Function of primary health care institutions in pandemics / 上海预防医学

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.

Awareness and use of reference managers by resident doctors in Nigeria

Reference manager (RM) also known as reference management software (RMS) are tools used by researchers to organize and manage bibliographic references. They are citation tools that enable researchers to track the scientific papers they have read, sources consulted, cited and used to generate a reference list or bibliography. This study investigated the awareness and pattern of use of RM tools by Resident Doctors (RDs) in Nigeria. Cross-sectional survey design was adopted for the study and semi-structured questionnaire was used for the data collection. Respondents' age was 35.9 ± 5.0, (53.8%) were males. Most of the respondents (92.9%) had heard of RM, 49.1% had ever used any RM with Mendeley topping the list (49.1%). However, many of the respondents (42.8%) did not use RM due to lack of requisite skills, while only (35.1%) respondents had ever received formal training on use of RM. Based on the findings of the study, it was recommended that awareness should be regularly created to encourage resident doctors to apply their knowledge of the tools in the management of their references while training should be conducted for those who do not use the tools.

The situation and related factors of satisfaction of HIV-infected people towards the follow-up management of primary medical and health care institutions in rural areas of Jiangxi Province / 中华预防医学杂志

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.

Follow-up of people living with HIV/AIDS by primary health care institutions in rural area of Jiangxi province / 中华流行病学杂志

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.

Analysis of the Accessibility of Common Essential Medicine for 6 Kinds of Chronic Disease in Primary Health Care Institutions in Hubei Province from 2015 to 2017 / 中国药房

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.

Analysis of Antibacterial Utilization for Patients with Acute Upper Respiratory Tract Infections in Community Health Care Institutions in Dongcheng District of Beijing / 中国药学杂志

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.

Study on the Basic Situation of Pharmacy Staffs and the Development of Pharmaceutical Care in Chongqing Primary Health Care Institutions / 中国药房

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.

Analysis on Health Resource Allocation and Service Utilization of Maternal and Child Health Care Institutions in Guizhou / 中国卫生经济

Objective:To discuss on the allocation and service utilization of health resources in maternal and child health care institutions and the existing problems in Guizhou Province,to provide a scientific basis for the further development of maternal and child health care.Methods:It analyzed the situation of health resource allocation,service utilization efficiency and maternal and child mortality in Guizhou province by means of statistical description,comparative analysis and correlation analysis.Results:The average number of health workers per hospital increased rapidly,the average number of beds per hospital grew slowly.The number of outpatient visits,the number of admissions and the number of people discharged were positive growth.The number of bed turnover,the working day of the bed,the bed use rate and the average hospitalization date appeared a certain degree of negative growth.Infant mortality rates,child mortality rates and maternal mortality rates under the age of five were all higher than the national average.Conclusion:Health resources of maternal and child health institutions in Guizhou should be tilted to the grassroots health institutions.It needed to further improve the efficiency of maternal and child health care use,strengthen the training of personnel and enhance the comprehensive service capacity of grassroots organizations.

Clima organizacional en un hospital público de Quindío Colombia / Clima organizacional em um hospital público de Quindío Colombia / Organizational climate in a public hospital from Quindio Colombia

Objetivo: Caracterizar el clima organizacional percibido por funcionarios asistenciales y administrativos en un hospital publico de Quindio-Colombia en 2015. Método: Estudio cuantitativo de tipo correlacional, que mide el clima organizacional de un hospital de baja complejidad mediante la caracterización de doce dimensiones. La población estudio la conformaron 114 funcionarios asistenciales y administrativos pertenecientes a un hospital público de Quindío-Colombia. Resultados: La medición del clima organizacional dio como resultado un promedio global de 69,81, con una calificación de 3,89 catalogándose como un nivel medio para el clima organizacional. Se evidenció una relación positiva altamente significativa entre el clima organizacional con la dimensión de relaciones interpersonales y de esta última con la coordinación externa. Conclusión: Se evidencia la importancia que para el funcionario tiene, desde su punto de vista, la "interacción amigable" que se interpreta como la relación respetuosa y efectiva con sus compañeros de área, necesaria para un ambiente de trabajo en equipo; de igual manera se evidenció la importancia de tener en cuenta las relaciones interpersonales con la coordinación externa lo que se puede traducir como el valor que el funcionario le confiere al liderazgo participativo en la percepción del clima organizaciona

