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Primary health care institutions and physicians play a fundamental role and are the first line in the prevention and control of pandemics.Since the outbreak of coronavirus disease-2019(COVID-19) in 2019, nearly 4 million primary healthcare professionals across the country have been actively participated in pandemic screening, routine diagnosis and treatment, observation (or monitoring) isolated subjects, and crossing management.Facing outbreaks of pandemics, the key issue for primary health care institutions is how to improve the prevention and control capabilities, and how to take effective and comprehensive response measures.Based on the practical experiences of primary health care institutions in prevention and control for COVID-19 in China together with domestic and international experience and lessons in history, this paper discussed the following issues:internal and external structure of primary health care institutions, medical material storage and reservation, technical support, capability of medical personnel, and continuous health management in residents.This study aims to provide suggestions to improve the capability of primary health care institutions in pandemics prevention and control.
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The HIV-infected people were investigated for their satisfactory situation towards the follow-up management of primary medical and health care institutions in Xinjian County, Yushan County and Guixi City of Jiangxi Province from January to July 2018 and related factors were also analyzed. The total score of the Infected Patients′ Follow-up Management Satisfaction Scale higher than 59 was defined as the satisfactory. 75.68% of 259 infected patients were satisfied with the follow-up management. Compared to farmers and other follow-up modes, non-farmers (OR=10.72, 95%CI: 2.07-55.63), and patients receiving follow-up service in responsible institutions (OR=6.44, 95%CI: 3.12-13.30) were more satisfied with follow-up management.
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Objective@#To understand the current status of follow up of people living with HIV/AIDS by health service at grass root in rural area of Jiangxi province and related factors, and provide references for the promotion of the follow up by grass root health service.@*Methods@#People living HIV/AIDS aged ≥18 years and diagnosed before 31 December 2017 in 6 townships of Xinjian, Yushan counties and Guixi city were included in the study in Jiangxi province. They had been followed up for more than one time after the first epidemiologic survey. The information about their demographic characteristics and HIV infection status were collected by using self-designed questionnaire. Univariate and multivariate logistic regression analyses were conducted to identify the factors that influencing the acceptance of follow up by grass root health service.@*Results@#Of the 373 surveyed HIV infected subjects aged (53.06±16.15) years, 261 were males (70.0%, 261/373). Among the surveyed subjects, the illiteracy and people who received only primary school education accounted for 54.7% (204/373). The rate of follow up of the HIV infected subjects by grass root health service was 55.8% (208/373), and those through heterosexual contact were 58.5% (190/325). The multivariate regression analysis showed that the acceptance of follow up by grass root health service was higher in those who were farmers (OR=7.36, 95%CI: 2.52-21.45), had family support (OR=16.01, 95%CI: 2.25-49.73), didn’t worry about discrimination (OR=12.97, 95%CI: 4.75-35.42), trusted health care provider (OR=5.07, 95%CI: 2.19-11.76) and showed AIDS symptoms (OR=10.58, 95%CI: 2.25- 49.73).@*Conclusions@#The performance of follow up of people living with HIV/AIDS by grass root health service was well, suggesting it is a feasible management model. Being famer or not, family member supporting or not, worry about discrimination or not, trusting health care provider or not and showing AIDS symptoms or not were the main factors influencing the acceptance of follow up by grass root health service.
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OBJECTIVE： To evaluate the accessibility of essential medicine for common chronic disease in primary health care institutions in Hubei province， and to provide evidence for improving essential medicine policy and strengthening the management level of chronic disease. METHODS： The purchase data of essential medicine for 6 kinds of common chronic disease （diabetes， hypertension， gastric ulcer， asthma， rheumatoid arthritis and epilepsy） were collected from centralized drug procurement platform of Hubei province from 2015 to 2017； essential medicin equipping rate was used to evaluate the availability， and minimum daily wage was used to evaluate the affordability. So that accessibility could be analyzed and suggestions for improving accessibility and affordability were put forward. RESULTS： From 2015 to 2017， the equipping rate of essential drugs varied from 40.00％ to 71.43％，and the availability of those medicine for common chronic disease was at a low level. The affordability improved slightly （the ratio of medication cost to minimum daily wage was decreased from 1.91 to 1.79 from 2015 to 2017） but remained low， and the ratio of medication cost to minimum daily wage for more than 70％ of 21 drugs was less than 1. CONCLUSIONS： Since the accessibility of essential medicine for common chronic disease was at a low level in Hubei province， it is suggested to optimize kinds of essential medicine for chronic disease， to promote the construction of hierarchical medical system， to reduce the price of essential medicine for chronic disease， and to improve the compensation mechanism of essential medicine for chronic disease to further strengthen the management of chronic disease in primary health care institutions.
