Exploration on the Implementation of the Integration of Medical and Preventive Model in China’s Primary Health Care Institutions

Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.

The situation of primary care institutions under the background of new medical reform in China

[目的] 分析新医改背景下我国基层医疗卫生机构的发展现状,探讨存在的问题,为进-步完善基层 卫生事业改革发展提供参考.[方法]利用2008 - 2 0 1 2年中国卫生统计年鉴数据,对基层医疗卫生机构基础设 施、人才配置和卫生服务利用状况进行分析.[结果] 2008 - 2 0 1 2年我国基层医疗卫生机构总数量年平均增速 为 1.55%,其中西部地区的机构数量最少、但年平均增速最快,中部地区的数量比西部多比东部少;在三大基 层医疗卫生机构当中,社区卫生服务中心（ 站）、乡镇卫生院和村卫生室机构数量年平均增长率分别为8 . 4 4 %、 -1.3%和 1.6%; 三大基层机构卫生技术人员数量年平均增长率分别为2 0 . 2 5 %、3% 和 5 . 0 2 % ; 三大基层机构 诊疗人次数年平均增长率分别为2 3 . 6 8 %、3. 96% 和 8. 92 %.截至2 0 1 2年 ,社区卫生服务中心卫生技术人员的 学历以大专为主（占40. 9%）,职称以师级/助理为主 （占32. 8%）; 乡镇卫生院卫生技术人员的学历以中专为 主 （占51. 3%）,职称以士级为主（占40. 2%）.[结论]新医改后我国基层医疗卫生机构发展迅速,但资源分 布仍不均衡;基层卫生技术人员数量不断增加,但学历职称层次仍偏低;基层医疗卫生机构卫生服务利用增 加 ,但患者就医仍缺乏有效引导.

Research on the Construction of Pharmacy Organization and the Development of Pharmaceutical Services in China’s Primary Medical and Health Institutions—Based on the Survey of 5 Provinces

Objective To explore the current situation and problems of the pharmacy organization and pharmaceutical services in primary medical and health institutions so as to provide a reference for improving relevant policies.Methods Multi-stage stratified random sampling was used to collect questionnaires from primary medical and health institutions in 5 provinces,and 102 questionnaires were distributed.Then Excel 2016 and IBM SPSS 21.0 software were applied for descriptive statistical analysis,chi-square test and multiple response analysis.Results and Conclusion A total of 92 primary medical and health institutions participated in the survey,and 92 valid questionnaires were recovered.The survey shows that 54.1%of the institutions have established more than 8 pharmaceutical administration regulations.63.5%and 31.8%of the institutions have formulated pharmaceutical administration and pharmacotherapy team charters(or management systems).29.7%of institutions have pharmacy personnel in accordance with relevant regulations.The higher proportion of pharmacy services are prescription review and adjustment,medication guidance,collecting and reporting adverse reactions,medication errors and medication hazard information.Primary medical and health institutions still need to further improve their pharmaceutical administration system,organizational structure,pharmacy professional training and clinical pharmacy service.

Model of Healthcare-Associated Infection Control in Primary Health Care Institutions:A Structural Equation Modeling

The purpose of this study was to construct the model of organization system,managemcnt,training and surveillance in healthcare-associated infection prevention and control(IC)of primary health care institutions and identify its efleet on patient safety and decreasing economic burden by standardizing IC.A cross-sectional survey was conducted with questionnaires.Data were collected from 268 primary health care institutions in Hubei province,China.Hypotheses on the model of IC were analyzed by means of confirmatory factor analysis and structural equation modeling.The results showed that the fit indices of the hypothesized model of IC satisfied recommended levels:root mean square error of approximation(RMSEA)=0.071;comparative fit index(CFI)=0.965;tucker lewis index(TLI)=0.956:weighted root mean square residual(WRMR)=1.014.The model showed that organization system had a direct effect on management(β=0.311.P<0.01),and training(β=0.365,P<0.01).Management and training played an intermediary role that partially promoted organization system impact on surveillance.Results also showed that institutional factors such as the number of physicians、the ninnber of nurses,the designated capacity of beds,the actual number of open beds and surgery trips had positive impacts on management(β=0.050,P<0.01;β=0.181,P<0.01;β-0.111.P<0.01;β=0.064,P<0.01;β=0.084,P=0.04);nd training(β=0.21,P=0.03;β=0.050,P=0.02;β=0.586.P=0.01;0=0.995,P=0.02;β=0.223.P=0.03).In conclusion.the model of organization system,managemcnt,training and surveillancc in IC of primary health care institutions is valuable tor guiding IC practice.

