks of defective or unsafe products in the market.

Resumo Introdução: o estudo de recolha de produtos defeitos é uma questão actual e complexa de gestão da qualidade da cadeia de abastecimento para garantir a segurança e a protecção dos consumidores. Objetivo: identificar as principais abordagens acadêmicas e jurídicas nacionais e internacionais utilizadas para conceber e executar estratégias de recolha de produtos. Materiais e métodos: foi aplicada uma abordagem de pesquisa exploratória, por meio de uma revisão da literatura e análise bibliométrica com Vosviewer, considerando os artigos publicados no período entre 1999 e 2019, nas bases de dados de Taylor e Francis, EBSCO, Science Direct, Scopus, Springer Link, IEEE, Google Scholar e Proquest. Resultados: houve um aumento no número de recalls nos últimos 20 anos, principalmente na indústria de brinquedos (161 %), no setor automotivo (140 %), produtos de beleza (70 %) e suprimentos elétricos (64 %). As principais metodologias para o estudo de recalls são de natureza qualitativa. Conclusões: são necessárias novas contribuições académicas para o desenvolvimento de modelos e metodologias que permitam a todos os membros da cadeia de fornecimento estarem envolvidos na concepção e execução de estratégias coordenadas para reduzir os riscos de produtos defeituosos ou inseguros no mercado.

Cold chain time- and temperature-controlled transport of vaccines: a simulated experimental study

The application status of chain management in prevention of perioperative pressure injury / 中国实用护理杂志

Perioperative pressure injury accounts for a large proportion of hospital-acquired pressure injury. However, most of them can be effectively prevented by taking measures. Hospital-acquired pressure injury has become one of the ten safety goals to prevent and reduce accidental injury. Chain management is a scientific management mode, emphasizing horizontal and continuous management. This paper summarizes the application progress of chain management in perioperative pressure injury from its concept, application mode, effect, existing problems and enlightenment. It suggests that we should pay more attention to the handover between ward and operating room and the collaboration between nurses and physicians, then establish a standardized prevention program of perioperative pressure injury to improve nursing care.

The application status of chain management in prevention of perioperative pressure injury / 中国实用护理杂志

Perioperative pressure injury accounts for a large proportion of hospital-acquired pressure injury. However, most of them can be effectively prevented by taking measures. Hospital-acquired pressure injury has become one of the ten safety goals to prevent and reduce accidental injury. Chain management is a scientific management mode, emphasizing horizontal and continuous management. This paper summarizes the application progress of chain management in perioperative pressure injury from its concept, application mode, effect, existing problems and enlightenment. It suggests that we should pay more attention to the handover between ward and operating room and the collaboration between nurses and physicians, then establish a standardized prevention program of perioperative pressure injury to improve nursing care.

The management and application of cold-chain for in vitro diagnostic reagent / 中国医学装备

Objective: To carry out effective management for the cold-chain temperature of in vitro diagnostic reagent so as to provide safe and credible inspection basis for clinical diagnosis and treatment. Methods: The remote control and alarm platform of cold storage and refrigerator were applied to achieve acceptance for temperature control of in vitro diagnostic reagent, and achieve acceptance for temperature and achieve differentiation management for unqualified product. These methods could ensure controllability of temperature for the reagent with requirements of cold-chain. Results: Through the management of cold-chain of in vitro diagnostic reagents, hospital has achieved effective supervising for them, and hospital has concrete record for these reagents in the entire medical process, and all of them were traceability. Therefore, it provide effective guarantee for clinical safety. Conclusion: The support of informatization technique and implementation of management system of hospital can ensure the cold-chain management of entire process is not out of control, and enhance the stability and accuracy of clinical test results and effective guarantee the safety of diagnosis and treatment for hospital.

