Ethics of Human Resources Management in the Cameroonian Health System, Medical Nomadism and the Ineffectiveness of the Fight against High Blood Pressure

Context/objectives: The fight against Chronic Non-Communicable Diseases (NCDs) is a long-term undertaking, which requires available, motivated and well-managed human resources (HR). The administrative management of skills on both qualitative and quantitative levels is one of the essential functions of a health system. To better implement policies of fight against High Blood Pressure (HBP) and other chronic diseases, it is important to establish strategies to retain health personnel. This loyalty requires favorable working conditions and consideration of the contribution-reward couple. Good working conditions are likely to reduce the phenomenon of medical nomadism;conversely, poor HR management can contribute to their exodus towards exotic “green pastures”, thus leading to an additional crisis in the Cameroonian health system. The fight against HBP is a complex, multifaceted and multifactorial reality that requires appropriate management model for all types of resources mainly HR. The main objective of this research is to show the impact of poor management of human resources in Cameroon health system on medical nomadism and the ineffectiveness of the fight against High Blood Pressure. Method: A cross-sectional descriptive survey among five hundred (500) health facilities in the center region of Cameroon has been conducted. A stratified probabilistic technique has been used, and the number of health facilities to be surveyed has been determined using the “sample size estimation table” of Depelteau. The physical questionnaires have been printed and then distributed to data collectors. After data collection, the latter were grouped during processing in Excel sheets. The Chi-square test was used for data with a qualitative value and that of Kolmogorov-Sminorf for data with a quantitative value to assess the normality and reliability of data. The Crochach’s Alpha reliability test allowed us to have a summary of the means and variances and then to search for intragroup correlations between variables. Descriptive analysis was possible with the XLSTAT 2016 software. Results: 43.60% of Health Facilities (HF) managers were unqualified. 82.20% of HF managers have staff in a situation of professional insecurity. They are mainly contractual (49.00), decision-making agents (24.40%), casual agents (08.80). The proportion of unstable personnel is average of 22.00% and very unstable, 12.00%.

Analysis of High Alert Medication Knowledge of Medical Staff in Tianjin:A Convenient Sampling Survey in China

The current situation of medical staff＇s awareness about high alert medication was investigated in order to promote safe medication and standardized management of the high alert medication in China. Twenty questions were designed concerning elementary knowledge of high alert medications, storage management, medication issues and risks. In order to understand the knowledge level and education status of high alert medication, a convenient survey was conducted among 300 medical staffs in Tianjin. Medical staff＇s average score of high alert medication knowledge was 12.43±0.27, and the average scores of elementary knowledge of high alert medication, storage management, medication issues and risks were 3.38±0.11, 2.46±0.14, 3.17±0.11 and 3.41±0.12 respectively. Occupation（F=4.86, P=0.003）, education background（F=5.57, P=0.019） and professional titles（F=13.44, P≤0.001） contributed to the high alert medications knowledge scores. Currently, the most important channel to obtain high alert medication knowledge was hospital files or administrative rules, and clinical pharmacist seminars were the most popular education form. It was suggested that the high alert medication knowledge level of the medical staff needs to increase, and it might benefit from targeted, systematic and diverse training to the medical staff working in the different circulation nodes of the medications. Further research to develop and validate the instrument is needed.

Long-term outcomes of high-risk elderly male patients with multivessel coronary disease： optimal medical therapy versus revascularization

Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy （OMT） and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients （65-92 years of age） with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who under- went OMT than in those who underwent revascularization （6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04）. However, the overall risks of major adverse cardiac cerebrovascular events （MACCE） were similar among all patients （6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67）. Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.

Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study revealed a significant negative correlation (rpb = −0.227, p 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = −0.129), insignificant (rpb = −0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ2= 17.14, df = 1, N = 81, p 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow-ups especially those were treated and left to go home;discussions be made with patients on severity of non-adherence and importance of adherence;use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.

