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Background: Primary medical staff (PMS) are the guardians of population health. However, their loss further worsens the shortage and uneven distribution of human health resources, which should be addressed immediately. This study aimed to investigate the current status of turnover intention of rural PMS in Xinjiang Production and Construction Corps (XPCC) in China and its influencing factors atthe individual and institutional levels to provide reliable baseline data for intervention strategies to protect valuable rural PMS. Methods: Participants were recruited from rural public health institutions of the XPCC using a cross-sectional multistage sampling process. Data on participants' turnover intention and individual- and institution-level indicators were obtained through standardized electronic questionnaires and statistical reports of regional health administrative departments. The key factors influencing PMS turnover intention were identified us ingunivariateandmulti-level logistic regression analysis. Findings: Overall, 20.5% (447/2182) of participants reported turnover intention. Univariate analysis showed that the occurrence of turnover intention was significantly influenced by marriage, education, age, year of working, monthly income, human resource management practices (HRMP), job satisfaction, per capita served population (PCSP) and number of beds (p < 0.05). Multi-level logistic regression analysis showed that bachelor's degree or above and intermediate professional title were closely related to the occurrence of turnover intention (p < 0.05), age 41-50 years old and above, high human resource management practice, and high job satisfaction effectively reduced the odds (p < 0.05). The odds of turnover intention increased by 37% (p < 0.10) for PMS in institutions with PCSP more than 250 people. In contrast, the odds of turnover intention decreased to 68% (p < 0.05) for PMS in institutions with more than 50 beds. Conclusion: Government-run primary medical institutions face the risk of PMS turnover intention. From a personal perspective, the high-risk population fortheturnover intention was mainly the PMS with bachelor's degrees or above and intermediate professional titles. The low-risk population was the PMS with aged over 40 years, a higher evaluation of human resource management practice, and job satisfaction. From the perspective of primary medical institutions, larger institutions can reduce the turnover intention of individuals, whereas the size of the service population has the opposite effect.
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Objective:To evaluate the current situation of organizational capacity and maturity of primary medical institutions(PMIs)in Beijing,and to provide a reference for improving organizational capacity and promoting sustainable development of PMIs.Methods:This study designs a self-assessment questionnaire based on the organizational capability index system established in the previous stage,and selects all PMIs in D district(urban)and S district(suburban)of Beijing as the research objects.Ten middle managers who are familiar with the operation of their organizations are selected from each organization as questionnaire respondents.A total of 295 valid questionnaires are collected and the organizational capability score and maturity of each PMIs are evaluated on the basis of verifying the reliability and validity of the questionnaires.Results:The score of organizational capability of the 33 PMIs included in this study is 4.10±0.40,and it indicates that the organizational capability of D district is higher than that of S district in all dimensions.In general,core capability in the first level indicators is the highest and development capability is the lowest.In the second level indicators,the score of prevention and control of infectious diseases capacity is the highest and the score of resource management capability is the lowest.Most of the PMIs are in the phase of basic stability and steady development.Conclusions:There are differences in the organizational capacity among PMIs in Beijing,and PMIs in developed areas are more likely to have higher organizational capacity.The PMIs in Beijing have moved out of the initial stage of development,but they should still focus on improving their resource management capability and learning capability.In addition,the PMIs should also pay attention to the cultivation of development capacity.
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Objective:To discuss the role of rural-order tuition-waived medical students in grass-roots public health, and put forward pertinent suggestions for further improving the effectiveness of rural directional general practitioner training programs.Methods:Through interviews with 63 graduated rural-order tuition-waived medical undergraduates from rural primary medical institutions in Sichuan Province, the standard procedures of spindle encoding and content analysis were used to analyze the influence of the training effect of rural-order tuition-waived medical students on grass-roots public health services.Results:The results showed that the training effect of rural-order tuition-waived medical students mainly reflected in theoretical learning, practical work ability, future career planning and post-graduation education, among which the training effect of theoretical learning and practical work ability was better. Rural-order tuition-waived medical students played a positive role in grass-roots public health services, mainly in the protection of key populations, home prevention and management of the elderly and chronic diseases patients, and home prevention and management of children and pregnant women.Conclusion:The measures for rural-order tuition-waived medical students to provide grass-roots public health services should include that the supporting policies of the state and schools can be continuously improved and implemented, college teachers should pay more attention to the guidance of the humanistic spirit of general medical students, and the curriculum system construction of rural-order tuition-waived medical students should highlight the courses related to grass-roots and general medicine. In the process of student training, we should construct effective practical methods and strengthen post-employment continuing education.