Objetivo: Caracterizar o clima organizacional percebido por funcionários assistenciais e administrativos em um hospital público do departamento de Quindío-Colômbia, em 2015. Método: Estudo quantitativo de tipo correlacional, o qual mede o clima organizacional de um hospital de baixa complexidade através da caracterização de doze dimensões. A população estudada foi conformada por 114 funcionários assistenciais e administrativos pertencentes a um hospital público do departamento de Quindío na Colômbia. Resultados: A medição do clima organizacional apresentou como resultado uma média global de 69,81, com uma qualificação de 3,89 catalogando-se como um nível médio para o clima organizacional. Evidenciou-se uma relação positiva altamente significativa entre o clima organizacional com a dimensão das relações interpessoais e desta última com a coordenação externa. Conclusão: Evidencia-se a importância que tem para o funcionário, desde sua perspectiva, a "interação amigável" a qual se interpreta como a relação respeitosa e efetiva com seus colegas de área, necessário para um ambiente de trabalho em equipe. Do mesmo modo, evidenciou-se a importância d as relações interpessoais com a coordenação externa, o qual pode se traduzir como o valor que o funcionário lhe dá à liderança participativa na percepção do clima organizacional.

Objective: To characterize the organizational climate perceived by the assistance and administrative staff members at a public hospital in Quindio-Colombia 2015. Method: A quantitative correlational study, which measures the organizational climate of a low complexity hospital through the characterization of twelve dimensions. The population being studied was conformed by 114 assistance and administrative staff members who belong to a public hospital in Quindío-Colombia. Results: The measurement of the organizational climate provided a result of a global average of 69.81 with a score of 3.9 being classified as a medium level for the organizational climate. There was evidence of a highly meaningful positive bond between the organizational climate and the dimension of interpersonal relationships and between this one with the external coordination. Conclusion: There is evidence of the importance given by the staff members to the "friendly interaction" that is interpreted as a respectful and effective relationship with their co-workers, which is, in turn, necessary for the generation of a teamwork environment. Additionally, it was found that a high degree of importance regarding interpersonal relationships with the external coordination is given; fact that can be understood as the value staff members confere to the participative leadership within their perception of organizational climate.

Analysis of Outpatient Prescriptions Investigation and Rational Drug Use in Primary Health Care Institutions of Jiangsu Province / 中国药学杂志

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.

Evaluating the quality of radiological protection in rural and urban primary health care institutions by using TOPSIS and RSR methods / 中华放射医学与防护杂志

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 .

Health care utilization of mexican patients with medically unexplained physical symptoms / Uso de los servicios de salud de pacientes mexicanos con síntomas físicos medicamente inexplicables

Abstract Objective: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. Methods: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians. The prevalence of medically unexplained physical symptoms was determined and both groups with or without symptoms were compared with regard to drug use, laboratory and other studies, leaves of absence, and referrals in the last six months. The group with medically unexplained physical symptoms was diagnosed using the Patient Health Questionnaire and the diagnostic criteria of Reid et al. Emergency or terminal illnesses were excluded. The chi square test was used with a statistical significance of p < 0.05. Results: Medically unexplained physical symptoms was diagnosed in 73 patients (7.0%). The majority were women (91.8%); their predominant symptom was from the gastrointestinal system in 56 (76.7%). This group had a greater use of clinical studies and referrals to other services (mean 1.1 vs. 0.5; p <0.0001 and 0.6 vs. 0.8; p < 0.01, respectively). Conclusions: The prevalence of medically unexplained physical symptoms was low, but with a greater impact on some health services. This could represent an overload in medical costs....au

Resumen Objetivo: Determinar la prevalencia de Síntomas Físicos Medicamente No Explicables y las características y uso de los servicios de salud entre el grupo de pacientes con Síntomas Físicos Medicamente No Explicables, y el grupo con otras enfermedades. Métodos: Estudio transversal, retroprospectivo y multicéntrico. Se incluyeron a 1,043 pacientes mayores de 18 años, en 30 unidades de atención primaria de una institución gubernamental en salud, en 11 estados de la República Mexicana, atendidos por 39 médicos familiares. Se estimó la prevalencia de Síntomas Físicos Medicamente No Explicables y se compararon los dos grupos con y sin estos síntomas, en cuanto al uso de medicamentos, estudios de laboratorio, de gabinete, incapacidades y referencias en los últimos seis meses. El grupo de Síntomas Físicos Medicamente No Explicables fue diagnosticado por el Patient Health Questionnaire (son los síntomas físicos más comúnmente referidos por estos pacientes en el primer nivel de atención), además de criterios diagnósticos de Reid et al. Se excluyeron urgencias o con enfermedad terminal. Se utilizó prueba Chi cuadrada con p <0.05 para significancia estadística. Resultados: El 7.0% (73) se diagnosticó como Síntomas Físicos Medicamente No Explicables, la mayoría mujeres (91.8%); el síntoma predominante pertenece al sistema gastrointestinal con 76.7% (56). Este grupo demandó mayor uso de estudios de gabinete y referencias a otros servicios (media 1.1 vs. 0.5; p <0.0001 y 0.8 vs 0.6; p <0.01, respectivamente). Conclusiones: La prevalencia de Síntomas Físicos Medicamente No Explicables fue baja, pero con impacto significativo en el uso de algunos servicios de salud. Esto pudiera representar un mayor costo comparado con otro grupo de pacientes...au