Patient and Health System Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Background: Non-adherence to hypertensive medication continues to become a contributing factor to hypertensive complications like stroke, heart attacks, kidney disease heart failure. Associated factors to non-adherence are complex, are both internal and external to the patient and are difficult to extrapolate. Reports from Chuka referral hospital records showed that in 2016 there were 140 patients with hypertensive complications from 560 patients who attended the medical clinic that year. Objective: This study sought to explore the patient’s related factors that are associated with non-adherence to hypertension medication. Methods: This is a descriptive study design of (N = 575) people among them doctors, pharmacists, nurses, record officers and hypertension patients. Simple random sampling for patients (n = 81) and census sampling for health care workers was done and data collected using questionnaires and interview schedules between April 4th-May 30th 2019. Inferential and descriptive statistics were used for data analysis, aided by SPSS version 25. Results: 64% of the patients stated that they had missed medication. A significant negative correlation (rpb = -0.23, p < 0.05) between age and non-adherence, significant positive correlation with monthly income (rpb = 0.24, p < 0.04), non-significant relationship between non-adherence and marital status (rpb = -0.13, p = 0.25) and patients’ level of education (rpb = -0.06, p = 0.57). The overall model of health system related factors were found to be significant (p < 0.05) and this included;quality of health service, physician patient relationship, stock out, health education, and availability of medicine (p = 0.012). Conclusion: Lacks of funds, unavailability of drugs are the leading factors to regimen completion. This could be easily be addressed by the government.

Nursing Effects of Medical Treatment Combination on Patients at High Risk of Developing Pressure Ulcers at Rural Homes

Objective:To explore the nursing effects of medical treatment combination on patients at high risk of developing pressure ulcers at rural homes.Methods:From January 2018 to December 2018,86 patients at high risk of developing pressure ulcers at rural homes who were in Wenjiang Hospital were randomly divided into a control group and an observed group.The control group received the routine publicity and education and visiting,while the observed group adopted the cooperative nursing model of medical treatment combination.Then compare the healing status and nursing satisfaction of the two groups.Results:Of the 43 patients with pressure ulcers in the observed group,18 had been in the second stage of pressure ulcers and 16 had been healed;14 had been in the third stage of pressure ulcers and 8 had been healed;11 had been in the fourth stage of pressure ulcers and 5 had been healed.The nursing satisfaction of the patients in the observed group was 95.35%.Conclusion:Conducting medical treatment combination on patients at high risk of developing pressure ulcers at rural homes can effectively improve the patients’and their families’awareness of pressure ulcer nursing,standardize their nursing behaviour,help recover the patients themselves and promote the patients’satisfaction.

护士高警示药品用药安全影响因素的质性研究

目的 :了解护士对高警示药品用药安全影响因素的认知体验,为护士更加安全有效地管理高警示药品提供参考。方法 :采用目的抽样法,选取不同科室的13名临床护士和护理管理者,以临床事件分析模型为理论框架,采用描述性质性研究方法对研究对象进行半结构式访谈和关键事件访谈,采用内容分析法对资料进行分析。结果 :构建了防止高警示药品错误实践的描述性模型——高警示药品用药安全:组织、护理与合作影响,提炼出组织因素、护士能力与责任、沟通合作3个主题和8个亚主题。结论 :护士高警示药品用药安全受到组织文化、自身知识与能力、医护患间沟通合作等因素影响。本研究为高警示药品用药安全管理实践提供了概念框架,同时也为医疗机构安全有效地管理高警示药品提供理论依据。

High Alert

THE threat of militant Islamist group Boko Haram in far north Cameroon is impacting many foreign-invested projects in the region. It has prompted the authorities to beef up security to protect foreign citizens and their work. which is vital in achieving the development goals of the country. Chinese workers and operations in Cameroon have been part of those affected by the security threats. In May 2014, Boko Haram militants kidnapped 10 Chinese road construction workers in Waza, about 20 km from the border with Nigeria. killing a soldier. The hostages were freed in October 2014,

省级医院优质医疗资源下沉实践与思考

全面深化医疗供给侧结构性改革,作为全周期医疗健康服务体系的重要一环,省级公立医院积极推进多形式医联体建设,促进优质医疗资源均衡布局和扩容下沉,构建分级诊疗服务格局。笔者以河南省人民医院“医院-政府”托管县级公立医院实践为案例,探析其经验做法,从体制机制、技术支撑、人才能力方面剖析存在的问题,并提出针对性建议。