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OBJECTIVE To explore and establis h a general pharmacist system suitable for China ’s national conditions ，and to improve the rational use of drugs in primary medical institutions . METHODS Under the leadership of Tianhe District Health Bureau of Guangzhou ，relying on the regional pharmaceutical specialty alliance ，general pharmacist system of medical consortium was established ，and the general pharmacist was responsible for the overall planning of pharmaceutical care in the medical consortium. The joint management office of pharmaceutical care was established ，and the training of the pharmacists in the medical consortium was organized. A regional audit center was established to realize the prescription review of 13 community health service centers in the medical consortium. “Internet plus ”home pharmaceutical care was carried out ，and science popularization education was provided for communities ，schools，enterprises and institutions. RESULTS After systematic training and assessment ，three pharmacist teams had been successfully established in the medical consortium to provide prescription review ，science popularization and education and family pharmacist services for community residents ；the regional audit center successfully intercepted 17.17％ of unreasonable prescriptions ，reducing the amount of unreasonable drug use by a total of 6.56 million yuan. After the intervention of prescription review system ，the qualified rate of outpatient prescriptions in community health service centers was ≥95％，and the qualified rate increased by an average of 6％. The department of pharmaceutical science popularization and education held 35 science popularization and free clinic activities ，of which 71.20％ of the residents believed that the activities had improved their understanding of drugs. In addition ，111 cases patients serviced by home pharmaceutical care were carried out successfully by pharmacist team ，and the patients ’acceptance of pharmacist intervention was 91.89％ . CONCLUSIONS Under the new medical reform ，it is feasible to implement a regional general pharmacist system within the medical consortium ， which improves the pharmaceutical administration and pharmaceuticalcare capabilities of m edical institutions in the medical consortium，as well as the level of rational drug use ，and reduces the me dical burden.
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Objective: To understand the status of child health services by primary medical institutions in less developed areas in Sichuan province and provide evidence for the development of health policy for poverty alleviation. Methods: Annual child health records in the primary medical institutions selected through multistage stratified sampling in 21 prefectures in Sichuan were extracted during 2014-2018. Field survey and telephone interview were used to evaluate the performance of child health services provided and the child guardian's satisfaction degree. Sample descriptive statistics, pair sample t-test, χ(2) test, trend χ(2) test, Pearson correlation analysis were used for statistical analysis. Results: Except child system management rate, the other indicators reflecting the status of child health service in less developed areas in Sichuan were on rise (P<0.05), and close to average level of whole province in 2018. Except child system management rate, the other indicators reflecting the status of child health management in less developed counties were lower than those in developed counties in Sichuan, most differences were significant (P<0.05). Except child health management rate of traditional Chinese medicine, the other indicators reflecting the status of child health management in less developed counties were higher than those in poverty-stricken counties in Sichuan, most differences were not significant (P≥0.05). Except child systematic management rate, the gap in indicators reflecting child health service status between less developed area and developed area was in reduction, some difference were significant (P<0.05). The child guardian satisfaction degree was associated with true child health management rates (r=0.947, P=0.015), and child health management rate of traditional Chinese medicine (r=0.996, P<0.001). Conclusions: Some achievements have been made in child health services provided by primary medical institutions in less developed areas in Sichuan. To achieve the 2020 poverty alleviation goal, it is necessary to take measures to increase input and improve service level.
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Child Health Services , Child , China , Health Services Accessibility , HumansABSTRACT
To understand the status of child health services by primary medical institutions in less developed areas in Sichuan province and provide evidence for the development of health policy for poverty alleviation. Annual child health records in the primary medical institutions selected through multistage stratified sampling in 21 prefectures in Sichuan were extracted during 2014-2018. Field survey and telephone interview were used to evaluate the performance of child health services provided and the child guardian's satisfaction degree. Sample descriptive statistics, pair sample -test, (2) test, trend (2) test, Pearson correlation analysis were used for statistical analysis. Except child system management rate, the other indicators reflecting the status of child health service in less developed areas in Sichuan were on rise (<0.05), and close to average level of whole province in 2018. Except child system management rate, the other indicators reflecting the status of child health management in less developed counties were lower than those in developed counties in Sichuan, most differences were significant (<0.05). Except child health management rate of traditional Chinese medicine, the other indicators reflecting the status of child health management in less developed counties were higher than those in poverty-stricken counties in Sichuan, most differences were not significant (≥0.05). Except child systematic management rate, the gap in indicators reflecting child health service status between less developed area and developed area was in reduction, some difference were significant (<0.05). The child guardian satisfaction degree was associated with true child health management rates (=0.947, =0.015), and child health management rate of traditional Chinese medicine (=0.996, <0.001). Some achievements have been made in child health services provided by primary medical institutions in less developed areas in Sichuan. To achieve the 2020 poverty alleviation goal, it is necessary to take measures to increase input and improve service level.
