Objective To provide references for the rational allocation of health personnel in rural hospitals through understanding the status of health human resources of rural hospitals in remote and poor areas of Sichuan Province. Methodes This study used cluster sampling method, combined with questionnaire survey and qualitative interviews. A total of 711 health workers of 29 rural hospitals in Pengzhou and Baoxing of Sichuan Province were interviewed. SPSS16.0 was used for descriptive analysis.Results The average age of rural hospitals health personnel in remote and poor areas of Sichuan Province was 30 years old. Post-secondary education accounted for 58.12%, and Bachelor degree or above accounted for 7.2%. The number of medium and senior professional titles account for 8.4 %. The ratio of doctors to nurses was 1:0.55. In the survey of health workers, those doctors with practice (assistant) license accounted for 38.5%, and those without any qualification occupied 27.1 %. Conclusions The professional titles of medical personnel of rural hospitals in remote and poor areas in Sichuan province are generally low. The distribution of professional categories is irrational. The staff in charge of prevention and care are inadequate. There exist a large number of unqualified medical workers. Therefore, the government should increase the investment in rural health and take measures to stabilize the team structure, introduce the talented, and strengthen the training for health personnel of rural hospitals to improve their overall quality.
Objective To identify the key influencing factors of death anxiety in rural elderly and their mechanisms of action. Methods A total of 701 rural elderly individuals from 6 prefecture-level cities (prefectures) in Sichuan Province were selected for a questionnaire survey on death anxiety, health-related physical fitness, and subjective well-being. A structural equation model was constructed to thoroughly analyze the influencing factors of death anxiety and their mechanisms of action. Results Higher levels of health-related physical fitness, higher levels of subjective well-being, and having more children were the top three protective factors against death anxiety among elderly people in rural Sichuan, with effect values of −0.392, −0.287, and −0.154, respectively. In contrast, suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. Suffering from chronic diseases was the leading risk factor for death anxiety, with an effect value of 0.127. The structural equation model fitting results showed that the medical insurance type of rural elderly in Sichuan (β=−0.062, P=0.002), suffering from chronic diseases (β=0.127, P=0.001), hospitalization due to health reasons in the past year (β=0.086, P=0.002), and educational level (β=−0.067, P=0.001) had indirect effects on death anxiety through health-related physical fitness. Not seeking medical treatment due to financial difficulties in the past year had an indirect effect on death anxiety through subjective well-being (β=0.060, P=0.002). The number of children had both a direct effect on death anxiety (β=−0.119, P=0.004) and an indirect effect through subjective well-being (β=−0.034, P=0.001). Health-related physical fitness had both a direct effect on death anxiety (β=−0.278, P=0.001) and an indirect effect through subjective well-being (β=−0.114, P=0.002). Conclusion Multiple factors directly or indirectly affect the level of death anxiety in the rural elderly population. Health-related physical fitness, subjective well-being, and the number of children are important protective factors. Moreover, health-related physical fitness and subjective well-being act as mediating variables in the chain of effects of multiple factors on death anxiety.
Objective To understand the demands on portable medicine kit of rural residents in well-off township hospitals, and to provide the basis for scientifically designing portable medicine kit for rural residents. Methods The methods of combining simple random sampling and cluster sampling were used to investigate and analyze the demands on portable medicine kit for 162 households from three well-off township hospitals in Shanghai, Zhejiang, and Sichuan province, respectively. Results The demand rate of 162 rural households on portable medicine kit was 75.3% (122/162). The main drugs that demanders expected in the portable medicine kit were cold medicine (86.1%), wound paste (82.0%), cooling oil (61.5%), essential balm (54.9%) and antihypertensive (34.4%); and the main medical devices that demanders expected were thermometer (82%), cotton swab (73%) and sphygmomanometer (32.8%). The sizes of portable medicine kit that demanders expected were 23.7±8.5 cm in length, 17.1±6.4 cm in width, and 14.1±6.5 cm in height. The main function characteristics of portable medicine kit that demanders expected were applicability (74.6%), safety (60.7%), light weight (68.0%), economics (60.7%), and waterproof (46.7%). A total of 72.1% of demanders expected the price of less than 15 yuan, and 91.8% expected kit made of hard materials as plastic as the first choice. Conclusion The demand rate of rural residents on portable medicine kit is higher in well-off township hospital. The design and production of portable medicine kit should fully meet the demands of rural residents. Only when sufficiant respect for the market demand is paid, can the promotion and application of portable kits will be ensured.