某三级专科医院DRG分组高倍率病例费用影响因素比较分析

[目的]基于天津市某三级专科医院DRG分组数据探讨专科医院DRG组高倍率病例影响因素,为医院进行有针对性的成本控制提供参考。[方法]收集某专科医院2022年10月1日-2023年9月30日上传的医保患者医保结算清单经分组器分组后正常入组数据,按照进入天津市医保局DRG分组器分组后的全市付费次均费用、平均住院天数计算入组病例费用的倍率,应用logistic回归分析高倍率病例的影响因素,采用灰色关联分析法分析高倍率病例各分项费用与住院总费用的关联度。[结果]入组病例总数为7829例,其中高倍率病例673例,占8.60%。Logistic回归结果显示,DRG合并并发症、15~60岁、非医嘱离院、实际住院天数长是高倍率病例产生的影响因素(P<0.05)。灰色关联结果显示,在10个高倍率的DRG组里,有5个DRG组的诊断费与其呈现最强的相关性,有3个DRG组的药品费与其呈现最强的相关性,有2个DRG组的综合服务费与其呈现最强的相关性。[结论]药品费、诊断费、综合服务费、合并并发症、15~60岁及住院天数长与高倍率住院费用的产生显著相关,是医院进行有指向性成本控制的重要因素。

高层次医学创新人才培养的理论思考和实践举措——基于国家科技奖的实证分析

科技革命带来了医学创新发展新需求,创新之道,唯在得人。国家科技奖代表了一定时期内我国科学技术领域取得的重要突破,其权威性高、荣誉性强。本文通过整理2016—2020年医学领域国家科技奖获奖情况,从获奖数量、获奖地区、获奖主体、学科分布和交叉融合等方面对获奖成果进行分析,从而把握我国医学科技创新的现状与问题,以期为健康中国建设培养高层次医学创新人才提供借鉴与启示。

三级公立医院绩效考核背景下医院运营管理的研究

国家三级公立医院绩效考核开始于2019年,运营效率作为考核的一部分,相关的国家监测指标有9个,包含收支结构和费用控制。绩效考核是医改工作的有力抓手,也是加快现代医院管理制度建立的强劲推手。通过分析某三级甲等口腔专科医院在绩效考核背景下运营效率指标的得分情况,找出原因;并通过加强党建引领,做好医院运营管理体系架构顶层设计,加强医疗质量管理,落实医改相关政策,加强能耗管理,不断提高员工福利待遇,强化公立医院功能定位,提高医疗服务收入占比,绩效分配体现医务人员的劳动技术价值,提高运营管理能力,助推医院高质量发展。

大型公立医院构建三尺质控模型的实践探索

目的构建“三尺”质控模型,促进医疗质量全面内涵管理。方法构建由“标尺、量尺、戒尺”组成的“三尺”质控模型,具体包括:以各项质量指标的标准化保障质量的基础管理,形成“标尺”;以“标尺”为准绳,落实全面质控和监督机制,保障质量的环节管理,形成“量尺”;运用绩效奖惩等措施落实质量的终末管理,形成“戒尺”。结果“三尺”质控模型的构建形成了全方位医疗质量监督管理机制,强化了医疗质量全面内涵管理,夯实医院高质量发展根基。结论“三尺”质控模型的构建与推广,有助于医疗质量持续改进和医疗服务能力有效提升,为我国各级医院医疗质量持续改进提供参考。

基于全面质量管理理论的临床专科能力建设实践

临床专科能力建设是优质医疗资源扩容的基础。以全面质量管理理论的六要素为框架,从人才队伍建设(人)、设备耗材管理(机和料)、制度流程管理(法)、医院文化建设(环)、质量控制和系统评价(测)等6个方面阐述了临床专科能力建设的主要做法。实践后,临床专科能力持续提升,并提高了优质医疗服务可及性。还需进一步整合各类资源,注重分院区专科能力建设,促进专科同质化发展。

医保精细化管理助力国家骨科医学中心运行探索

随着医保DRG支付改革的不断深入和高值医用耗材集中采购的落地,国家骨科医学中心建设单位以国家公立考核以及医保支付改革为目标,以优势学科为重要管理对象,提出了以专科病种同质化管理为基础、临床诊疗组综合服务能力评价为核心,医用耗材合理性使用为抓手,资源激励为价值导向的医保精细化管理方案。通过医保精细化管理提高国家骨科医学中心运行,形成优势学科的规模效应,为国家医学中心建设和管理提出思考和建议。