Exploring the Application of Value Chain Management in the Operation of Medical Conjoined Economy / 中国卫生经济

Conjoined mode had great significance on promoting the formation of good medical order during exploring the reform of public hospitals.What aspects should the Medical Association pay attention to in the economic operation management,so as to ensure the effective operation? Value chain management was a kind of management method appearing at the end of last century.The management could be introduced to analyze the industrial chain of medical industry and the internal decomposition of Medical Association.The value of operation could be applied to promote the stable and orderly operation of Medical Association and promote the formation of core competitiveness of hospitals.Therefore,it discussed the application of value chain management in economic management under different modes of medical alliance.

Production, storage, and destination of seafood industry waste in five states of Brazil / Produção, armazenagem e destinação do resíduo da industrialização de pescado em cinco estados brasileiros

Large quantities of waste are generated throughout the seafood supply chain. Although this material has a great potential for use (e.g. pharmaceutical industry, animal feed production), if not managed properly it represents an environmental risk. In order to meet the volume, destination, and method of storage of waste of Brazilian seafood supply chain, we got information from 29 companies that have Official Veterinary Inspection (SIF). After the industrialization of seafood only 44% on average of the total raw material is used for human consumption and 59.2% of the unused portion is discarded in landfill.(AU)

Grandes quantidades de resíduo são geradas ao longo da cadeia produtiva do pescado. Embora este material apresente um grande potencial de aproveitamento (e.g. indústria farmacêutica, produção de ração), se não for corretamente destinado, representa risco ambiental. A fim de conhecer o volume, a destinação e o método de armazenamento do resíduo produzido pela indústria do pescado no Brasil, 29 empresas de processamento de pescado, sob Serviço de Inspeção Federal (SIF), foram estudadas em todo o país. Identificou-se que cerca de 44% do total produzido é matériaprima utilizada para consumo humano, e 59,2% representa resíduo sem finalidade útil, descartado em lixões.(AU)

Exploration on the Talent Training Mode of Medical Direction of Chain Management Major in Higher Vo-cational College / 中国药房

OBJECTIVE:To provide reference for improving the quality of talent training for medical direction of chain man-agement major in higher vocational college. METHODS:The situation of pharmaceutical retail chain industry market was analyzed in China;the problems of talent training mode were summarized to put forward reform plan and measures according to disadvantag-es. RESULTS:Based on the market situation as continues expansion of pharmaceutical retail chain industry market scale,shortage of professional talent pool,the formulation of new retail mode in China,and training mode situation as not enough in-depth cooper-ation between college and enterprise,poor practicality and pertinence of course setting,irrational teachers'structure,teaching re-form could be conducted on the basis of modern apprenticeship system in following aspects,such as college and enterprise shared the responsibility of training and cultivating,student admission is recruitment;college and enterprise designed curriculum system and assessed students together;double tutorteam of college teacher and enterprise teacher was constructed. CONCLUSIONS:The talent training mode based on modern apprenticeship system is the entry point for teaching reform of medical direction of chain management major in higher vocational college,which is conducive to cultivate high quality pharmaceutical management talents meeting industry needs and social development.

Brief analysis feasibility research of the application about modern supply chain management in high-value medical consumables / 中国医学装备

As an important part of medical supplies, the logistics management of high-value medical consumables becomes a key link in modern hospital administration. Compare between the management of high-value medical consumables and modern supply chain management. Based on 4R theory, discusses and analyses the management of high-value medical consumables in Fuwai hospital. By means of 4R theory, modern supply chain management has been optimized for the actual consumable management. And found out a effective method to resolve bullwhip effect caused by the limitations of high-value medical consumables. This research demonstrate modern hospital want to win the competitive initiative only by the improvement of material flow management level.