Caracterización de los desechos sólidos en instituciones de salud como etapa básica para el plan de manejo / Solid waste characterization at healthcare institutions as a basic stage in the management plan

Introducción: la gestión de los desechos sólidos de instituciones de salud es un proceso destinado a garantizar la adecuada higiene y seguridad para los trabajadores, la comunidad y el medio ambiente que la rodea. De primordial importancia para abordar cualquier programa de control de las situaciones de riesgo derivadas del manejo inadecuado de los desechos sólidos de instituciones de salud, es su caracterización según los tipos y el estimado de las cantidades generadas. Objetivo: caracterizar los desechos sólidos generados en instituciones de los tres niveles de atención a la salud. Métodos: se realizó un estudio descriptivo en siete instituciones de los tres niveles de atención a la salud de la provincia La Habana durante el período comprendido de Enero/2009 a Septiembre/2009. Se aplicó un cuestionario elaborado a los efectos de este estudio y tuvo como instrumento básico de referencia la Encuesta de residuos de hospitales, desarrollada por el CEPIS. Resultados: la cantidad de desechos sólidos generados varió entre las instituciones de los diferentes niveles de atención y las categorías consideradas, con predominio en el nivel secundario donde se destacaron los desechos infecciosos. Conclusiones: el estimado de las cantidades de desechos sólidos generados brindó una información útil para su manejo en las instituciones participantes, lo cual permitió fomentar acciones para el reuso y el reciclaje,así como, estimar los recursos humanos y materiales y programar las actividades de capacitación necesarias para el establecimiento de un sistema de manejo seguro en las instituciones participantes en el estudio(AU)

Introduction: Solid waste management at healthcare institutions is aimed at ensuring appropriate hygiene and safety for workers, the community and the environment. Programs for the control of risk situations stemming from inadequate management of solid waste at healthcare institutions should indispensably be based on characterization of wastes according to type and estimation of the volumes generated. Objective: Characterize solid wastes generated at institutions from the three health care levels. Methods: A descriptive study was conducted at seven institutions from the three health care levels in the province of Havana from January to September 2009. A dedicated questionnaire was applied, whose basic reference tool was the "Hospital waste survey" developed by CEPIS. Results: The volume of solid wastes varied between the various health care levels and categories considered, with a predominance of the secondary level, where infectious wastes stood out. Conclusions: Estimation of the volume of solid wastes revealed useful information for their management by the institutions involved, making it possible to foster reuse and recycling actions, estimate the human and material resources required, and program the training activities necessary for the establishment of a safe management system(AU)

Studies on the reform of payment system of grass-roots health care institutions in China / 中华医院管理杂志

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.

Challenges and development strategies for maternal and children health care institutions / 中华医院管理杂志

The improvement of women and children health,along with the growth in health needs,brings forth new challenges to maternal and children health care institutions.The dual demands of quantity and quality in maternal and children health services compel the institutions to improve capabilities under the current conditions,and more importantly,to further clarify the functional orientation which is the key issue for its development.This article is based on the analysis of the historical development and current situation of the maternal and children health care institutions,which sets up the functional orientation according with the rules and characteristics of maternal and children health services.The paper proposed a series of suggestions on its development,such as the health service admission system,appropriate staffing standards and the institution-construction standards.

Analysis of the effect of the basic drug system in 12 non-primary health care institutions of Lu Zhou / 中国生化药物杂志

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.