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OBJECTIVE: To investigate the use of antibacterials for patients with acute upper respiratory tract infections(AURIs) in community health care institutions in Dongcheng district, so as to provide references for rational use of antibacterials in primary health care institutions. METHODS: All the outpatient prescriptions of AURIs patients from 65 primary health care institutions in Dongcheng district in 2016 were selected. The antibacterial and multiple antibacterial prescription rate were analyzed from the perspective of drug categories, patients′ and doctors′ characteristics. RESULTS: This study included 164 575 AURIs prescriptions of community health care institutions in Dongcheng district in 2016. The antibacterial prescription rate(APR)was 12.1% and the multiple antibacterial prescription rate(MAPR) was 0.6%. The top antibacterials in the list of varieties were second generation cephalosporin(60.2%) and macrolide(16.2%), the penicillin preferred by the guidelines were not used. The APR for the male and patients with acute laryngitis or acute tonsillitis was higher. Compared with patients 18-50 years old,the use and combination of antibacterials for patients >50 years old werehigher(P<0.05).There were significant differences in the use and combination of antibacterials among doctors of different genders, education and titles(P<0.05). CONCLUSION: The issue of antibacterial abuse in the AURIs treatment in primary health care institutions should be given sufficient attention. Regular standardized antibacterial treatments training and continuing education for all doctors in primary health care institution are necessary.
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OBJECTIVE:To investigate the basic situation of pharmaceutical staffs and the development of pharmaceutical care in Chongqing primary health care institutions,and to provide references for promoting the development of pharmaceutical work in primary health care institutions. METHODS:A questionnaire survey was conducted to investigate the basic situation of pharmaceutical staffs and the development of pharmaceutical care in primary health care institutions from 38 districts and counties of Chongqing,and the data was analyzed statistically to put forward suggestion. RESULTS:A total of 1147 questionnaires about the general situation of primary health care institutions were sent out,and 813 valid questionnaires were collected,with effective recovery rate of 70.88％. A total of 1972 questionnaires about the general situation of pharmaceutical staffs and the development of pharmaceutical care were sent out,and 1904 valid questionnaires were collected,with effective recovery rate of 96.55％. The average number of pharmaceutical staffs in the community health service center was 4.5(2-14 persons),that of pharmaceutical staffs in township hospitals was 2.5(0-12 persons),accounting for 8.69％ and 8.17％ of professional medical staffs,respectively. Some of respondents were part-time nonprofessionals. The highest educational level of surveyed pharmaceutical staffs was college degree (51.79％),followed by high school degree and secondary school degree (21.64％). The professional titles were mostly assistant pharmacists (34.35％),followed by pharmacists (30.04％). Only 2.73％ of the licensed pharmacist certificates were obtained,and no one obtained the clinical pharmacist training certificate of National Health and Family Planning Commission. In community health service center and township hospital,the higher proportion of the job positions of the pharmacists were in outpatient pharmacy(79.67％ and 81.44％),inpatient pharmacy (32.94％ and 56.57％),TCM pharmacy(27.54％ and 40.85％) and warehouse (22.20％ and 24.05％);the lower proportion of the job positions of the pharmacists were in clinicalpharmacy room(1.40％ and 0),laboratory(0.23％ and 0)and PIVAS(0.23％ and 0). Top 6 pharmaceutical care projects carried out by the community health service center included drug dispensing(100％),out-patient prescription comment(70.00％),ADR monitoring(62.67％),medication consultation(60.67％),antibiotics prescription comment(58.00％),medication education and medication guidance(50.00％);pharmaceutical outpatient service,therapy drug monitoring and pharmacogenomics detection were not developed. The pharmaceutical care projects carried out by township hospital included drug dispensing (100％),ADR monitoring (62.29％),medication consultation (59.73％),medication education and medication guidance (53.85％),outpatient prescription comment (51.58％),and antibiotics prescription comment (45.40％);centralized intravenous pharmacy admixture and administration, pharmaceutical outpatient service, therapy drug monitoring and pharmacogenomics detection were not developed. CONCLUSIONS:The pharmaceutical talents are short in Chongqing primary health care institutions and part-time staffs also have a certain proportion. The overall quality of pharmaceutical staffs is not high,and their professional skills and capabilities are limited. The institutions do not pay enough attention to pharmaceutical care, and the development of pharmaceutical care is not ideal. To promote the development of pharmaceutical care,primary health care institutions should pay more attention to pharmaceutical care,increase the investment of funds in combination with the actual situation,optimize post setting,perfect the construction of institutions,and strengthen the introduction and training of pharmaceutical staffs so as to constantly improve their professional level and pharmaceutical care capabilities,and provide high-quality,safe,humanized and professional pharmaceutical care.
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OBJECTIVE: To analyze the current situation of rational drug use in primary health care institutions of Jiangsu province, and to improve the rational use of drug there. METHODS: Multi-phase and stratified sampling. 4 127 prescriptions were sampled from 6 primary health care institutions in 3 cities of Jiangsu province on the 15th of every odd number month in 2016.The number of drugs per prescription, the prescription fee, the percentage of antibiotics, injections and essential drugs were used as the indicators. RESULTS: The average number of drugs per prescription is 2.32; the average prescription fee is 65.99 yuan; these two indicators are rational. The average percentage of antibiotics and injections are 35.67% and 36% respectively, which are in a high level. All the institutions have been equipped with essential drugs, however, the situation of drug supply still needs to be improved. The discrepancies among different regions are statistically significant. CONCLUSION: The unbalanced development among regions should be considered when establishing the rational drug use policy of primary health care institutions. The abuse of antibiotics and injections should be supervised in multiple approaches. The drug purchasing in primary health care institutions should be guaranteed, and the education and instruction to dual referral patients also need to be strengthened.