SPD助力手术室高值医用耗材精细化管理

对生产厂家、供应商、物流公司、设备物资科及手术室进行规范化管理,利用SPD医用耗材管理系统及智能感知柜管理系统,改变原有手术室高值医用耗材逆向物流的模式,建立院内手术室高值医用耗材的正向物流管理模式及追溯机制,以降低临床医用耗材管理工作强度,实现高值医用耗材可视化管理和精细化管理,为医院进行科学合理的宏观调控提供可靠准确的信息,在保证高值医用耗材使用快捷的同时,最大限度地保证手术室高值医用耗材在使用中的安全性及可追溯性。

日本个人医疗费用封顶制实践及启示

日本个人医疗费用封顶制以患者利益为主导,聚焦重大疾病保障;制度改革循序渐进,确保了医保基金可持续;自付限额以年龄和收入为划分维度,防止了泛福利化。这些实践经验对我国未来实施个人医疗费用封顶制具有一定的借鉴意义。我国应逐步优化基本医疗保障资源配置,设置与家庭收入相挂钩的自付限额,明确个人医疗费用封顶制的保障范围,创新医保支付方式和医疗过程监督机制。

分析青年高血压患者药物治疗时的遵医嘱服药概率以及影响因素

目的研究和分析青年高血压患者药物治疗时的遵医嘱服药概率及影响因素。方法随机选取2022年1—12月滨州医学院附属医院就诊并接受降血压药物治疗的100例高血压患者为研究对象,根据服药时是否遵医嘱的调查结果分为研究组(遵医嘱服药,81例)和对照组(未遵医嘱服药,19例),对于两组之间的临床资料进行分析,以明确导致青年高血压患者在药物治疗中未遵医嘱服药的危险因素。结果经单因素分析,两组患者的文化程度、疾病认知度、药物不良反应、焦虑评分、抑郁评分对比,差异有统计学意义(P均<0.05)。经多因素分析显示,文化程度(OR=2.457,95%CI=1.193~3.107)、疾病认知度(OR=2.369,95%CI=1.207~3.114)、药物不良反应(OR=2.561,95%CI=1.489~3.082)、焦虑评分(OR=2.468,95%CI=1.347~3.119)、抑郁评分(OR=2.406,95%CI=1.352~3.069)是导致青年高血压患者在应用降血压药物治疗期间未遵医嘱服药的危险因素(P均<0.05)。结论青年高血压患者在应用降血压药物治疗时,存在不遵医嘱服药情况,患者是否遵医嘱服药主要与文化程度、疾病认知度、药物不良反应等因素有关。

公立医院高质量发展背景下医用耗材遴选体系的构建与思考

目的构建医用耗材遴选体系,遴选出适应医院和业务发展需求、患者满意的质优价廉产品,促进临床科学、合理使用医用耗材。方法分析医疗机构医用耗材遴选管理现状及难点,从明确总体要求、确定管理架构及制度、建立规范遴选流程、选择合适遴选品种、设定遴选标准方面着手,并依托医用耗材采购交易平台以及借助SPD模式,构建科学完善的医用耗材遴选体系。结果同类耗材品种减少,耗材单价平均降幅达14.63%以上,临床科室满意度达90%。结论构建科学完善的医用耗材遴选体系有助于降低患者费用及医院成本,改善服务质量,适应公立医院高质量发展要求。

基于协同理论的国家心血管病区域医疗中心高质量发展模式研究

国家区域医疗中心建设是“十四五”时期国家深入推进新型医疗服务体系改革的重要载体。针对当前国家区域医疗中心建设存在的协同机制不健全、协同动力不足以及考核评价体系缺失等问题,借鉴协同理论和个案研究法,在管理体制协同、运行机制协同和评价机制协同3个维度对国家区域医疗中心建设路径进行分析;探索构建国家区域医疗中心“13331”高质量发展管理新模式;在党建引领、医疗技术、科技创新、医教协同、品牌影响力等方面为新形势下推动国家区域医疗中心高质量发展提供经验借鉴和案例参考。