ABSTRACT
Objective:To investigate the compassion fatigue of medical staff working in centralized quarantine sites and its influencing factors during the COVID-19 epidemic.Methods:From September 2020 to October 2020, a cross-sectional study was conducted on 213 medical staff working in 13 quarantine centers in two districts of Shanghai. A self-made general information questionnaire, professional quality of life scale, general self-efficacy scale and perceived social support scale were used in the study.Results:The score of empathy satisfaction was 33.00(28.25, 37.75), and there were 141 cases (66.20%) with supercritical value. The score of job burnout was 26.00(21.50, 30.50), and 96 cases (45.07%) exceeded the critical value. The score of secondary traumatic stress was 25.00(20.50, 29.50), and 192 cases (90.14%) exceeded the critical value. Multivariate logistic regression analysis showed that average daily working hours, job satisfaction, self-evaluation of work pressure, general self-efficacy and perceived social support were the influencing factors of compassion fatigue among medical staff. Compared with those who worked for 0 h in the polluted area, those who worked for more than 8 h had a higher degree of compassion fatigue ( OR=7.787, 95 %CI: 1.127-53.820);compared with those who were more satisfied with their work, those who were less satisfied with their work had a higher degree of compassion fatigue ( OR=6.209,95 %CI:1.474-26.157); compared with those with no or low stress, those with high stress had higher degree of compassion fatigue ( OR=2.567, 95 %CI: 1.228-5.366); compared with those with high self-confidence, those with low self-confidence or moderate self-confidence had higher degree of compassion fatigue ( OR=13.519, 95 %CI: 3.394-53.848; OR=3.462, 95 %CI: 1.038-11.548); compared with those with high perceived social support, those with low perceived social support had higher degree of compassion fatigue ( OR=2.071, 95 %CI: 1.027-4.175) (all P<0.05). Conclusion:The status of compassion fatigue of medical staff working in the centralized quarantine sites need to be improved. We should pay more attention to the those medical staff having long daily working hours in the polluted area, those with low job satisfaction, poor self-evaluation of work pressure, poor general self-efficacy and low perceived social support.
ABSTRACT
Objective:To investigate the changes of disease constitution in general practice outpatients before and after COVID-19 pandemic.Methods:Rank-sum ratio (RSR)method and Pareto method were used to comprehensively analyze the disease composition of patients in general practice outpatients in Huacao Community Health Service Center of Shanghai from January 2019 to December 2021.Results:The number of visits to general practice clinic decreased from 2019 to 2021. The top five diseases in RSR were circulatory system, endocrine, nutrition and metabolism, respiratory system, digestive system, and nervous system(RSR=1.000,0.917,0.896,0.813 and 0.750), all of which were classified as Class A factors, with a cumulative composition ratio of 80.45%. Taking the above 5 categories as the main diseases, and consistency analysis was performed for the annual changes. The coefficient of concordance of the top five diseases was poor, and not statistically significant ( WR=0.956, χ 2=11.47, P>0.01), suggesting that the disease spectrum was changed. The visits of patients with respiratory diseases dropped from the 2nd place to the 3rd after COVID-19 pandemic, with an average annual change rate of-14.31%, the lowest among all diseases. Among the top five diseases, nervous system disease had the highest annual change rate (7.68%). Among the factors affecting health status and contact with health care institutions, eye and appendage diseases ranked the first with the annual change rate of 12.97% and 10.35%,respectively. Conclusions:After the outbreak of COVID-19 pandemic, the disease spectrum in general practice clinics has changed. Measures must be taken in time to meet the needs for medical care.