Application of chain management in education among hypertensive patients of the community / 中国实用护理杂志

Objective To investigate the effect of chain management on education among hypertensive patients of the community. Methods A total of 144 cases of hypertension patients in community were selected as the research objects, they were divided into the control group(72 cases, from February to July 2015) and the countryside group (72 cases, from September 2015 to February 2016).The control group was given routine education, and the countryside group received education with chain management. The treatment compliance and blood pressure values were compared between the two groups before and after intervention. Results The score of patients behavior of drug compliance, adverse drug, self life management and cigarettes-alcohol addiction management after intervention in the countryside group were (20.32±4.41), (34.62±5.08), (41.27±3.54), (10.02±1.79) points, while they were (13.41±3.07), (26.23 ± 5.12), (39.78 ± 2.47), (7.94 ± 1.83) points in the control group. And the scores of the countryside group were significantly higher than those of the control group (t=2.930-9.864, P 0.05). The systolic blood pressure, diastolic blood pressure and mean arterial pressure after intervention in the countryside group were (129.63 ± 8.07), (80.12 ± 7.62), (87.43 ± 9.35) mmHg(1 mmHg=0.133 kPa), while they were (135.42 ± 8.13), (87.56 ± 7.79), (99.31 ± 8.72) mmHg in the control group, and there were significant differences(t=4.295, 3.800, 9.201, P<0.01). Conclusions The chain management mode of community hypertension patients with education, can effectively improve the control of blood pressure in patients, improve the treatment compliance of patients.

Determinando los factores del capital relacional en la interacción de cliente proveedor en MiPyMES

El objetivo de esta investigación ha sido determinar y analizar los factores que caracterizan el capital relacional en la interacción cliente-proveedor en pequeñas y medianas empresas en una región específica de México. Con fundamento en la revisión de literatura se identifican las perspectivas de análisis de la variable de capital relacional en el trato con los proveedores. Se desarrolló y aplicó un cuestionario para recabar datos en 258 micro, pequeñas y medianas empresas (MiPyMES) del noreste de México. Se utilizó la técnica de análisis factorial exploratorio para la determinación de los factores que mejor reflejan la estructura subyacente de las variables de estudio. Se obtuvieron tres dimensiones importantes mediante lo cual se puede afirmar que la comunicación y el compromiso, la integración y la socialización son los factores que caracterizan la relación cliente - proveedor en las micro, pequeñas y medianas empresas estudiadas.

The objective of this research was to determine and analyze factors that characterize relational capital in the supplier customer interaction in small and medium enterprises in a specific region of Mexico. Based on the literature review, the prospects for analysis of relational capital variable in dealing with suppliers are identified. It was developed and applied a questionnaire to collect data on 258 small and medium enterprises (SME's) in northeastern Mexico. The exploratory factor analysis technique for the determination of the factors that better reflect the underlying structure of the study variables was used. Three important dimensions by which we can say that communication and engagement, integration and socialization are the factors that characterize the client relationship were obtained related to the SME's studied.

O objetivo desta pesquisa foi determinar e analisar os fatores que caracterizam o capital relacional na interação cliente-fornecedor em pequenas e médias empresas em uma região específica do México. Com base na literatura de análise de revisão perspectivas de capital variável relacional em lidar com fornecedores são identificados. Foi desenvolvido e aplicado um questionário para coletar dados sobre 258 micro, pequenas e médias empresas (MPMEs) no nordeste do México. foi utilizada a técnica de análise fatorial exploratória para a determinação dos fatores que melhor refletem a estrutura subjacente das variáveis do estudo. fornecedor por micro, pequenas e médias empresas estudadas - três dimensões importantes pelos quais podemos dizer que a comunicação e engajamento, integração e socialização são os fatores que caracterizam o relacionamento com o cliente é obtido.

Practice and exploration of hospital supply chain management based on JCI accreditation standard / 中华医院管理杂志

An exploration was made on the content and methodology of supply chain management of a hospital in line with the fifth edition JCI standard.By means of enhanced management of supply chain procurement,tracking validation,risk management and indicators monitoring,the speed and certainty of relevant processes are improved,with hospital operation effectiveness and efficiency enhanced.