Gestão do ambiente organizacional na expansão e desenvolvimento do mercado de serviços de saúde no Brasil / Internal environment management for expansion and development of the health care market in Brazil

Introdução: diante do aumento dos gastos com saúde, uma questão importante diz respeito às dificuldades para efetivação dos investimentos nas unidades hospitalares (UHs), com vistas a evitar a deterioração dos serviços. Em face da escassez de recursos para investimento, ainda maior entre as UHs da rede pública de saúde no país, vislumbra-se a busca de solução alternativa, melhorando a gerência do ambiente hospitalar. Objetivos: este estudo testa a associação entre a gerência do ambiente hospitalar e as seguintes funções de organização da acreditação hospitalar (AH): o treinamento; a educação do paciente e do familiar; a governabilidade e a gerência da informação. Métodos: a amostra de conveniência é composta de 33 relatórios da AH, concluídos entre 2004 e 2009. Para tratar o material empírico, foram usados o modelo de regressão múltipla e a análise fatorial, com vistas a avaliar a influência daquelas funções de organização na gerência do ambiente hospitalar. Resultados: os testes da hipótese revelaram associações positivas e significativas entre as funções organizacionais selecionadas, o tipo de propriedade da UH e a gerência do ambiente hospitalar. Conclusões: como contribuição teórica, este trabalho esclareceu os fundamentos econômicos das relações existentes entre funções organizacionais e ambiente hospitalar. Como contribuição metodológica, o modelo estatístico utilizou dados de relatórios da AH, uma fonte de dados inédita na pesquisa sobre economia da gestão. Como contribuição gerencial, identificou fatores que influenciam o desempenho da gerência do ambiente hospitalar, contribuindo para o compromisso de gestores e profissionais de saúde com a mudança na organização.

Introduction: Given the increased expenses on health care, it is important to overcome difficulties in effectively applying investments in hospital units in order to avoid quality degradation of care services. The search of an alternative solution relying on improved management of the organizational environment is crucial to tackle issues of scarce investment resources, especially in public hospitals. Objectives:This study tests the association of hospital environment management with the following functions related to hospital accreditation: training; patients’ and family members’ education; governability; and information man agement. Methods:The convenience sample comprises 33 hospital accreditation reports from 2004 through 2009. The empirical data was analyzed using multiple regression and factorial analysis, with a view to assessing the influence of the organizational function on the management of the hospital environment. Results:The hypothesis tests pointed to positive and significant correlations involving the selected organizational functions, the type of hospital ownership, and the management of the hospital environment. Conclusions:As a theoretical contribution, this paper sheds a light into the economical grounds of the associations between organizational functions and the hospital environment. As a methodological contribution, the statistical model relied on data collected from hospital accreditation reports, an original source of data in studies on management economics. As a managerial contribution, this paper identifies factors influencing the management performance within the hospital environment, supporting managers and health professionals to fulfill their commitment to organizational change.

Ha perdido la profesión odontológica la batalla contra la caries dental o ha perdido el rumbo: análisis de la situación en México / Has the dental profession lost the battle against tooth decay or has it lost its way: analysis of the situation in Mexico

Objetivo: se presenta un estudio retrospectivo con base en la bibliografía existente de losúltimos cuarenta años acerca de la odontología en México y su contribución a la salud bucodentalen la población, sobre todo en relación con la caries dental. Métodos: se revisarontres aspectos principales: la formación odontológica en escuelas y facultades del país, elservicio de las instituciones públicas de salud y la atención a la población desde la prácticaodontológica privada. Se analizó la bibliografía existente de investigadores mexicanosdesde 1970 hasta el 2011. Resultados: en este análisis se observa una falta de planeaciónpara la creación de escuelas y facultades de odontología, sustentada en las necesidadesreales de la población. Además, es notable la ausencia de un organismo rector que unifiquelos objetivos para la formación de odontólogos en las 120 escuelas existentes en México.Del mismo modo, se observan la falta de desarrollo de la función preventiva de las institucionesde salud, que trabajan con el mismo modelo de servicio de cuando fueron creadas,y una educación odontológica carente de planeación y una normatividad actualizada parala formación de recursos humanos. Conclusión: todo esto se traduce en una profesión quepractica principalmente una actividad centrada en atacar las lesiones y no la enfermedad y,mucho menos, en aplicar acciones para prevenirla. Ello ha propiciado una competencia porun mercado de pacientes que puedan pagar los servicios, pero no ha contribuido a mejorarla salud bucal de la población...

