Length of stay for acute myocardial infarction patients in eastern rural area in China from 2001 to 2011 / 中国医师杂志

Objective To describe the average hospital length of stay (LOS) and its trend and variation in rural areas of eastern China,and to analyze the hospital characteristics associated with LOS.Methods We collected the data of representative in-patients with acute myocardial infarction (AMI) in eastern rural areas in 2001,2006 and 2011 by random sampling.The hospital length of stay and its changing trend were described.Hospitals were divided into tertiles-high,middle,low-based on the median LOS;the characteristics of patients,AMI treatment,as well as outcome were compared across the tertiles of hospitals.The association between the hospital characteristics and LOS was analyzed after adjusting for patient-level characteristics.Results We examined the medical records of 2 361 patients hospitalized with AMI from 32 hospitals in the eastern rural areas.The average LOS were (14.7 ± 10)days in 2001,(12.4 ± 10.1)days in 2006,and (11.9 ± 6.5) days in 2011,decreasing annually (F =15.41,P ＜ 0.001).When looking at the cohort on the three time points (2001,2006,and 2011) with ruling out the factors of complication during hospitalization and the LOS outliers,the average LOS still indicated an trend of decline (F =5.44,P =0.02).However,after adjusting for the differences in patient factors,few marked differences in LOS were found over the years (P =0.89).Across the three tertiles of hospitals,categorized as high,middle and low based on the average LOS,a statistical difference existed in the use rate of statin during hospitalization (P ＜0.05).After adjusting for patient-level characteristics,the hospital characteristics were not significantly associated with the average LOS.Conclusions This study showed a trend of an annual decrease of LOS in patients hospitalized with AMI from the eastern rural areas in China.There is nevertheless still significant room for further improvement.Therefore,it is crucial to effectively advance the standardization for AMI patients of diagnosis and treatment,improve healthcare quality,and reduce patient LOS,which is the very key to enhancing the AMI treatments in the rural region of Eastern China.

Analysis of the applications of antibacterial agents to outpatients in primary hospitals in Hefei City of Anhui Province / 中国基层医药

Objective To investigate the applications of antibacterial agents to outpatients in primary hos -pitals in Hefei City of Anhui Province,and to provide reference for rational use of antibacterial agents.Methods In 2011, fourty-five primary hospitals in Hefei City were selected randomly ,including urban community health service centers (Group A) and township hospitals(Group B),and thirty or fourty outpatient prescriptions were analyzed monthly . Results In Group A, the percentage and intensity of antimicrobial usage , the proportion of the combination and injectable formulation were ( 45.36 ±20.02 )%, ( 89.73 ±25.50 ) DDDs · ( 100 cases ) -1 · d-1 , 13.34%, 23.16%,respectively,and the data in Group B were (61.36 ±17.18)%,(108.46 ±32.27)DDDs· (100 cases) -1 · d-1,29.13%,46.39%,respectively,which the former were significantly lower than the latter.Conclusion In primary hospitals,the applications of antibacterial agents to outpatiants are not rataional ,including high percentages of usage and unreasonable selection of species ,and more supervision and training need to be given to the medical staff , especially in township hospitals .

Making secondary care a primary concern: the rural hospital in Ecuador

En Ecuador, el acceso de la población rural a servicios adecuados de atención secundaria de salud se ha hecho cada vez más difícil. A pesar de que los sectores público y privado han acertado en dedicar esfuerzos a la atención primaria y a la salud pública, la mayoría de las poblaciones rurales no tienen acceso a una adecuada atención secundaria. Por lo general, los modelos tradicionales de atención médica secundaria en zonas rurales no se han adaptado a las nuevas situaciones, como la tendencia general a la descentralización, el énfasis en el desarrollo de capacidades locales, el antagonismo entre el acceso universal y la autonomía financiera, las alternativas financieras innovadoras y los recién llegados médicos de familia. En 2001, la organización no gubernamental con sede en los Estados Unidos de América Andean Health & Development (Saludesa en Ecuador) inauguró un hospital rural de 17 camas, construido conjuntamente con el municipio local y el Ministerio de Salud de Ecuador. El hospital atiende a una comunidad rural de 50000 personas que antes no tenían acceso local a servicios secundarios de salud. Los esfuerzos de AHD/Saludesa para desarrollar una red autosostenible pública/privada de atención primaria/secundaria de salud y de alta calidad han generado una considerable experiencia en la administración de un hospital rural. El proyecto piloto de AHD se concentró en un hospital rural y logró su autosostenibilidad total en 2007. Esto se logró mediante una combinación de mecanismos financieros, entre ellos la venta de paquetes prepagados de atención sanitaria, un contrato con el Instituto Ecuatoriano de Seguridad Social, contribuciones municipales y el pago tradicional por los servicios.