Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System:A Cross-sectional Study in Nanjing,China

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service（CHS） under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor‐patient relationships, information and support, organization of care, and accessibility（P 〈 0.001）. One or more factors such as gender and self‐perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients＇ satisfaction with CHS by strengthening their awareness of the gatekeeper policy.

Analysis of Inpatient Bed Allocation Equity and Utilization in the City Community Health Service Center of China

The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.

Quantitative Analysis on Economic Contribution of Community Health Service in China

In China, the implementation of community health service shows that the prevention is an essential and important part of our national health system and is helpful to decrease the medical expenditure gradually. According to the data from Health Statistic Information Center of Ministry of Health in China, we calculated that the total health expenditure of China would be decreased 8000.0 million yuan only in 2001, among which, 1188.3 million, 1953.9 million and 4833.0 million yuan were respectively saved for the government budget, the society and resident if implementing the policy of community health service powerfully. And every outpatient can save 15.46 yuan per time. By the quantitative analysis on the economic contribution of community health service, it can be proved that a great economic benefit could be gotten from the implementation of community health service.

Research progress on the health status and community management service needs of mobile elderly people

The health status of the floating elderly population and the need of community management ser-vices are complex and important problems.Owing to the change of living environment and the insecure medical care,the mobile elderly people have more health and psy-chological problems compared to the rest of the elderly population.Therefore,the community should take a va-riety of measures to meet their needs and help them to better adapt to the new living environment,and maintain their physical and mental health.This paper aims to sum-marize recent studies on the physical and emotional health problems of mobile elderly people and related community management service needs.

The Role of Library and Information Science Education in the Development of Community Health Information Services for People Living with HIV/AIDS: Perspectives of Directors and Managers of Public Libraries

This article identifies the role of library and information science (LIS) education in the development of community health information services for people living with HIV/AIDS (PLWHA). Preliminary findings are presented from semi- structured qualitative interviews that were conducted with eleven directors and managers of local branches in the Knox County Public Library (KCPL) System that is located in the East Tennessee region in the United States. Select feedback reported by research participants is summarized in the article about strategies in LIS education that can help local public librarians and others in their efforts to become more responsive information providers to PLWHA. Research findings help better understand the issues and concerns regarding the development of digital and non-digital health information services for PLWHA in local public library institutions.

The Management of Mental Health, and Service Networks in Italy

Madness has attracted and frightened for centuries,and talking about this means discussing how this diversity was built and managed in different social contexts and historical periods.Not all societies have had,and still have,the same relationship with madness.It is only with the affirmation of the Modern State,and of Capitalism,that the idea of“normality”indispensable to be able to conceive diversity as something dangerously distant and different from the norm takes over.In our post-modern society,people with mental illness in Italy can resort to specialists and social-health services.But the heterogeneous answers given after the approval of law 180 appear to be increasingly diversified.In this research,much attention will be paid to how the social and health services,located in different areas of Italy(Messina,Rome,Trento)face the current growing risk of social,housing and economic isolation of these fragile subjects.The aim of the research is to explore the possibility of a new relationship between the social-health service and the local community.On the one hand,research investigates what the contribution of the services could be.On the other what the spaces of protagonism and participation of the community could be in inclusion process account.In order to better understand the differences between these two dimensions,a qualitative research approach was chosen through the conduct of in-depth interviews.In this way it was possible to investigate:(1)the partial representations characteristic of the single individual,family members,operators and stackholders in general;(2)the services around the topic dealt with is articulated.From the first results of the research it emerges that the territory can no longer be considered as an abstract entity,but becomes the social space within which the construction of a new community welfare can and must take place.