Construction Practice of Modern Pharmaceutical Logistics and Dispensing System in Outpatient Pharmacy / 中国药房

OBJECTIVE:To introduce the experience on how to build modern pharmaceutical logistics and dispensing system in outpatient pharmacy,and to provide reference for the construction of modern outpatient pharmacy. METHODS:The pharmaceuti-cal logistics system could be constructed by setting up secondary warehouse,pharmaceutical supply chain management system (PSCMS) and electronic drug storage system (EDSS);pharmaceutical dispensing system could be constructed through allocating automatic drug dispensing machine with different functions reasonably to carry out dispensing way of different modes combination, building automated pharmacy management system and developing emergency plan for the system fault of the automated pharmacy. The effects of logistics and dispensing system in our hospital were evaluated through comparing related index before and after the application of the systems. RESULTS:With the aid of PSCMS,the drug purchase information could be collected and calculated au-tomatically,the frequency and working time of the purchase were reduced by 50% and 75% respectively,and the accuracy of the purchase plan was increased by 12.5%;with the EDSS,the position and number information of the drugs could be acquired imme-diately,and the complementation and inventory time were decreased by 67% and 58% respectively;the time for manual dispens-ing was reduced by 68%,and the incidence of internal mistakes was decreased by 76.7%;under new dispensing system,the pre-scription could be distributed automatically and intelligently,the rate of automatic prescription processing was increased to 72.7%, and the average waiting time to pick up drugs was controlled to below 10 min. CONCLUSIONS:The pharmacists’working effi-ciency and the quality of pharmaceutical care have been improved by the modern pharmaceutical logistics and dispensing system, which settle the foundation for the transformation of the pharmaceutical care mode.

Hierarchical chain management model in blood glucose control and its influence factors in patients with diabetes mellitus / 中国医师进修杂志

Objective To explore the hierarchical chain management model in blood glucose control and its influence factors in patients with diabetes mellitus.Methods Health management database of diabetic patients was established in 2007 and managed by hierarchical chain management.The number of the patients reached to 1010 till 2011.The blood glucose control of diabetic patients was analyzed and its influence factors were analyzed by multivariate unconditional Logistic regression method.Results The concentration of glycosylated hemoglobin( HbA1c ) of 1010 patients with type 2 diabetes was (8.21 ±:2.70)％.Four hundred and eighty-seven cases (48.22％) reached the blood glucose standard,303 cases (30.00％)reached the blood pressure standard,245 cases (24.26％) reached the blood lipids standard,and 76 cases (7.52％) reached all three standards.Multivariate analysis showed that occupation (OR =2.521,95％ CI:1.871 - 3.397),education level (OR =1.890,95％ CI:1.642 - 2.174),disease course (OR =1.035,95％CI:1.016 -1.055),systolic pressure (OR =1.016,95％ CI:1.007 -1.025) and triglyceride (OR =1.204,95％CI:1.063 - 1.365) were the risk factors of blood glucose control (P ＜0.01).Conclusions Hierarchical chain management model is helpful for the blood glucose control in patients with type 2 diabetes.The comprehensive control and treatment of type 2 diabetes should be taken combined with related risk factors,such as blood pressure,blood lipids and diabetes disease course.

Influencing factors of standardization in the hierarchical chain management of type 2 diabetes / 中国综合临床