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Objective@#To understand the status of child health services by primary medical institutions in less developed areas in Sichuan province and provide evidence for the development of health policy for poverty alleviation.@*Methods@#Annual child health records in the primary medical institutions selected through multistage stratified sampling in 21 prefectures in Sichuan were extracted during 2014-2018. Field survey and telephone interview were used to evaluate the performance of child health services provided and the child guardian’s satisfaction degree. Sample descriptive statistics, pair sample t-test, χ2 test, trend χ2 test, Pearson correlation analysis were used for statistical analysis.@*Results@#Except child system management rate, the other indicators reflecting the status of child health service in less developed areas in Sichuan were on rise (P<0.05), and close to average level of whole province in 2018. Except child system management rate, the other indicators reflecting the status of child health management in less developed counties were lower than those in developed counties in Sichuan, most differences were significant (P<0.05). Except child health management rate of traditional Chinese medicine, the other indicators reflecting the status of child health management in less developed counties were higher than those in poverty-stricken counties in Sichuan, most differences were not significant (P≥0.05). Except child systematic management rate, the gap in indicators reflecting child health service status between less developed area and developed area was in reduction, some difference were significant (P<0.05). The child guardian satisfaction degree was associated with true child health management rates (r=0.947, P=0.015), and child health management rate of traditional Chinese medicine (r=0.996, P<0.001).@*Conclusions@#Some achievements have been made in child health services provided by primary medical institutions in less developed areas in Sichuan. To achieve the 2020 poverty alleviation goal, it is necessary to take measures to increase input and improve service level.
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OBJECTIVE: China has been attempting to control the patients' choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered poor. We aim to analyse whether unsuccessful treatment in primary medical institutions can lead to the patients' choice of high-level medical institutions. DESIGN: A retrospective cluster sample study. SETTING: The study setting was in Macheng city, Hubei province. PARTICIPANTS: The respondents are township-county (TC) patients (patients who first went to township hospitals and then county hospitals within 30 days for the same disease) who experienced unsuccessful treatment in primary medical institutions. A total of 2090 TC patients were screened out based on the New Rural Cooperative Medical System database in 2013. MAIN OUTCOME MEASURES: The choice of patients between township hospitals (primary medical institutions) and county hospitals was observed. We compared TC patients' ratio of choosing county hospitals (RoCC) before TC experience with after TC experience. Thereafter, we compared RoCC of TC patients and non-TC patients (patients who did not experience TC) based on coarsened exact matching. RESULTS: The ratio of TC for outpatient in township hospitals is 0.68% and that of TC for inpatient in township hospitals is 3.37%. RoCC for TC disease increased from 20.8% to 35.5% (p<0.001), RoCC for other disease increased from 35% to 37.3% (p=0.01). TC patients had significantly higher RoCC than non-TC patients (p<0.001). CONCLUSIONS: Patients' choice of high-level medical institutions is highly associated with the experience of unsuccessful treatment in primary medical institutions. Moreover, people likely select high-level medical institutions thereafter regardless of conditions in rural China. Unsuccessful treatment in primary medical institutions is inevitable for patients. Thus, additional measures should be considered in lowering the potential risks for patients when treatments fail. TRIAL REGISTRATION NUMBER: ChiCTR-OOR-14005563.