ABSTRACT
Objective:To analyze consecutive patients visits in a community health service station in Beijing.Methods:The basic information and behavior of the patients who visited Sanliheerqu Health Service Station in Beijing Xicheng district from January 1, 2015 to December 31, 2019 were retrieved from the electronic health records. The visiting situation, the stratification of the number of visits, and the correlation between the basic information and the consecutive visit was analyzed.Results:A total of 4 696 patients visited 202 560 times during 2015 to 2019, of whom 1 162 were consecutive patients (24.7%) with a total of 100 083 visits (49.4%).The annual number of visits, the total number of visits and the number of consecutive visits all showed an upward trend during the five years.The top 5 reasons for consecutive visit were all chronic diseases (hypertension, type 2 diabetes, dyslipidemia, coronary heart disease, and stroke) with median annual visits of 11 to 18, and it was increasing with the year. The rates of incidental visits (1-3/year, 66/1 162, 5.7%) and continuous visits (4-26/year, 1 020/1 162, 87.8%) in 2015 were higher than those in other years; while the rates of frequent visits (27-52/year, 71/1 162, 6.1%) and very frequent visits (>52/year, 5/1 162, 0.4%) were lower. The rates of frequent visits (181/1 162, 15.6%) and very frequent visits (78/1 162, 6.7%) in 2019 were higher than those in other years (χ 2=182.40, P<0.001).Compared with the non-consecutive visit group, the proportion of women (38.1%,735/1 930) and overweight/obesity (39.6%, 777/1 960) in the consecutive visit group was higher (χ 2=36.09, 69.69, P <0.001). Conclusion:The consecutive visit rate of residents in this institution needs to be improved. The utilization rate of primary medical resources for patients with consecutive visit is high and the number of medical visits is on the rise. Gender and BMI of patients may be related to consecutive visit.
ABSTRACT
The Xidu Community Health Service Center has become the first general practice outskirt teaching site of Shanghai Zhongshan Hospital since May 2015; the Fudan University Shanghai Medical College Xidu General Practice Clinical Teaching and Training Base was formally established in May 2018. For last 6 years, with the cooperation with Zhongshan Hospital the Xidu Community Health Service Center has participated in teaching and training of general practice residents and general practitioners, which also greatly promoted the development of clinical service, disease prevention and scientific research of the center itself. This article introduces the "Fudan-Xidu" integrated model and its experiences in general practice teaching, focusing on the background, the organization, teaching implementation, achievements and future prospects, to provide a reference for talent training of general practice in grassroots institutions.
ABSTRACT
Background: The government has launched various schemes for reduction in maternal mortality rate and neonatal mortality rate. The Janani Shishu Suraksha Karyakram (JSSK) was launched to increase the institutional delivery by providing the entitlements for mother and infants by government. Objectives: The objectives of the study were to assess the implementation status of JSSK and to identify the beneficiaries and provider perspective. Materials and Methods: The cross-sectional study was carried out during January 2014-December 2015. A total of 19 primary health centers (PHCs) and 10 community health centers (CHCs) were selected to study the implementation status of JSSK in Ahmedabad district. Results: All the PHCs and CHCs had basic infrastructure facilities. In 50% PHCs and the entire CHCs provider perceived that there was overload in the work after the implementation of scheme. Provider perceives that there was lack of awareness of entitlements among beneficiaries. Conclusion: All the PHCs and CHCs have the required infrastructure facilities to provide maternal and child health services. The laboratory services were available in all health centers, but it was inadequate.
ABSTRACT
Objective:To investigate the rehabilitation resources of community health centers in Shanghai. Methods:December, 2018, all 247 community health centers in 16 districts of Shanghai were investigated with Health Institution Questionnaires, including the number of rehabilitation personnel (physiatrician, physical therapists) and the number of rehabilitation beds, etc. Results:There were 152 physiatrician and 597 physical therapists in community health centers in Shanghai. The numbers of physiatrician and physical therapists per 1000 registered population were 0.01 and 0.04, and were 0.03 and 0.12 for per 1000 registered elderly population. There were 17 484 beds in community health centers, in which the rehabilitation beds were 1425, accounting for 8.15%. Besides, the numbers of rehabilitation beds per 1000 registered population and registered elderly population in Shanghai were 0.10 and 0.30. Conclusion:The development of community-based rehabilitation in Shanghai is unbalanced. There is lack of community-based rehabilitation resources, the supply of service is insufficient, and there is gap between supply and demand. It is suggested to strengthen the support to community-based rehabilitation, and improve the supply of community-based rehabilitation resources.