Objective To analysis the influence factors of standardization in the hierarchical chain management of type 2 diabetes and to enhance the hierarchical chain management of type 2 diabetes.Methods ( 1 ) Six hundred and ninty patients with type 2 diabetes completed 1 years management were divided into well-controlled glycosylated hemoglobin ( HbAlc ) group (＜7.0％ ) and bad-controlled glycosylated hemoglobin (HbAlc) group ( ≥ 7.0％ ).The conditions of diet,physical activity,medication,self-blood sugar monitoring and participation in health seminars were investigated and analyzed.(2) The patients were divided into standardized management group and not standardized management group.Their age,sex,educational background,occupation,monthly income per person,medical security,the course,cognition for glycuresis,two-way transfer,and chronic complications were investigated and statistically analyzed.Results ( 1 ) The proportions of physical activity (70.1％ vs 54.2％,x2=6.163,P=0.018),self-blood sugar monitoring(60.4％ vs 43.8％,x2=6.268,P=0.016) and participation in health seminars (56.0％ vs 41.7％,x2=4.577,P=0.045) in the well-controlled HbAlc group were significantly higher than those in the bad-controlled HbAlc group.(2) Their age [(61.08 ±10.04) years old vs ( 57.75 ± 9.89 ) years old,t=2.539,P=0.012],educational background ( ratio of low educational attainment:8.3 ％ vs 17.2％,x2=6.426,P=0.041 ),medical security (own expense ratios:4.6％ vs 11.5％,x2=3.543,P=0.048 ),awareness of diabetes ( ratio of poor awareness of diabetes:19.4％ vs 41.0％,x2=17.518,P=0.000 ),two-way transfer ( ratio of not transfer treatment:4.6％ vs 14.8％,x2=7.662,P=0.022) and chronic complications ( ratio of chronic complication:41.7 ％ vs 26.2％,x2=6.130,P=0.017) were significantly different between the standardized management group and not standardized management group.(3) Logistic regression analyses indicated that the age ( OR=0.954,P=0.006),monthly income per person ( OR=4.101,P=0.018 ),medical security ( OR=7.617,P=0.003 ),cognition for glycuresis ( OR=0.030,P=0.000),two-way transfer ( OR=9.079,P=0.000) and chronic complications ( OR=0.456,P=0.031 ) were the risk factors of standardized management.Conclusion We should focus on the impact factors affecting the standardized management of patients including age,monthly income per person,medical security,awareness of diabetes,ratio of not transfer treatment,positive strategies for chronic complications,improve the hierarchical chain management of type 2 diabetes,and then make the diabetic patients to early participate in standardization management of diabetes mellitus and delay the appearance of complications.

A contribuição da logística integrada às decisões de gestão das políticas públicas no Brasil / The contribution of integrated logistics to public policy management decisions in Brazil

Neste artigo buscamos identificar e sistematizar os componentes logísticos da gestão de políticas públicas, analisando como as decisões logísticas são centrais e, ao mesmo tempo, específicas para se pensar a melhoria do Estado e dos serviços públicos. Além disso, buscamos identificar como essas decisões logísticas, do ponto de vista da logística integrada e do gerenciamento da cadeia de suprimentos, podem ser consideradas, nos processos decisórios da gestão de políticas públicas, como instrumento de promoção da eficiência e de impactos significativos nos próprios resultados da administração pública. Para tanto, este artigo identifica e classifica uma série de decisões logísticas essenciais que caracterizam a ideia de logística no setor público. Também analisa algumas experiências e casos que demonstram a importância e especificidade dessas discussões para as políticas públicas.

This article aims to identify and classify the logistics aspects of the management of public policies, examining how logistics decisions are essential to improve the state organizations and public services performance. Adopting integrated logistics and supply chain management point of view we seek to identify how these logistics decisions can be considered in decision making processes of public policy management as a tool to promote efficiency and significant impacts on results of public organizations management. Therefore, this article presents a series of essential decisions that concern the central idea of logistics in the public sector. It also discusses some experiences and cases that demonstrate the importance and specificity of these discussions to public policy.

Organización del abasto de medicamentos en los servicios estatales de salud: potenciales consecuencias de la mezcla público-privada / Organization of the drug supply chain in state health services: potential consequences of the public-private mix.