Aim: A retrospective study based on a literature review about dentistry in Mexico and itsimpact on the population’s dental health, with a special focus on dental caries, is presented.Methods: Three main areas were reviewed: training of dentists in Mexican dental schools;dental health care in public institutions, and dental care in the private dental practice. Publicationsfrom 1970 to 2011 by Mexican researchers were analyzed. Results: In this analysis itis noted that there is a lack of planning for the creation of dental schools, in relation to thedental care needs of the population. Besides that, there is an absence of a governing bodythat unifies the objectives for the training of dentists in the 120 existing schools in Mexico,as well as an obsolete preventative role of health care institutions, which work with a healthcare model that has not changed since they were created. There is also a lack of planningand updated regulations for the training and formation of human resources in dentalschools. Conclusions: All this translates into a profession whose practice is mostly focusedon attacking the injuries, not the disease, and much less attention is given to implementactions in preventive dentistry. This has led to a competition for a market of patients whocan afford their services, but has not contributed to improve dental health in the population...

Atención domiciliaria de la persona anciana: una perspectiva bioética / Atenção domiciliária da pessoa idosa: uma perspectiva bioética / Home care for the elderly: a bioethical view

Una práctica cada vez más frecuente es la atención domiciliaria de las personas ancianas, la cual genera ciertos problemas que dependen directamente de la longevidad misma, de la patología que pueden padecer y de la actitud que asumen sus familiares o quienes los atienden. El artículo presenta una reflexión sobre esta realidad desde la perspectiva Bioética, con el ánimo de proponer cambios en las actitudes que se adoptan frente al anciano que es atendido en la casa.

A atenção domiciliária das pessoas idosas é uma prática cada vez mais freqüente. Esta origina alguns problemas que dependem diretamente da longevidade do paciente, da patologia que pode sofrer e da atitude que assumam os seus familiares ou quem os cuidam. Neste artigo apresenta-se uma reflexão sobre esta realidade desde a perspectiva bioética, a fim de introduzir mudanças nas atitudes adotadas frente aos idosos cuidados é tratado em casa.

Home care for the elderly is becoming increasingly common. This creates certain problems that are directly dependent on the patient’s longevity, pathology and the attitude assumed by the patient’s family members or caregivers. The article examines the facts of this situation from the standpoint of bioethics, in an effort to propose changes in the attitudes adopted towards the elderly who are cared for at home.

Bioética en Nicaragua / Bioethics in Nicaragua / Bioética em Nicarágua

Este trabajo describe la situación de la bioética en Nicaragua, caracterizando las circunstancias y el contexto de las actividades de educación médica y las unidades prestadoras de servicios de salud. El desarrollo de un nuevo modelo de atención integral en salud, la implementación de políticas de salud que garanticen a la población el mayor acceso y gratuidad a los servicios, y los cambios acontecidos en los cuidados médicos, debidos en parte al reconocimiento creciente de una mayor autonomía de los pacientes y al uso creciente de nuevas tecnologías médicas, hace que se presenten algunas limitantes y dilemas en las unidades asistenciales y entre el personal de salud. La bioética en Nicaragua tiene un desarrollo incipiente: no está institucionalizada ni se han previsto los mecanismos formales que permitan resolver los problemas éticamente complejos, por lo tanto, constituye un gran reto por parte de las instituciones educativas y rectoras de la salud.

This work describes the bioethics situation in Nicaragua, with information on the circumstances and the context of activities in medical education and health care providers. The development of a new model of comprehensive health care-the implementation of health care policies that guarantee Nicaraguans better access to care and services free of charge, and the changes that have occurred in medical care, due in part to the growing recognition of greater patient autonomy and the increase in the use of new medical technologies-all have contributed in some part to current obstacles and dilemmas in medical clinics and between health care personnel. Bioethics in Nicaragua is in the initial stage of development. It is neither institutionalized nor is it subject to formal mechanisms that permit the resolution of complex ethical problems, thus presenting an important challenge for institutions of higher learning and decision-makers in health.

Este trabalho descreve a situação da bioética na Nicarágua, caracterizando as circunstâncias e o contexto das atividades de educação médica e as unidades prestadoras de serviços de saúde. O desenvolvimento de um novo modelo de atenção integral em saúde, a implementação de políticas de saúde que garantam à população maior acesso e gratuidade aos serviços, e as mudanças ocorridas nos cuidados médicos, devidas em parte ao reconhecimento crescente de uma maior autonomia dos pacientes e ao uso crescente de novas tecnologias médicas, determinam que se apresentem alguns dilemas e limitantes nas unidades assistenciais e entre o pessoal de saúde. A bioética na Nicarágua tem um desenvolvimento incipiente: não está institucionalizada nem se acham previstos os mecanismos formais que permitam resolver os problemas eticamente complexos, portanto, constitui um grande desafio por parte das instituições educativas e gestoras da saúde.