Comprehensive reform of community health service in east,middle and west regions of China:from patients’perspective

Objectives:To analyze the satisfaction of patients with community health service(CHS)and the changes of the CHS delivered before and after the new health reform in different regions of China,and to put forward relevant policy recommendations for CHS development.Methods:Twelve community health centers were selected by random sampling in each of the eight typical cities in the east,middle and west regions of China.Questionnaire survey was conducted among patients visiting these institutions during daily work hours.Results:The proportions of the participants who stated that the medical environment,service attitude and medical skills of the doctors were improved were higher in the west region than those of the east and middle regions;but the percentage of patients who held that the drug price had lowered was higher in the east region than those of the middle and west region,the differences were of statistical significance(P<0.0125).The patients’satisfaction rates with medical environment,service attitude,and technical skills of the medical staff in the west region were 88.9%,91.5%and 81.6%respectively,which were higher than those in the east and middle regions.In the east region,the satisfaction rate with the reimbursement for this visit was 58.5%,which was highest among the three regions;in the west region,patients’satisfaction rates with drug types and preventive care were 51.5%and 65.9%,respectively,which was significantly higher than those in the east and middle regions(P<0.0125).As recommended by the participants,the top three aspects of health services that need to be improved were drug type and quality(25.3%),drug prices(21.8%)and technical skills(18.2%)in the east region;infrastructure(28.2%),drug prices(21.8%)and drug types and quality(21.2%)in the middle region;infrastructure(30.8%),drug types and quality(28.1%)and reimbursement(27.9%)in the west region.Conclusions:The comprehensive CHS reform should take the opinions of patients into account;essential drug system should be consolidated continually;and the reform of the payment system should be promoted by actively cooperating with the health insurance organizations.

Development of community health service-oriented computer-assisted information system for diagnosis and treatment of respiratory diseases

Objective:Community health services are an emerging trend.We have found in practice that diagnosis and treatment of respiratory diseases in the community are distinct.The respiratory department’s daily work involves a number of outpatient registration items and a vast workload.The routine manual operation is inefficient and it is not convenient to make effective statistical analysis of the outpatient data to identify the risk factors closely related to diseases.Therefore,it is imperative to process the outpatient information of patients with respiratory diseases effectively and efficiently in a unified manner by means of computer technology.Methods:The design and realization of the Community Health Service-oriented computerassisted Information System for Diagnosis and Treatment of Respiratory Diseases(CHS-DTRD)was completed as part of the community intervention study on bronchial asthma that was carried out jointly by the Nanjing First Hospital Affiliated to Nanjing Medical University and the Hospital of Nanjing University of Science&Technology,and based on 2 years of experience and the needs of an overall analysis.Results:The computer-assisted information system for diagnosis and treatment was developed using Java Server Page(JSP)technology and introducing the advanced Asynchronous JavaScript XML(AJAX)technique and MS-SQL Server was used in the background database.CHS-DTRD was composed of eight functional modules(outpatient data maintenance,outpatient appointment,intelligent analysis for disease risk factors,query and statistics,data dictionary maintenance,database manipulation,access control,and system configuration).CHS-DTRD featured a friendly interface,convenient operation,and stability and reliability.Conclusion:Community health-oriented diagnosis and treatment of respiratory diseases is simple,programmable,and intuitive,thus the workload of physicians is significantly reduced and the work efficiency is improved.This system facilitates an intelligent analysis of disease risk factors using data mining technology,and provides physicians with suggestions on intelligent analysis for diagnosis of disease and conclusion of disease causes.

The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective:This study focuses on Hangzhou,a Chinese city with a population of nine million urban and rural residents,to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then dis-seminate the findings through international third parties.Methods:Measures such as data analysis,study of documents and regulations,fieldwork,and expert discussions were used to systematically investigate primary health care in Hangzhou.The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.Results:Community health services in Hangzhou are characterized as follows:They are gov-ernment led;they are guaranteed with enough financing,personnel,facilities,and regulation;sup-ported by the unified information platform;general practitioners have been assigned the key role of health‘gatekeepers’;they provide primary care combined with basic public health services;there are integrated urban and rural health services and insurance coverage;and there is health care-pen-sion-nursing integration and general practitioner-contracted‘smart’services.Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole,and some health indicators in Hangzhou are comparable to those in Western developed countries.Conclusion:It is reasonable to believe that the primary health care level in China,including Hangzhou,will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

Performance evaluation indicator system for the implementation of essential drug system in community health service institutions