OBJETIVO. Evaluar las consecuencias de la subrogación privada sobre el proceso general de abasto y el surtimiento completo de recetas en los servicios estatales de salud. MATERIAL Y MÉTODOS. La investigación se realizó utilizando técnicas cuantitativas y cualitativas en 13 entidades federativas. La información se recolectó mediante entrevistas y observación directa. Las entrevistas se aplicaron a personal de los servicios estatales de salud relacionados con la cadena de abasto de medicamentos y a usuarios de los servicios de atención. La aproximación cuantitativa examinó, en una muestra por conveniencia de usuarios, el porcentaje de recetas completas surtidas. RESULTADOS. Las entidades que han optado por el modelo tercerizado en su totalidad y lo controlan adecuadamente han incrementado el suministro de medicamentos entre sus usuarios y garantizado el abasto en las unidades de atención a su cargo. Otras entidades con modelo tercerizado tienen múltiples problemas: compra directa de medicamentos no incluidos en el cuadro básico, incumplimiento de proveedores y escasez de insumos en los laboratorios que proveen a la empresa. Como principales inconvenientes de todos los modelos se identificaron la subordinación de los criterios médicos a los criterios administrativos; la insuficiente planeación basada en las necesidades locales de atención; la heterogeneidad de los procedimientos; el conocimiento insuficiente de la normatividad y la falta de regulación. CONCLUSIÓN. Los resultados indican que la incorporación de proveedores privados en la cadena de abasto de medicamentos podría no ser la solución para abatir el desabasto que padecen los servicios de salud, especialmente a escala hospitalaria. El cambio hacia modelos subrogados (tercerizados) se ha desarrollado sin incorporar mecanismos de evaluación, y las consecuencias que esta transición puede acarrear sobre los sistemas estatales de salud deben ser investigadas con mayor profundidad.

OBJECTIVE. To assess the consequences of private outsourcing on the overall supply and filling of prescriptions in state health services. MATERIAL AND METHODS. The research was conducted using quantitative and qualitative techniques in 13 states. The information was collected through interviews and direct observation. The interviews were carried on staff of state health services related to the drug supply chain and users of health services. The quantitative approach examined the percentage of stocked full recipes in a sample of users. RESULTS States that have opted for the fully outsourced model, and properly monitored this choice, have increased the supply of drugs to their users and guaranteed the supply in the care units in charge. Other states with the outsourced model have multiple problems: direct purchase of drugs not included in the basic drugs catalogue, failure of suppliers and shortage of supplies in the laboratories that provide the company. The main disadvantages identified in all models were: the subordination of the medical criteria to administrative criteria, insufficient planning based on local care needs, heterogeneous procedures, insufficient knowledge of regulations and lack of normativity. CONCLUSION. The results indicate that the incorporation of private providers in the drug supply chain may not be the solution to bring down the shortage faced by health services, especially at the hospital level. The shift to outsourcing models has developed without incorporating evaluation mechanisms and the consequences that this transition can have on state health systems must be investigated more deeply.

Study and effect assessment of the hierarchical chain management model of type 2 diabetes / 中国医师进修杂志

Objective To explore the hierarchical chain management model of type 2 diabetes and determine its evaluation.Method Based on the hierarchical chain management of the three community health service institutions and Dahua hospital in Shanghai Xuhui district,215 cases of type 2 diabetes had been involved in the study.Results Compared with the baseline before management,lasting blood glucose (FBG),2 h postprandial glucose (2hPBG),glycosylated hemoglobin (HbA1c),low density lipoprotein cholesterol (LDL-C),systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the diabetes after 12 months' management declined [(8.50 ±2.81) mmol/L,(11.09 ±4.01) mmol/L,(8.56 ±2.41)% ,(3.31 ± 1.06) mmol/L,(139.06 ±20.68) mm Hg (1 mm Hg = 0.133 kPa),(78.20 ± 12.11) mm Hg vs.(7.41 ±2.04) mmol/L,(9.03 ±2.46) mmol/L,(7.34 ± 1.59)% ,(3.00 ± 1.06) mmol/L,(135.48 ± 17.82) mm Hg,(77.27 ±11.83) mm Hg],and the differences were statistically significant(P＜0.01 );control rate of FBG,2hPBG,HbA1c,LDLC,SBP,DBP had improved significantly [19.5% (42/215),20.9% (45/215),24.7%(53/215),20.0%(43/215),27.4%(59/215),30.2%(65/215) vs.50.7%(109/215),53.0% (114/215),54.0%(ll6/215),42.3%(91/215),47.0%(101/215),45.6%(98/215)](P＜0.01).Conclusion Primary and secondary-care hospital based hierarchical chain management model is valid and can be implemented for type 2 diabetes.