The Acquisition and Utility of the Family Medical History in Primary Care: A Cross-Sectional Study

Background: Acquisition of family medical history (FMH) is emphasized as a part of obtaining a complete medical history, but whether FMH is consistently documented and utilized in primary care, as well as how it can affect patient care in this context, remains unclear. Thus, the objectives of this study were to determine: 1) if FMH is regularly acquired in a representative primary care practice (the Queen’s Family Health Team, QFHT);2) what is included in the FMH obtained;3) what the utility of FMH is with regards to patient management in primary care;and 4) to utilize healthcare practitioners’ perspectives in order to elucidate any findings regarding the acquisition and utility of FMH at the QFHT. Methods: Patients were interviewed in order to obtain their FMH. For each patient, the FMH obtained was compared to the FMH documented in the patient’s record to determine the record’s completeness. Each patient’s FMH was analyzed for significant history of coronary artery disease (CAD), diabetes mellitus type II (DMII), substance abuse (SA) and colorectal cancer (CRC). Participants were patients scheduled for appointments at the QFHT between May and July 2011. Any patient of the QFHT older than 25 years was eligible to participate. Clinical staff of the QFHT completed an online questionnaire to determine healthcare practitioners’ perspectives regarding the acquisition and utility of FMH. Results: 83 patients participated in the study. Participants ranged in age from 25 - 86 years (median: 63 years);69% were female. FMH present in patients’ records was often either incomplete (42% of charts reviewed) or not documented at all (51% of charts reviewed). Knowledge of FMH can affect patient management in primary care for the diseases assessed (CAD, DMII, SA and CRC). HCP do consider FMH to be important in clinical practice and 86% of respondents stated that they regularly inquired about patients’ FMH. Interpretation: Despite the belief by HCP that FMH is important, there is a disparity between this belief and their practices regarding its documentation and utilization. Finally, analysis of the FMH of the representative population studied shows that information commonly missing in patients’ FMH can affect patient management at a primary care level.

Contributions of Primary Health Care and Next Step Considerations: A Systematic Review

The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random etiologies to lifestyle, race, and environmental factors. The aim behind these changes is to serve the public health requirements by delivering frequent and easy services based on the individual, couple, or family. Accurate evaluation of the magnitude by which primary health care contributes to the health care system is essential to the improvement of these contributions and determining next step considerations. The number one factor has been associated with greater access to medical care, better health outcomes, and reduced hospitalization and ER (emergency room) visits. The number one consideration may also help balance the adverse effects of poor financial situations on well-being. Therefore, we need more primary care doctors in the US. Research is also necessary to understand which essential consideration models provide acceptable health results.

Health Training Needs at Primary Care Level Health Facilities in Rural Western Uganda

Introduction: Continual education is recognized worldwide as a tool for the professional development of health care practitioners. It is however effective when the training targets the appropriate needs of the target beneficiaries. This study was therefore aimed at identifying priority training needs of Primary Care Level health professionals in rural Western Uganda. Methods: This was a descriptive cross-sectional survey among 35 rural community health facilities represented by their managers in rural Western Uganda. Participants were invited to Mbarara University of Science and Technology and responded to a self-administered questionnaire and also participated in qualitative group discussions guided by Facilitators from the Community Based Education and Research Services unit within the Community Health Department of Mbarara University of Science and Technology. Priority health training needs were determined based on the computed weighted scores. Results: The majority of managers of rural primary care level health facilities were medical officers by the level of training (51.43%) and male by gender (68.57%). Priority health training needs identified were child health and maternal health with total weighted scores of 12.0 and 10.9 respectively. Qualitatively, emerging themes included;leadership and management, and supervisory roles during student field attachments. Conclusion: Priority health training needs at rural Primary Care level health facilities were child health, maternal health, leadership and management, and supervisory skills. There is dire need to train rural primary care level, health professionals. In-service training based on identified needs should be offered by MUST in partnership with regional stakeholders. This is likely to enhance the quality of services provided by rural primary care level health facilities.