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Objective To ascertain and evaluate the quality of radiological protection in rural and urban primary health care institutions . Methods Questionnaires were designed to investigate the protection levels in diagnostic radiology in primary health care institutions in six cities in 2013 and to evaluate the results by using the technique for order preference by similarity to an ideal solution ( TOPSIS) combined with the rank sum ratio ( RSR) method.Results The six cities and an integrated case ( all the data of the six prefecture-level citys were merged as one for comprasion ) were ranked based on the comprehensive assessment.The order from good to bad was Suzhou , Dalian, Yichang, integrated case, Shaoxing, Quzhou and Heihe.The results were divided into three grades , with Suzhou, Dalian at best grade, Yichang, integrated case, Shaoxing, Quzhou at middle grade, and Heihe at poor grade. Conclusions The quality of protection in radiation diagnosis varied considerably .Suzhou ranked the first and Heihe ranked the last .The study suggests that efforts should be focused on the management of key cities and indicators to upgrade whole protection level in radiation diagnosis .
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The paper presented the payment system theory of the primary health care service in China,the current status of the health service system,and analyzed main challenges for the time being.Based on such studies,the authors made the following policy proposals.The first is adjustment of the fiscal payment method of the government to such institutions in line with the classification guidance principle; the second is to shift the payment method of primary public health services to the post payment of fee-for-service; the third is reform of the performance-based salary system to link payment to medical workers directly with the amount and quality of their services; the fourth is a set of result-oriented performance appraisal indicators,with rising proportion of performance pay; the fifth is to integrate the outpatient clinic fund covered by medical insurance and the primary public health service fund,into a capitation payment.
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Objective To analyze the usage of basic drugs in non-primary health care institutions in Luzhou,Sichuan,to comment on the performance of the basic drug system,and to provide reference data for relevant ministries and departments.Methods To collect and to statistically analyze the data of the categories and sales amount of the basic drugs used by three level-3A health care institutions and nine level-2 health care institutions from Jan 1,2010 to Dec 31,2012. Results The purchasing proportion of the basic drugs in the level-3A institutions for 2010,2011,and 2012 are respectively 15.62%,17.84%,20.01%;similarly,the data for the level-2A institutions are respectively 29.35%,32.16%,35.07%;the data for the level-2B institutions are respectively 34.73%,37.05%,40.02%.The sales proportion ofthe basic drugs for the years of2010,2011,and 2012 are respectively 10.43%,12.38%,15.04% for the level-3A institutions,25.08%,27.24%,30.12% for the level-2A institutions,and 29.24%,32.08%,35.03%for the level-2B institutions.Conclusion Non-primary health care institutions should firmly execute the basic drug system, enhance the propaganda of this policy,try to increase the purchasing proportion of the basic drugs,supervise the prescription behavior of the doctors, and optimize the basic drug index in order to use drugs more appropriately and efficiently.
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OBJECTIVE:To provide reference for implementation of national essential drug system in primany helth care institations.METHODS:The information of application of essential drug in 21 medical institutions were collected and analyzed statistically in respect of category of drugs,amount of drugs,consumption sum,medical incomes,incomes from drugs,ratio of drugs,total number of persons and bed day in hospital,etc.Category of drugs,classification of drug and spectrum of disease were compared with those of National Essential Drugs List.RESULTS:There were 295 kinds of essential drug which include 16 kinds of dosage forms and 25 kinds of spectrum of disease.Category of essential drugs used in community medical institutions accounted for 37% of total category of drugs and that in secondary medical institutions accounted for 33%.Consumption sum of essential drug in community medical institutions accounted for 18% in total consumption sum and that in secondary medical institutions accounted for 12%.Ratio of drugs in community medical institutions were 62% and that in secondary medical institutions were 43%.CONCLUSION:Category of drugs and spectrum of disease are in line with that in National Essential Drugs List but should be adjusted according to spectrum of disease and ratio of performance and price.Proportion of essential drug should be increased and monitoring for drug use should be enhanced to reduce ratio of drugs.
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OBJECTIVE:To strengthen the reporting and monitoring of adverse drug reactions(ADR)in primary health care institutions.METHODS:A monitoring network for primary health care institutions was set up;the ADR monitoring system in primary health care institutions was improved and the monitoring ability of the monitoring personnel in primary health care institutions was enhanced.RESULTS:The ADR reporting and monitoring proceeded smoothly and both the quantity and the quality of ADR reporting enhanced significantly.CONCLUSION:Effective mechanism and means on ADR monitoring contribute to the improvement of ADR monitoring level in primary health care institutions.