ABSTRACT
From April 2017 to September 2019, the START (standardized reception, teaching, analysis, research, training) method was adopted to train 50 general practitioners at the community general practice teaching clinic of Shanghai Huangdu Community Health Service Center. After 3 months of training, the progress of clinical competence and teaching ability were assessed. After training, the scores of clinical skills and communication skills were significantly higher than those before training (P<0.01). The scores of medical history taking, clinical thinking and health education were higher than before (all P<0.01). But there was no significant difference in record writing and reception time management between those before and after training (all P>0.05). The scores of the ability for building physician-patient relationship, collecting information and providing feedback, understanding complaints from patients′ perspective, sharing information and obtaining informed consents were higher than that before training (all P<0.01). The teaching ability of plan design and teaching method were significantly improved compared with that before training (all P<0.01). The satisfaction rate of START method was 96.0%(48/50). The START method applied in community teaching clinic can significantly improve the clinical competency and teaching ability of general practitioners.
ABSTRACT
Objective@#To survey the demands of tobacco control service among male smoking patients in primary health care settings in Shanghai.@*Methods@#Eight community health service centers in Shanghai were selected through stratified cluster sampling method. A total of 1 458 male patients, who visited their doctors in community health centers in January 2017, completed the questionnaire and were eligible for our study. The contents of questionnaire included demographic information, smoking history, knowledge of tobacco smoking, attitudes toward tobacco control; and the questions regarding smoking cessation service were only for the smokers.@*Results@#Of the 1 458 male patients, there were 679 current smokers (46.6%, 679/1 458), among whom 358 (52.7%, 358/679) intended to quit. The demand rate for the knowledge regarding tobacco and health, smoking cessation plan, overcoming barriers were 58.9% (211/358), 56.4% (202/358) and 53.1%(190/358), respectfully. The rate of demand for smoking cessation hotline was 38.5% (138/358). Those who were under 45 years of age, retirees, suffering from chronic disease (s), having knowledge of tobacco, having knowledge of smoking cessation pathway (s), smoking cessation recommendation from medical staff were more willing to accept tobacco control services.@*Conclusions@#The demand for tobacco control services and utilization rate are relatively low among male smoking patients in primary health care settings in Shanghai. Based on the results acquired from the survey the appropriate measures should be taken.
ABSTRACT
In order to improve the quality of clinical teaching, Xidu Community Health Service Center of Shanghai Fengxian District established a teaching clinic for training of general practitioners in 2015. The clinic served as a suburban teaching station of Department of General Practice of Zhongshan Hospital, a tertiary university hospital. This article introduces the implementation methods, achievements, practical experiences and work prospects of the clinic. The issues of system evaluation and the generalization of this teaching model for training of general practitioners are also discussed in the article.
ABSTRACT
Abstract@#Public services conducted by government officials are still weak, they cannot satisfy the quality expected by the public. This is indicated by the existence of various complaints from the community through mass media. Community Health Service is one of government officials and workers use it. The aim of this study was to assessment the workforce satisfaction index in the utilization of community health center in Jombang. Methods: This research is an observational research that applies quantitative method by applying community satisfaction index questionnaire. The data was collected in July 2017. The number of sample were 30 respondents chosen by using accidental sampling method. Results: The results showed that 1) the ease of procedures was poor, 2) the suitability of the requirements was poor, 3) directness of service was very good, 4) the discipline of officers was very good, 5) the responsibility of officers was poor, 6) the ability of officers was poor, and 7) the speed of service of officers was very good, 8) the fairness of service was poor, 9) the friendliness of the officers was very good, 10) the fairness of costs was very good, 11) the suitability of cost was very good, 12) the accuracy of the schedule was good, 13) the location was poor, 14) the security of the location was good. Conclusion: still needs several improvements in seven elements of WSI in the Community Health Center.
ABSTRACT
Objective@#To understand the status quo and differences of the rights and interests of primary medical staff in a community, and to provide targeted suggestions for improving the rights of such staff.@*Methods@#From October to November 2018, a questionnaire survey was conducted on all the medical staff of 8 community health service centers in a district of Shanghai, and 562 valid samples were obtained.@*Results@#The primary medical staff had the highest demands for " pay rise" (4.783±0.598), " paid vacation" (4.569±0.873)and " additional reserve fund" (4.553±0.963); the lowest demands were placed on " education-based promotion" (3.797±1.382), " refresher training" (3.801±1.314), and " opinion feedback mechanism" (4.018±1.223). At the same time, the rights and interests of these staff in different occupational categories were significantly different(P<0.05)in " daily reimbursement" , " housing subsidy" , " refresher training" and " opinion feedback mechanism" .@*Conclusions@#The salary demands of the primary medical staff are the most obvious, and there are differences in the demands of medical staff in different occupational categories. It is suggested to establish a more reasonable salary system and pay attention to the differentiated appeals of different medical personnel.