Association between availability of glucose-lowering drugs in primary health institutions and diabetes patients’medication adherence:a cross-sectional study in Shandong Province,China

Background:Primary health care system is a critical component of diabetes care and management.This article aimed to analyze the availability of glucose-lowering drugs in primary health institutions(PHIs)in China,and to explore the relationship between availability of glucose-lowering drugs and medication adherence among type 2 diabetes mellitus(T2DM)patients.Methods:This cross-sectional study conducted in Shandong Province,eastern China(hereafter referred to as Shandong),between August and December 2017.In total,2520 community-managed T2DM patients were selected from 68 PHIs in Shandong,including 62 village-level and 6 township-level PHIs.The self-developed questionnaire was used to survey the availability of glucose-lowering drugs in PHIs.Patients’medication adherence was assessed by four self-reported questions,and was classified as either adherent or non-adherent.Descriptive statistics was used to analyze the availability of glucose-lowering drugs in PHIs and the medication adherence among the T2DM patients.Multilevel logistic regression models were used to explore the relationship between the availability of glucose-lowering drugs in PHIs and patients’medication adherence.Results:A total of 1866 T2DM patients prescribed with at least one glucose-lowering drug were included in analysis.Among them,58.5%patients followed their antidiabetic treatment well.In village-level PHIs,the patient’s adherence rate was lower than in township-level PHIs(55.9%vs.61.1%,P<0.05).Among the 68 PHIs,average(2.53±0.97)glucose-lowering products(generic names)were available,which in village-level PHIs were less than in township-level PHIs(2.47 vs.3.17,P<0.05).And the number of available glucose-lowering products in PHIs was associated with the adherence of T2DM patients.Conclusion:Poor availability of glucose-lowering products was found in PHIs in Shandong.The availability of glucose-lowering products in PHIs was positively associated with patients’medication adherence,and could be enhanced to improve the control of diabetes in primary care settings.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Dissatisfaction with the Health Service and Non-Adherence to Antihypertensive Medication Treatment in Brazil

Purpose: Possibly the dissatisfaction with health services influences the non-adherence to medication treatment process. However, such association needs further investigation to extrapolate its results to different groups, for instance, those using only public health services. The aim of the study was to investigate the association between dissatisfaction with the public health service and non-adherence to antihypertensive pharmacotherapy. Methods: Cross-sectional descriptive study. 392 patients with hypertension participated;these were undergoing outpatient treatment at Primary Health Care, in a city of Brazil. Data collection occurred between December 2011 and March 2012 through home visits with the application of semi-structured questionnaire. Results: The majority of the interviewed were satisfied with the care received. However, it was found that there was association between non-adherence to pharmacotherapy and dissatisfaction with the reception service, scheduling appointment, care received from the health team, solvability of health problems, group activities, and physician professional. Conclusion: When health professionals do not aim for a service of quality that promotes user’s satisfaction with the health service, it cannot reach good levels of adherence to therapy.

基于SERVQUAL模型的基层医疗卫生服务质量评价研究

目的:在县域医共体的建设背景下,评价社区卫生服务中心服务质量及影响因素,提出基层医疗卫生服务质量改善对策。方法:运用SERVQUAL模型,从社区卫生服务中心服务质量的有形性、可靠性、响应性、信任性、移情性方面,形成问卷条目;通过多因素二分类logistic回归探索筛查服务质量差距的影响因素;借助IPA象限图呈现居民对社区卫生服务中心的SERVQUAL模型各维度服务质量重要性的分布情况。结果:问卷各项条目的服务质量差距均为负值,服务保证性和移情性维度的服务质量差距得分最高,分别为-0.47±0.59分和-0.47±0.65分;服务有形性维度的服务质量差距得分最低,为-0.40±0.55分。年龄、收入情况和慢病年限是服务质量差距的影响因素。结论:当前基层医疗卫生服务质量与居民的期望之间存在一定差距,基层医疗卫生服务机构应重视对低年龄、高收入和慢病病程较长的居民的服务需求。