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Hospitals, County , Hospitals, Urban , Patient Preference , Primary Health Care/standards , Adult , Aged , China , Choice Behavior , Cluster Analysis , Female , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE： To provide reference for optimizing the structure of family doctor team and improving rational drug use in primary medical institutions of China. METHODS： Combined with relevant literatures and author’s work experience， the situation of rational drug use in primary medical institution and the development of family doctors team were reviewed. The problems existing in the rational drug use service provided by family doctor team were analyzed to put forward relevant suggestions. RESULTS & CONCLUSIONS： There are some problems in primary medical institutions， such as blind selection or abuse of antibiotics， high frequency of injection use. Provinces and municipalities that implement the family doctor model in China have gradually formed five kinds of family doctor contract service modes， such as “1+1+1” contract service mode， “basic package+personality package” contract service mode. The existing family doctors team have problems in the development of rational drug use services， such as lack of pharmaceutical service personnel， low business ability， limited pharmacy knowledge of team members， and insufficient participation of pharmacists. A reasonable family doctor team should pay attention to the cultivation of pharmacy service pharmacists， strengthen pharmacy professional knowledge training of medical staff， and build a corresponding “pharmaceutical joint” platform by means of the medical association platform if necessary so as to promote rational drug use in primary medical institutions.
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OBJECTIVE:To evaluate the effects of the implementation of National Essential Medicine System on the utilization rate of hormone drugs in primary medical institutions in China systematically.METHODS:Retrieved from CJFD,Wanfang database and VIP,the literatures about the use of hormone drugs were collected before and after the implementation of National Essential Medicine System.Meta-analysis was performed by using Stata 13.0 software after utilization rate dam extraction and quality evaluation with Cochrane system evaluator manual 5.1.0.RESULTS:A total of 20 literatures were included.Results of Meta-analysis showed that utilization rate of hormone drugs after the implementation of National Essential Medicine System was significantly lower than before implementation,with statistical significance [RD =-0.03,95 ％ CI (-0.05,-0.02),P＜ 0.001].Results of subgroup Meta-analysis of utilization rate of hormone drugs in different areas before and after the implementation of National Essential Medicine System showed that the utilization rate of hormone drugs in eastern areas was significantly lower after the implementation of National Essential Medicine System than before [RD=-0.06,95％ CI(0.09,-0.03),P=0.001] with statistical significance.There was no statistical significance in the utilization rate of hormone drugs in middle area [RD=-0.02,95 ％ CI(0.06,0.02),P=0.235] or western area [RD=-0.01,95％ CI (-0.02,0),P=0.122] before and after the implementation of National Essential Medicine System.CONCLUSIONS:The implementation of National Essential Medicine System reduces the utilization of hormone drugs in primary medical institutions.The effect of the eastern area is more obvious than in middle and western area.
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Objective To investigate the status of safe injection practice in primary medical institutions.Methods 55 primary medical institutions in Hubei Province were randomly selected,questionnaire survey on status of safe injection in primary medical institutions was conducted.Results A total of 55 questionnaires were distributed,50(90.91％) valid questionnaires were obtained.All valid questionnaires were from primary level medical institutions of Hubei Province,16 of which were from community health centers,17 from township health centers,and 17 from village health clinics.None of 50 primary medical institutions repeatedly used syringe and hemostix,all used disposable sterile syringe,only 7(14.00％) medical institutions used retraction type self-destructing syringe.Only 5 (10.00％) medical institutions were equipped with hand hygiene facilities and sharps containers,32 (64.00％) medical institutions didn't provide sharps containers on treatment carts,21 (42.00 ％) injection rooms didn't install hand-drying facilities,18 (36.00 ％)medical institutions didn't provide alcohol-based hand rub on treatment carts and didn't install hand-drying facilities in treatment rooms.Of sharp injures among health care workers (HCWs) reported in 2015,114 HCWs sustained 117 times of injuries,74 cases(63.25 ％) were caused by ampoule.Of medical waste disposal,there existed some problems,such as leakage and repeated use of sharps box,didn't close sharps box timely,as well as without providing sharp containers in locations where sharps might be produced.Conclusion There are a variety of hidden risks of unsafe injection in primary medical institutions,like insufficient facilities and unsafe disposal of medical waste.