ABSTRACT
Objective To survey the status of aspirin application asautiplatelet therapy for secondary prevention of coronary artery disease (CAD) in Beijing communities.Methods A cross-sectional survey on status of aspirin use was conducted among 60 communities in Beijing from September 2014 to January 2015.Items of survey included the duration of aspirin application,aspirin dosage,application time,reasons for interruption and reasons for non-application.Results Total 61 000 questionnaires were delivered and 56 969 valid ones were retrieved with a recovery of 93.39％.The aspirin application rate was 78.22％ (15 105/19 311)among patients with diagnosed CAD,while that was 81.42％ (1 319/1 620) among patients with self-reported CAD (x2=9.06,P＜0.01).There was no effect of early cardiovascular disease family history on aspirin application among patients with diagnosed CAD (P =0.77).Among the patients with diagnosed CAD,the reasons of no aspirin application were:rejection with unknown reasons,worry about stomach side effects,clopidogrel application,not suitable subjectsand other antiplatelet drugs application.Conclusions The proportion of aspirin application is relatively high among coronary artery disease patients in Beijing communities.The results of survey provide the direction of patient education in the future.
ABSTRACT
OBJECTIVES: The purpose of this study was to examine the success and barrier factors of hypertension registration program in Goseong community health center proven improving hypertension treatment rate by community health survey. METHODS: We conducted a qualitative research using both a performance review of the program and in-depth interviews with the 8 operators who had worked for this program in April 2018. RESULTS: In this study, the success factors were analysed as follows: First, the willingness to improve health indicators, second, the implementation of large-scale projects, third, improving program processes, fourth, continuous efforts for achievement of goal, not output or reward, and the barrier factors are as follows. First, uniform output monitering, second, evaluation after the fashion of contest, third, the confusing concept of an integrated health promotion program, fourth, the attitude of the person worried with task change. CONCLUSIONS: This study suggested that the health community health center should follow the basic principles of public health, and the central government should introduce a health policy of decentralization.
Subject(s)
Humans , Clothing , Community Health Centers , Health Policy , Health Promotion , Health Surveys , Hypertension , Politics , Public Health , Qualitative Research , RewardABSTRACT
Objective@#To investigate the relationship between insomnia and cognitive function in middle-aged and elderly patients.@*Methods@#Patients aged ≥ 45 years visiting outpatient clinic of You′anmen Community Health Center from October 2016 to December 2016 were enrolled in the study. Among 850 participants there were 159 patients with persistent insomnia, 188 with paroxysmal insomnia (insomnia group) and 503 with normal sleep (normal sleep group) according to DSM-5 diagnostic criteria. The sleep quality and cognition were evaluated using Pittsburgh Sleep Quality Index(PSQI) and Montreal Cognitive Assessment(MoCA) and compared among 3 groups. Relationship between sleep quality and cognition, influencing factors of cognition were explored in this study.@*Results@#The total score and all sub-scores of PSQI in persistent insomnia group were higher than those in the normal sleep group. The total score of PSQI and all sub-scores (except hypnotic drugs and daytime dysfunction) of paroxysmal insomnia group were higher than those of normal sleep group. The total PSQI score and all sub-scores (except sleep disorders) of the persistent insomnia group were higher than those of the paroxysmal insomnia group. The total score of MoCA and the sub-scores of naming, attention, language, abstract thinking, delayed recall and orientation ability of the persistent insomnia group were lower than those of the normal sleep group (P<0.05). The language ability of paroxysmal insomnia group was lower than that of normal sleep group (P<0.05). The language ability of persistent insomnia group was lower than that of paroxysmal insomnia group (P<0.05). The total score of MoCA was negatively correlated with the total score of PSQI and sub-scores of sleep time and sleep efficiency (r=-0.162, -0.131, -0.190; P<0.05). Logistic regression analysis showed that age was a risk factor for cognitive impairment (β=0.038, P=0.000) and sleep efficiency was a protective factor for cognitive function (β=0.260, P=0.000).@*Conclusion@#The overall cognitive function of middle-aged and elderly patients with persistent insomnia is poor, the abilities of naming, attention, language, abstract thinking, delayed recall and orientation are decreased; and the cognitive function is associated with age and sleep efficiency.