基层医疗卫生机构以健康价值为导向的运行成就与效能研究

目的:分析健康价值导向下基层医疗卫生服务绩效评价指标体系的应用效果,评估基层医疗卫生机构以健康为中心的运营成就与效能。方法:选取杭州市X地区和台州市Y地区6家基层医疗卫生机构作为调查对象,采用综合指数法和数据包络分析测算基层医疗卫生机构健康产出的运行效能。结果:样本地区基层医疗卫生机构以健康价值为导向的整体运行成就平均得分为70.01分、整体运行效能为0.794,66.67%的基层医疗卫生机构存在着不同程度的医疗和预防资源投入冗余与健康产出不足。结论:基层医疗卫生机构以健康价值为导向的整体运行成就仍有较大提升空间,应增强基层健康管理能力,提升内在运行过程效能,实现健康产出效益最大化。

中医馆健康信息平台应用现状与思考

本文基于中医馆健康信息平台应用现场调研和问卷调研结果,发现中医馆健康信息平台推广应用过程中存在后续经费投入不足、与医院信息系统对接困难等一系列问题。笔者基于调研结果,就如何更好地推广应用中医馆健康信息平台提出相关建议,以期更有效地提升基层中医馆信息化水平和诊疗能力。

2005-2021年我国卫生人力资源发展趋势及公平性分析

背景“健康中国2030”战略对卫生人力资源配置提出了更高需求,国内开展了较多地区卫生人力资源公平性的评价研究,但尚无从全国视角对我国多种医疗机构、多类别卫生人力资源进行的概述。目的对2005—2021年全国31省(自治区、直辖市)12类医疗卫生机构、5类卫生人力资源进行趋势描述和公平性分析,为未来各卫生机构人力资源配置优化提供参考。方法全国卫生人力资源数据来自《中国卫生统计年鉴(2006—2012)》《中国卫生和计划生育统计年鉴(2013—2017)》《中国卫生健康统计年鉴(2018—2022)》,人口数据和经济数据来自《中国统计年鉴(2006—2022)》。计算2005—2021年各省(自治区、直辖市)各类医疗卫生机构、各类卫生人力资源的人均占有量,计算年均增长率和集中指数(CI)以描述发展趋势,并根据经济发展水平进行公平性分析。结果2005—2021年,我国卫生人员总量持续上升,年均增长率为5.58%,农村地区增长较快,年均增长率达10.87%。在各类医疗卫生机构中,社区卫生服务中心(站)的卫生人员数增速最快(年均增长率达18.05%),卫生监督所(中心)的人员数增速较低(年均增长率为0.18%),疾病预防控制中心的卫生人员数总体呈下降趋势(年均增长率为-0.39%)。除社区卫生服务中心(站)外,各类医疗机构卫生人员总数的CI<0.20。结论我国各类医疗卫生机构人力资源人均占有量在农村地区增长较快,地区间人均资源分配的公平性尚佳,但总量不足,重要机构和人员类别需要注意。要继续加强农村卫生人力资源的投入,国家和各省(自治区、直辖市)要稳定公共卫生队伍,健全基层医疗卫生服务发展,提高公平性与可及性。