【摘要】目的介绍华西医院支援西部地区卫生工程项目的实践和成效。方法过去5年间，华西医院响应国家号召，通过各种帮扶形式，开展了一系列对口支援活动。结果华西医院利用自身的资源优势，通过各种帮扶形式，提高基层医院的医疗救治水平和综合服务能力，为建立城市支援农村卫生工作的长效机制进行了积极的实践和探索，取得显著成效。结论基层卫生事业与人民健康需求和现代医学进步存在着相当的差距，医疗体制改革对部属部管医院的对口支援提出了更高的要求，对口支援的许多细节还需要我们去进一步完善。【Abstract】Objective To introduce the practice and progress of the supportive rural hygiene program of West China Hospital. Methods In the past five years, West China Hospital had made a lot of supportive rural hygiene practice. Results West China Hospital made good use of its own advantages in resources to develop the treatment level and the comprehensive service capability of primary hospital. West China Hospital did a lot of practice to establish the effective system of assistance of city medical care to rural areas, and had already achieved remarkable effects. Conclusionre is a lot of disparity between the basic public health or the requirement of people and the modern medicine progress. Many details for support should be further consummated.
ObjectiveTo understand the treatment status and economic burden of convulsive epilepsy patients in Hailin City, Heilongjiang Province, who had received an epilepsy management program that was terminated for 6 years, and to estimate the long-term effect of the epilepsy management program.MethodsFollow up the 234 patients in the program of epilepsy prevention and management in rural areas at the end of December 2011 by standardized questionnaire and interview.ResultsAmong the 234 patients who received antiepileptic drugs (AEDs) and follow-up management at the end of epilepsy prevention and management program in rural areas, 172 patients received Phenobarbitone (PB) and 62 patients received Sodium valproate (VPA). 86 patients completed the survey. Among them, 46 (53.49%) were still taking original drugs, 31 (36.05%) changed to other AEDs, 9(10.47%) gave up the treatment due to the closure of the program. The treatment costs of patients in adherence group were also lower than that of other patients, and the average cost was only 43.61% of that of the replace group. There were statistical significant differences in annual household income, drug costs, offset seizure frequency and current seizure frequency between the two groups.ConclusionThe epilepsy management program had remarkable long-term effects and short-term effects, it had advantages in treatment effect and reducing drug costs. It could be recommended throughout rural China.
Objective To quantify the potential medical preference of rural day surgery patients, and provide a policy basis for further promoting the development of day surgery in county-level hospitals. Methods Based on the discrete choice experimental design questionnaire, all rural inpatients undergoing day surgery in three departments of the First Affiliated Hospital of Fujian Medical University between September and October 2022 were selected as survey subjects, and one-to-one structured questionnaire interviews were conducted. The Mixed Logit model was used to analyze the preference size, marginal willingness to pay and average marginal effect of patients on five medical attributes and levels. Results A total of 223 copies of questionnaire were issued, and 223 valid ones were collected, with an effective recovery rate of 100%. The five medical attributes were statistically significant in the impact on the medical preference of rural day surgery patients (P<0.001), and the patient’s preference was most affected by the physician category attribute (β=1.776, P<0.001). When the medical services from experts were unavailable, patients hoped to get 4862.51 yuan in compensation; when the patients received medical services from county-level hospitals instead of higher level hospitals, patients hoped to get 3154.60 yuan in compensation; when the availability of medical equipment and drugs was low, patients hoped to get 1447.72 yuan in compensation; patients were willing to spend 1197.29 yuan more to reduce the time spent from home to hospital. When the completeness of hospital medical equipment changed from “low” to “high”, patients’ preference increased by 52.89%. Conclusion Focusing on the cultivation of health personnel and the availability of medical equipment and drugs in county-level hospitals has a positive effect on improving the development of day surgery in county-level hospitals.