ABSTRACT
OBJECTIVE:To study influential factors for retail chain drugstore undertaking the pharmacy function of community health center based on the perspective of retail chain drugstore pharmacist. METHODS:The stratified sampling method was used to conduct questionnaire survey among pharmacists in retail chain drugstores from Pearl River Delta(Guangzhou,Foshan, Dongguan),eastern Guangdong,western Guangdong and northern Guangdong. Multivariate analysis of variance was performed to study main effects of independent variables,pairwise comparison and interaction,with social demographic characteristics(gender, age,educational level,major,profession at title,working life,location)as independent variables,using fear of workload increase,inadequate pharmaceutical care,lower wages,inadequate electronic prescription acceptance and change in the work model as dependent variable. RESULTS:A total of 242 questionnaires were sent out,involving 239 valid questionnaires with effective recovery rate of 98.8%. The results of multivariate analysis of variance showed that majors of main effect and the interaction between major and professional title affected the fear of increase in the workload;age,education and working years of main effect,and the interaction between age and location affected the fear of inadequate pharmaceutical care;professional title of main effect affected the fear of electronic prescription acceptance;age and location of main effect,and the interactions between age and professional title influenced the fear of change in work model. CONCLUSIONS:It is suggested to strengthen pharmaceutical care and electronic prescription acceptance of pharmaceutical staff in retail chain drugstore,increase the number of professional pharmaceutical staff,allocate pharmaceutical staff reasonably and consider about regional differences.
ABSTRACT
Objective To screen stroke risks among middle-aged and elderly people in community outpatient clinics in Shanghai.Methods A stroke risk screening was conducted among people aged 45-75 years selected with convenient sampling method from 10 community health service centers in Putuo district,Yangpu district and Pudong New Area of Shanghai during January to July 2017.The questionnaire and clinical measurement were used for screening.Multivariate logistic regression analysis was used to analyze the risk factors in subjects with high stroke risk.Results In this study,1 094 individuals with high stroke risk were screened out from 1 750 participants (62.5％).The proportion of high risk cases was higher among men (66.7％,473/709) than that among women (59.7％,621/1 041),unmarried,divorced or widowed (75.0％,90/120)than married or cohabitants (61.6％,1 004/1 630),living alone (72.1％,70/97) than living with others (61.9％,1 024/1 653) (x5=8.969,8.571,4.081;P＜0.01).Compared with non-high-risk subjects,the high-risk subjects had higher BMI,systolic blood pressure,diastolic blood pressure,fasting blood glucose,glycated hemoglobin,total cholesterol,triglycerides,serum creatinine and homocysteine,and were more likely to have carotid plaques or stenosis,the difference was statistically significant (P＜0.05).Multiple logistic regression analysis showed that unmarried/divorce/widowed,high BMI,systolic blood pressure,fasting blood glucose,total cholesterol,and carotid plaque or stenosis were positively associated with high stroke risk(OR=2.015,1.173,1.013,1.456,1.139,1.026,2.103;P＜0.05).Conclusions The proportion of high stroke risk individuals among middle-aged and elderly people is higher in community general practice outpatient clinics in Shanghai.Patients with high BMI,systolic blood pressure,fasting blood glucose and total cholesterol,and carotid plaque or stenosis,as well as those unmarried/divorced/widower should be the subjects for stroke intervention.
ABSTRACT
Objective To investigate the prevalence and related risk factors of anxiety symptoms in elderly patients from one community health service center in Shanghai.Methods Patients aged 60 to 85 years visiting Kongjiang Community Health Service Center from August to December of 2016 were included in the survey.The patients were evaluated with Generalized Anxiety Disorder Scale-7 (GAD-7),Sociodemographic and Health-related Variables Questionnaire,Mental Health Knowledge Scale and Lubben Social Network Scale-6 (LSNS-6).Results Total 2 006 questionnaires were distributed and 1 981 valid questionnaires were returned with a recovery rate of 98.75％.The overall GAD-7 score was 0 (0,2),and 13.5％ (267/1 981) participants had positive anxiety symptoms.Multivariate logistic analysis showed that 6 variables were related to anxiety symptoms,including educational background,exercise frequency,percentage of medical costs over total household expenses,life satisfaction,the amount of chronic somatic disease,mental health knowledge awareness (P ＜ 0.05).Conclusion The prevalence of anxiety symptoms in the study population is relatively high.Anxiety symptoms are associated with multiple factors,to which the attentions should be paid.