基于公办与民办差异视角的养老机构医养结合服务质量评价研究

背景近几年,关于我国医养结合服务模式、影响因素等的研究报道较多,但关于养老机构医养结合服务质量的研究报道较少,且缺乏对不同类型养老机构医养结合服务质量差异的比较研究。目的评价公办与民办养老机构医养结合服务质量。方法2020年10月—2021年9月,采用分层随机抽样方法在内蒙古自治区包头市、陕西省西安市、湖北省宜昌市、浙江省绍兴市共4个地区进行问卷调查,共选取25家养老机构老年人1106名。通过SERVQUAL模型构建包含可靠性、及时性、保障性、规范性、移情性5个维度和15项二级指标的医养结合服务质量评价指标体系,结合熵权法与模糊综合评价法分别计算公办、民办养老机构医养结合服务质量评分并进行比较。结果公办、民办养老机构老年人对医养结合服务质量满意度综合评价值分别为41.66、38.82分,其中公办养老机构15项二级指标评分均在40.00分以上,民办养老机构13项二级指标评分在40.00分以下。结论公办与民办养老机构老年人对医养结合服务质量满意度综合评价结果存在一定差异,其中规范性、移情性维度评分差异较大,可靠性、及时性、保障性维度评分差异较小,这为发现不同维度下医养结合服务存在的问题、促进养老机构医养结合服务高质量提供了参考。

社区导向的医防融合:理论基础和当代实施路径探析

本篇评论阐明了我国基层医疗卫生体系相对于国际初级卫生保健体系的两个独特特点:更狭窄的患者人群和业务范围,以及更薄弱的基本医疗能力。以此为基础,文章总结和对比了20世纪的两种最具代表性的,且在全球产生了广泛影响的两种与医防融合关系极为密切的整合基本医疗服务中的临床和公共卫生部分的理论-实践模式:“社区导向的基本医疗”模式和“赤脚医生”模式。在此基础上,本文进一步结合于2023年第四季度在上海市基层医疗卫生体系中观察到的多项实际案例,阐述了未来在我国的基层医疗卫生机构中,转化和实施这两种医防融合模式的可行路径和对外部条件的需求,并提出了在不同地区实施上述模式的原则性建议。

家庭医生签约服务背景下签约居民基层首诊效果评价研究

背景2016年全面推行家庭医生签约服务以来,居民基层首诊意愿逐步提升,但签约居民基层首诊效果评价尚需进一步探讨。目的了解签约居民的首诊性评价现状,探讨其影响因素并提出改善策略。方法采用多阶段分层随机抽样法在山东省三市抽取54所社区卫生服务机构/乡镇卫生院,共4000名签约居民。采用汉化版基本医疗质量评估量表(PCAT)的首诊性维度问卷进行调查,比较不同特征的签约居民首诊性维度得分,采用多元线性回归分析影响签约居民首诊性评价的因素。结果共回收有效问卷3859份,问卷有效回收率为96.48%。其中,乡镇卫生院签约居民为2086名(54.1%),社区卫生服务中心为1773名(45.9%);三个地区的首诊性维度总得分为3.49分,得分最高的条目是“您的签约机构周六、周日开门吗”(3.74分);得分最低的条目是“在非营业期间,如果您在晚上生病了,您的签约机构会有医生或护士出诊吗?”(3.05分)。多元线性回归分析结果显示,签约机构、个人月收入、文化程度、婚姻状况、职业、身体健康、是否确诊慢性疾病是签约居民首诊性维度得分的影响因素(P<0.05)。结论签约居民的首诊性评价较好,但还需加强家庭医生签约服务政策宣传,引导签约居民形成基层首诊的就医观念,通过明确非工作日出诊流程、提升基层医疗卫生机构服务供给能力、加强医疗卫生机构共享平台建设、发挥医疗保障制度杠杆作用等措施推动居民基层首诊,进而提升签约居民首诊性评价。

后疫情时代我国基层医疗卫生服务发展现状、挑战及建议

基层医疗机构是我国医疗卫生服务体系的主力军,是国家卫生保健系统的基石。在COVID-19疫情期间,我国基层医疗机构发挥了巨大作用,但同时也凸显出许多短板。本文通过系统文献检索与分析,发现我国基层医疗机构存在患者就医需求不高、卫生系统整合性不强、服务基础薄弱、突发公共卫生事件应急能力不足等问题,据此提出基于“三力理论”的基层医疗机构建设策略,以期为完善基层医疗卫生服务体系、提升基层医疗卫生服务能力、更好地完成“健康中国2030”战略目标提供参考。

基层医疗机构在创伤救治体系中的定位与思考

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