Objective To understand current situation of medical service and management in Yong’an Central Township Health Center (YaC) through on-the-spot investigation, in order to provide references for personal employment and essential medicines list implement in township health centers. Methods Questionnaire and focus interview were carried out, which included the general information, human resources, medical service and management, and the practice of essential medicines list. Results The hardware equipments of YaC were fine, and the target population had fairly good health and economy status. The ratio of General Practitioner (GP)/ nurse and GP/ pharmacist were all above the national average level. The members with college degree and above accounted for 61.6%, and about 88% staffs were with or below primary profession titles. There was a balance between personnel flow out and in. The drug income accounted for 53.6% of the whole in 2009 and the medical expenses increased compared to 2008. Essential medicines list was put into practice in April 1st of 2010 with no relevant technical documents as correspondence. Conclusion YaC, as a good representative of fairly well-off rural Township Health Center in western China, needs to cope with challenges of irrational personnel structure, low educational background and professional title of the staff and human resources flow, and requires developing policy and adopting measures step by step. The management of YaC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are necessary to maintain current service quality.
Objective To survey the drug distribution status in 24 township medical units in Shuangliu county, so as to provide references to explore the drug distribution mode for well-off township hospital. Methods An outline was made to interview the relevant workers who were in charge of the rural drug distribution management in all levels of the food and drug supervision bureaus of Sichuan province, Chengdu city or Shuangliu county, the township hospitals, the village clinics, and the drug distribution enterprises. At the same time, a self-designed questionnaire was distributed to 24 county township medical units (ie, three central township hospitals, three community health centers, and 18 general township hospitals). The Epidate3.1 was used for data-inputting, and the SPSS 17.0 was used for descriptive statistics and stratified analyses. Results At present, there was only one enterprise taking responsibility of the rural drug distribution in Shuangliu county since the strategy of enterprise direct-distribution under “two nets” supervision starting iShuangliu county of Sichuan province; Township medical units; Drug distribution; Status surveyn 2003, and there was no obvious difference in distribution before and after that strategy. The general satisfaction of 24 county township medical units with the distribution enterprise was only 50%, and the satisfaction with the price and the number of drug distribution was the lowest, accounting for 37.5% and 33.3%, respectively. Conclusion The enterprise direct-distribution under the “two nets” supervision for rural drug distribution makes the drug distribution market regular and gets good social effect, but there are still the same problems such as lack of marketization, low transparency, and high drug price, so it is necessary to introduce a new competition and management mechanism to promote the new breakthrough in rural drug distribution.
Objective To investigate the disease constitution and drug application of inpatients in Yong’an Central Township Health Center (YaC) in Shuangliu County of Sichuan province in 2009, so as to provide baseline data for further research. Method Questionnaire and focus interview were carried out, case records and drug application information of YaC inpatients in 2009 were collected. The diseases were classified according to ICD-10 based on first diagnose. Drug application was analyzed based on pharmaceutical dosage form, pharmaceutical effect, cost, and clinical departments. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Result a) The total number of inpatients was 4 335 and the female/male was 55.59% vs. 44.1%, their disease spectrum included 18 categories, which accounted for 85% of disease classes of ICD-10; b) The inpatients suffered from top 5 systematic diseases were 3 531, accounted for 81.45%, which included the respiratory, digestive, urinary tract and urogenital, circulatory systems, as well as trauma and toxicosis. Except the trauma and toxicosis, the female was more than the male in all the rest main systematic diseases; c) The top 15 single diseases were chronic bronchitis in acute stage, acute upper respiratory infection, pneumonia, acute gastroenteritis, chronic bronchitis, urinary stone, acute appendicitis, chronic gastritis, acute gastritis, vertebrobasilar ischemia, cesarean section, fracture, acute urticaria, and meniere disease; d) The total inpatients with top 15 single diseases accounted for 59.81%, including 6 chronic diseases and 9 acute diseases. The patients’ average costs of chronic disease were higher than that of acute disease; and e) The proportion of western medicine cost accounted for 80% to 90% of total cost, and the cost of anti-microbial drugs and drugs of humoral regulation ranked as the top two. Conclusion a) The inpatients in 2009 are mainly in age of 25 to 59, and over 60 years old as well. The top two diseases mainly attacked are in respiratory and digestive systems, acute diseases are more than the chronic; b) Except for pneumonia, urinary stone, uroschesis, urinary stone, trauma, and toxicosis, the female inpatients are more than the male for complaining all other diseases; c) The number of inpatients received hysterotomy is as 4.24 times as that of natural labor, and the rationality should be paid attention to; d) The commonly used drugs, according to the costs, involve in 4 kinds of drugs and 1 kind of vaccine, which are in accordance with the main burden of the diseases; e) Supervision should be focused on the drugs of high cost or the one most frequently used; and f) The 0.9% Sodium chloride injection, Glucose injection and Cefuroxime listed in the EML (2009) satisfy the needs of treatment for YaC inpatients in 2009.
Objective To investigate the disease constitution and hospitalization cost in Yong’an Central Township Health Center (YaC) in Shuangliu County of Sichuan Province from 2008 to 2010, so as to provide baseline data for further research. Methods Questionnaire and focus interview were carried out; case records and cost information of YaC inpatients in 2008, 2009 and 2010 were collected. The diseases were classified according to ICD-10 based on the first diagnose and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of inpatients were 4 236, 4 335 and 4 844 in 2008, 2009 and 2010, respectively. Females were more than males (56.99% vs. 42.96%, 55.59% vs. 44.1%, 54.36% vs. 45.62%), and their disease spectrum included 20 categories, which accounted for 95% of disease classes of ICD-10; b) The inpatients suffering from top three systematic diseases accounted for 62.74% to 72.31%, which included the respiratory, digestive, urinary tract and urogenital systematic disease; c) The top 15 single diseases were upper respiratory infection, acute bronchitis, pulmonary infection, acute gastroenteritis, fracture, acute appendicitis, chronic bronchitis, calculi in urinary system, cerebral vascular insufficiency, lumbar vertebra disease, acute gastritis, superficial injury, chronic gastritis, hypertension, and cholecytolithiasis or cholecystitis; d) The number of inpatients in the group of over 15-24 ages with chronic diseases increased with age and females were more than males. The acute disease burden of inpatients in 0-4 age group was the heaviest, who only suffered from acute diseases and males were more than females. The inpatients in 25-54 age group suffered from more acute diseases than chronic diseases and females were more than males; and e) The inpatients’ average costs of chronic diseases were higher than those of acute diseases in 2010 (1 564.45 yuan vs. 1 104.11 yuan) and those of either Xintian Central Township Health Center (1 311.81 yuan) or Gaozha Central Township Health Center (1 002.99 yuan). Conclusion a) In recent three years, the main systematic diseases that inpatients suffer are digestive, respiratory, and urinary tract and urogenital system diseases; the acute diseases are more than the chronic; the acute diseases mainly include infection and injury; b) During the past three years, the top 15 diseases have been stable and the same diseases include upper respiratory infection, pulmonary infection, acute bronchitis, acute appendicitis, acute gastritis, acute gastroenteritis, fracture, chronic gastritis, chronic bronchitis, and calculi in urinary system; c) It should be paid attention to the inpatients with chronic diseases in over 15-24 age group and the inpatients with acute diseases in 0-4 age group; and d) The inpatients’ average costs of top 15 diseases in 2010 were higher than those of either XtC or GzC, and consideration on rationality of the hospitalization cost should be paid attention to.