ABSTRACT
Objective To survey on the intention of seeking pediatric service in primary care institutions among parents in Shanghai rural area .Methods A survey on the intention of pediatric care-seeking was conducted during June to December in 2016 using simple random sampling method in Fengxian District of Shanghai.Subjects were choosen from the parents visiting pediatric department in Xidu Community Health Center ( CHC) (289 ), parents having kids in the local kindergarten ( 121), and medical staff working in this district with children under age 14 (205).Results Total 615 individuals were surveyed and 572 responded with a response rate of 93.0%.The age of participants was (32.1 ±6.4) years, and they were 191 males and 381 females.Among all responders, 88.4%(505/571) wanted to have pediatric service in CHC, 9.5%(54/571) did not care and 2.1%(12/571) did not want.If the CHC had service provided by pediatric specialists , 81.5%( 466/572) intended to seek pediatric care in CHC , 10.8%(62/572) did not care and 7.7%(44/572) did not want.If the general practitioner provided pediatric service, the rates were 51.9%(297/572), 12.1%(69/572) and 36.0%(206/572), respectively.In comparison, the intention to seek care provided by pediatric specialists was stronger (Z ＝-12.553, P ＜0.001). Parents who were not medical professionals preferred to set pediatric clinic in CHC ( OR ＝6.849, P ＝0.026); parents who were not Shanghai residents preferred to see pediatric specialists (OR＝2.732, P＝0.033).Parents who were older than 30 years (OR＝1.770, P＝0.013), who were medical professionals (OR＝2.093, P＝0.003) or having children aged 0-3 years (OR＝2.154, P＝0.001) preferred to visit general practice clinics .Only 11.7%(66/562) would choose CHC when their children were ill . Parents who were older than 30 years (OR＝2.083, P＝0.038) or whose family income was less than 8 000 yuan/m (OR＝1.967, P＝0.030) preferred to choose CHC.The reason for choosing CHC was close to home for 93.8%(61/65) and good treatment effect for only 18.5%(12/65).The expectations of pediatrics in CHC included more comprehensive medical equipment (82.2%, 466/567), higher service level (77.8%,441/567), more complete medicine stock (74.8%, 424/567)and regular expert outpatient service (70.0%, 397/567).Conclusion Parents have strong demands of providing pediatric care in CHC, but the pediatric skills of general practitioners are not trusted .The CHC should upgrade related facilities and medicine stock for further improving the quality of pediatric service .
ABSTRACT
Hangzhou Sijiqing Community Health Service Center has started the precise contract service mode with the characteristics of competitive contract,regional medical alliance and team service form 2016,which improved hypertensive and diabetic patients management in community.After adopting the precision contract service mode,the contracting rate of hypertensive and diabetic patients increased from 56.1％ (2 680/4 777)to 81.6％ (5 602/6 863),the rate of referral to regional medical alliance increased from 26.1％ (2 678/10 259)to 44.4％ (5 589/12 589),consultation rate of contracted doctor increased from 47.1％ (54 603/115 986) to 56.3％ (93 219/165 725),contract renewing rate increased from 41.3％ (5 794/10 822) to 67.2％ (7 282/10 838),and the rate of home nursing care in increased from 9.5％ (47/495) to 61.5％ (392/637).The precise family doctor contract service is an effective mode for primary care,which improves the management rate of hypertensive and diabetic patients,provides continuous medical service,facilitates referral and home nursing service,and promotes the continuity of contract service.
ABSTRACT
In recent years,Shanghai is exploring the implementation ot comprehensive budget management in community nealtn center,but facing some problems in process:the budget management model is still not unified,"separation between revenue and expenditure" policy is not really implemented,the financial subsidies is not combined with performance appraisal.Meanwhile within the center,the personnel funds are approved by public sector,the operation funds are not standardized,and project funds are relatively chaotic.It is recommended to carry out cost accounting of community health center,clarify expenditure,introduce standardized workload in community health center to promote budgeting scientifically,strengthen the information construction to make budget implementation assessment,and establish a performance appraisal linked to the government subsidy mechanism.