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Objective To understand hand hygiene(HH) among health care workers(HCWs) in primary medical institutions in Shijiazhuang,and evaluate HH compliance,so as to formulate the strategy for HH management.Methods In 2015,one county-level comprehensive medical institution and two township medical institutions from each of seven counties of Shijiazhuang city were randomly selected,HH qualified rates of HCWs in all divisions of internal medicine before clinical procedures and after HH were analyzed statistically.Results 118 HCWs before clinical procedures and 130 HCWs after HH were monitored.The qualified rate of HH of physicians and nurses before clinical procedures were 44.26％ (27/61) and 40.35％ (23/57) respectively;HH qualified rate of nurses in township hospitals before clinical procedures were higher than county-level hospitals(x2 =6.447,P =0.011);the qualified rate of HH of physicians and nurses after HH were 98.41 ％ (62/63) and 98.51 ％ (66/67) respectively;there were significant differences in the qualified rates before clinical procedures as well as after HH in HCWs at different levels and types of medical institutions(all P＜0.05).Conclusion The qualified rate of HH among HCWs in primary medical institutions in Shijiazhuang before clinical procedures is low,medical institutions should improve the HH compliance among HCWs from various aspects.
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Objective To investigate the current situation of healthcare-associated infection(HAI)organization management systems in primary medical institutions.Methods 95 primary medical institutions in 5 provinces (au-tonomous regions,municipalities)in China were investigated.Results Of 95 primary medical institutions,82 (86.32%)established HAI management groups,65 (68.42%)set up antimicrobial management departments,87 (91.58%)assigned professionals for antimicrobial management.Before 2010,only 26 antimicrobial management departments were set up,which increased to 65(68.42%)in 2015.Hospitals established rules and regulations on medical waste management (n=93,97.89%),disinfection and sterilization(n = 87,91.58%),disposable sterile medical device (n=87,91.58%),HAI prevention and control measures (n=79,83.16%),occupational health and safety protection for health care workers(n=76,80.00%),outbreak reporting system (n=73,76.84%),hand hygiene (n=69,72.63%),and monitoring on HAI (n=56,58.95%).Conclusion Current situation of HAI or-ganization management systems in primary medical institutions needs to be improved,health administrative depart-ments should strengthen supervision to improve the level of HAI prevention and control.
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Objective To understand the current situation of medical waste management in primary medical insti-tutions in China.Methods The management of medical waste in 95 primary medical institutions in 5 provinces of China in 2016 were investigated.Results Of 95 primary medical institutions,90(94.74%)dispose medical waste by centralized processing,92(96.84%)separately collect medical waste,89(93.68%)have specific locations for temporary waste storage and handover registration,46(48.42%)have wastewater treatment facilities,and are re-sponsible by full-time or part-time personnel.Before 2000,only 4 (4.21%)primary medical institutions carried out medical waste classification management and centralized disposal,which increased to 92(96.84%)and 90(94.74%) respectively in 2014;before 2000,only 5(5.26%)primary medical institutions conducted temporarily medical waste storage and treatment,which increased to 89(93.68%)in 2014.Conclusion Medical waste management in primary medical institutions has been improved significantly,but there still remain some problems,training relevant to waste management knowledge needs to be strengthened among health care workers,medical waste management procedures should be standardized,sound medical waste management and supervision system should be improved.
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Objective To investigate the current situation and existing problems of healthcare-associated infection (HAI)management in primary medical institutions in Henan Province.Methods 36 primary medical institutions in 18 regions were investigated with random sampling method,development of HAI management in primary medical institutions before and after 2013 were compared.Results Among 36 primary medical institutions,31 (86.11 %) had cleaning,disinfection,sterilization,and isolation systems,13 (36.11 %)implemented HAI monitoring system, 31 (86.11 %)performed regular training on hand hygiene knowledge,6 (16.67%)allocated antimicrobial manage-ment professionals.The development rates in HAI management group,hand hygiene system,training on related knowledge among staff,HAI monitoring,and antimicrobial management in 36 primary medical institutions before 2013 were all lower than those after 2013 (41 .67% VS 75.00%;2.78% VS 30.56%;22.22% VS 69.44%;5.56%VS 33.33%;25.00% VS 66.67%,all P <0.05).Conclusion HAI management level in primary medical institu-tions has improved than before,but deficiencies still exists and needs further improvement.
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The funds of New Rural Cooperative Medical System, including the input of the state, the collective and personal, must be strictly managed and reasonably used, so as to implement the New Rural Medical System Policy well and contribute all the participated peasants. It analyzed the needs of improving the level of accounting personnel qualifications, account settings, original vouchers quality, price, charge management and medicine management process in Financial management of primary medical institutions, and put forward suggestions on improving the accounting training, access, medicine purchasing, selling and storage management, information management, information disclosure, supervision and inspection in financial management of primary medical institutions.