A Cross-sectional Study Assessing Predictors of Essential Medicines Prescribing Behavior Based on Information-motivation-behavioral Skills Model among County Hospitals in Anhui, China

Background： The self-consciousness and practicality of preferentially prescribed essential medicines （EMs） are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills （IM B） model to identify the predictors of essential medicines prescribing behavior （EMPB） among doctors and to examine the association between demographic variables, IMB, and EMPB. Methods： A cross-sectional study was carried out to assess predictive relationships among demographic variables and IM B model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the I MB model to test the instruments using analysis of moment structures 17.0. Results： A total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old （range： 22-67 years old）. The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 a： 7.34 （hundred mark system： 75.77） and 19.92 ± 3.44 （hundred mark system： 79.68）, respectively. Approximately half（50.8%） of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data （x^2/df= 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066）. More work experience （β = 0.153, P 〈 0.001 ） and behavioral skills （β = 0.449, P 〈 0.001 ） predicted more EMPB. Higher income predicted less information （β = -0.197, P 〈 0.001） and motivation （β =0.204, P 〈 0.001 ）. Behavioral skills were positively predicted by information （β = 0.135, P 〈 0.001 ） and motivation （β = 0.742, P 〈 0.001 ）. Conclusion： The present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.

Impact of the zero-markup drug policy on volume of medical service:based on 57 county hospitals of China

In the present study,we aimed to assess the long-term impact of zero-markup drug policy on volume of medical service in county hospitals of China.This study used 57 county hospitals’records of medical service from 2011 to 2015,and a fixed effect model was applied to examine the impact of the zero-markup drug policy on volume of medical service.The outcome indicators included the number of patient visits,the number of prescriptions,the number of discharged patients,the length of stay,the number of patients who had surgeries and the number of patients who had CT or MRI,monthly.The number of hospitals which implemented the zero-markup drug policy was increased continuously.By the end of 2015,41 hospitals(71.9%)implemented this policy.The panel regression showed that most indicators were insignificantly decreased,including the number of patient visits(P<0.01),the length of stay(P<0.05),the number of patients who had surgeries(P<0.01)and the number of patients who had CT or MRI(P<0.01).However,the number of prescriptions and the number of discharged patients were not significantly changed.The implementation of the zero-markup drug policy might affect the reduction of the volume of medical service in county-level hospitals and the reason needs to be clarified in future studies.

Bootstrapping Data Envelopment Analysis of Efficiency and Productivity of County Public Hospitals in Eastern, Central, and Western China after the Public Hospital Reform

China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals（39, 45, and 43 in Eastern, Central, and Western China, respectively） were collected during 2012–2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal–Wallis H test and Mann–Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency（PTE）, and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012–2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012–2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the three areas of China, especially in Central China.

Study on salary level of medical doctors in county-level public hospitals and related influencing factors

This study aimed to investigate the salary status of medical doctors who work in county-level hospitals, and analyze the existing problems. We collected the data from questionnaires and applied both EXCEL and SPSS to conduct analysis. Doctors working in county level-hospitals received relatively lower salaries, with 78.5% of the doctors making lower than 5000 RMB per month. Influencing factors for the salary levels included personal factors, attributes of the hospitals, workload and performance appraisal. Reasonable adjustment for the salary levels is needed to refine important elements of salary distribution, and to construct a rational performance appraisal system.

Efficiency and Productivity of County-level Public Hospitals Based on the Data Envelopment Analysis Model and Malmquist Index in Anhui, China

Background： China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis （DEA） model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development. Methods： We chose 12 country-level hospitals based on geographical distribution and the economic development level inAnhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions. Results： During 2010-2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was 〉1, and the rest are 〈1 between 2010 and 2015. Conclusions： In 2010-2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.

基层医院鼻内镜手术回顾与总结

贵州相对全国其他省份而言鼻内镜手术开展较晚,而在基层医院开展就更加滞后,受技术及设备的影响,许多基层医院对开展鼻内镜手术仍望而生畏。我院自2010年3月~2014年4月行功能性鼻内镜手术178例,现报道如下。1.1临床资料。慢性鼻-鼻窦炎患者178例(345侧),其中男96例,女82例,年龄13~68岁,平均38.5岁,病程3个月~36年,平均4.7年。患者均有不同程度的鼻塞、流脓涕、头痛、

Comparative Seroprevalence of Hepatitis B Virus among in-Mates and Low Risk Voluntary Blood Donors in Garissa, Kenya

Hepatitis B virus (HBV) infection is a potentially life-threatening infection that attacks the liver and can cause both acute and chronic disease. This creates a high risk of death from cirrhosis and liver cancer. Hepatitis B infection poses a major health concern globally. It is estimated that 257 million people are infected globally with 780,000 deaths reported annually. In Kenya, HBV prevalence stands at chronic states of intermediate range (5% - 7%) and high (≥8%) with regional variations. Garissa County carries a high HBV infection risk with a reported prevalence of 14.1% in pregnant women attending antenatal care (ANC) clinics. This study was carried out to determine and compare the seroprevalence of HBV among in-mates and voluntary blood donors at Garissa Main Prison and Garissa County referral hospital respectively in Garissa, Kenya. A total of 130 in-mates and 130 voluntary blood donors were sampled in this study. Serum was tested for Hepatitis B surface antigen (HBsAg) using a rapid test cassette (Amitech Diagnostics Inc.). A questionnaire was also used to collect socio-demographic factors of the study participants. Data were entered and analyzed using SPSS version 20. Majority of the study participants were males (86.9% among inmates and 95.4% among blood donors). Majority (76.2%) of the in-mates and of the donors (83.1%) were aged between 20 - 40 years while majority (51.4% of the donors and 81.5% of in mates) had only a primary school level of education. HBV seroprevalence was significantly higher among in mates compared to blood donors. Out of the total number of in-mates tested, 7 (5.4%) were HBV seropositive. Conversely, among blood donors 4 (3.1%) were seropositive. There was a significant association between HBV seropositivity and gender among both the blood donors and in-mates. There was no significant association between HBV seropositivity and both level of education and age. No data currently exists on HBV seroprevalence in Kenyan prisons and these study findings may be used as a proxy for other prisons within the country. Further studies to determine other predisposing risk factors should be conducted. Additionally, molecular studies to determine circulating HBV genotypes in this group of people and region are required.