ObjectivePublic health information collection is critical in improving the capacity of basic public health services. Our study took the "Wei Jian E Tong" APP as an example to evaluate the willingness and influencing factors of rural public health service personnel to continue using such APPs.MethodsWe applied exploratory sequential design in mixed-method research and chose Renshou county in Sichuan province as the representative region. Firstly, we used the personal in-depth interview to initially explore the status quo, applicability, continued willingness to use APP and other issues. Secondly, we used unified theory of acceptance and use of technology (UTAUT) and expectation confirmation theory (ECT) to construct a hypothetical model of influencing factors of user satisfaction. We then designed a structured questionnaire covering 7 measurement dimensions to survey all users of the APP at the survey site. Finally, we used structural equation model to verify the research hypothesis.ResultsA total of 21 individuals were interviewed in this survey, including leaders of township health centers, public health doctors, and rural doctors. Qualitative results showed the major defects were insufficient funds and policy support in the promotion and application, additionally lack of software functionalities and system incompatibility. A total of 593 valid questionnaires were collected from the quantitative survey on the satisfaction of township doctors and village doctors. Structural equation model results showed that seven direct hypotheses were established, of which compatibility had the largest effect value user satisfaction with a total effect value of 0.617, followed by facilitating condition (r=0.211), performance expectancy (r=0.137), effort expectancy (r=0.091) and social influence (r=0.068).ConclusionsTo promote the application of information collection apps in primary public health services and improve user satisfaction, the focus should be on solving software incompatibility and create interconnection among all levels of medical systems. At the same time, it is necessary to solve funding problems as a whole, optimize software functions, improve the performance evaluation system, and improve software training and promotion.
Objective The Chengdu initiative essential medicine policy is part of the Special Healthcare Program of Comprehensive Reform for Coordinated and Balanced Urban-rural Development. We aimed to investigate the current situation of medicine use in rural hospitals and community health service centers, so as to provide evidence for policy-makers to select essential medicines and facilitate rational use of medicines. Method We selected 7 township/community health institutions from which to collect medicine use information, including medicine category, number of medicine categories, cost and consumption. Descriptive analysis and the ABC classification method were applied for statistical analysis. Results The number of medicine categories used in the community health institutions was four times greater than that in the township health institutions. Traditional Chinese medicine preparations accounted for 40% of the total medicine cost. Polypharmacy, overuse of injections, and improper use of antibiotics were major manifestations of the irrational use of medicines. Conclusion The selection and use of essential medicines should be base on high quality evidence as well disease burden, the economic situation and specific demands in different areas. Drug and therapeutics committees should be set up to perform dynamic monitoring, education, evaluation and continual improvement of an essential medicines list.
The shortage of health workforce in rural and remote areas has been commonly concerned by every country around the word. It is one of world health issues, challenging the aspirations of achieving equity. In this regard, WHO developed the Global Policy Recommendations to improve the accessibility of the health workforce in rural and remote areas through improved retention. This article focuses on the key steps of the policy guideline developed from evidence-based medicine methodology and from angle of guideline development, mainly about background, issues, evidence retrieval and selection, quality grading of evidence, and the forming of recommendation plan, in order to further explore how to correctly understand, obtain, evaluate and apply currently available research evidence, and how to use the GRADE system to make scientific and feasible recommendations in the decision-making process, emphasizing the importance of evidence and the GRADE system in the evidence-based health decision-making.
ObjectiveNew Rural Cooperative Medical Systems (NCMS) has been constructed as a financial protection for rural population commencing 2003. With the development of NCMS, there were quite a few management models existing across the nation. In order to assess the management alternatives, we try to explore how to set up a set of indicators to analysis management effect of different management models. MethodsBy literature review, we sorted all qualitative indicators into 8 types. Delphi and Multi-Attribute utility theories were applied to construct the appraisal indicators, including shaping first and second level indicators and assigning the weights for each type of indicators. ResultsWe managed to identify the indicator system which was comprised of 4 types of first level indicators, aiming at claim, manament process, transparency and supervision on accredited hospitals. Besides, there were 9 sub-indicators. ConclusionThe evaluation indicators are constructed for future assessment on management effect of rural health insurance.