Objective:This research aims to develop a more scientific and reasonable performance evaluation indicator system for the implementation of an essential drug system in community health service institutions.Methods:The Delphi method was used to establish an indicator system based on three rounds of expert consultations,and the fuzzy comprehensive evaluation method was used to determine the weights of the indicators.Results:The participation in the three rounds of consultations were 100%(10/10),90%(18/20),and 85%(17/20),which showed that the experts had real enthusiasm for participating in this research.The authority coefficients of the first-,second-,and third-level indicators were 0.75,0.76,and 0.76,respectively,which showed that the consultation results were dependable.The concordance coefficients of the second and third rounds were 0.489 and 0.487,respectively(P<0.001),indicating that the expert opinions were highly consistent.The performance evaluation indicator system consisted of three first-level indicators(supporting,implementation,and effect indicators),nine second-level indicators,and 21 third-level indicators.Conclusion:In this new performance evaluation indicator system,the selected experts were representative,the consultation results were dependable,the constructed evaluation indicator system was reasonable,and the setting of weights was scientific.

The Quality of Service Community Health Center in Taiwan

The purpose of this study is to use the model of service quality concepts to evaluate the service qualities of"community health centers"in order to find out the service quality gaps and thus reinforce the competitive edge.This study took Datong District Health Centre in Taipei city as the research object and performed a questionnaire survey with internal and external customers.In terms of internal customers(service staff),50 employees participated and a total number of 50 effective questionnaires were returned.In terms of external customers,convenience sampling was adopted to collect the questionnaires,679 answered questionnaires were returned,effective copies being 667.The research tool was the questionnaire that was designed mainly on the basis of SERVQUAL(the scale of service quality determinants)and with reference to the practical data of service process during its implementation at subject service departments.The findings included the conclusions such as"there exists significant effect between service quality and customer satisfaction","the biggest difference among service qualities is service performance gap(GAP3),showing that there is still a room for improvement regarding the service provided at the health centre"and"different demographic variables have significant effects on customer satisfactions,e.g.higher age groups,lower education level and jobless people have lower satisfaction on the service received".The research result can be provided to relevant organisations as a reference for improvement.

Efficiency of community health service in urban and suburban areas of Shanghai:based on production function

Objective:To analyze the efficiency of community health service in urban and suburban areas of Shanghai.Methods:Fifty community health centers in Shanghai that registered to create“National Demonstration Community Health Center”in 2013 were included in our study.The service efficiency was analyzed with the methods of econometrics based on Cobb-Douglas production function.Results:Two production functions were formulated for urban community health services and those in suburban areas;the equation for urban areas was:lnY=7.778+0.450lnL+0.350lnK+μ;and the equation for suburban areas was:lnY=6.329+0.728lnL+0.350lnK+μ.The results showed that among the inputs,labor had more effect on output than capital did.It also showed that marginal ben-efit of labor was different in urban and suburban areas.Urban community health centers were in the interval of decreasing returns to scale,while suburban community health centers were in the interval of constant returns to scale.Conclusion:Increasing human resource investment is a key factor for increasing community health service output.Due to the difference of scale merit between urban and rural areas,govern-ment or other policy makers should make the development policy for them accordingly.Those com-munity health centers in urban areas should pay more attention to the service efficiency and service innovation.

Types of community health services selected by urban and suburban residents in Nanjing and influencing factors

Objective:The purpose of the current study was to determine the types of community health services selected by urban and suburban residents in Nanjing and the influencing factors in an ef-fort to improve the community health services to better meet the residents’demands.Methods:Between 15 May 2013 and 15 June 2013,eight community health service centers from four districts in Nanjing(Gulou District and Baixia District in urban areas and Jiangning District and Pukou District in suburban areas;two centers from each district)were selected using a stratified random sampling method of investigation sites.After an intercept interview with 487 community residents,univariate and multivariate analyses were performed by means of logistic regression.Results:Among the 487 users of community health services,there were 241 residents from urban areas(49.5%)and 246 residents from suburban areas(50.5%).Among the respondents,there were 191(39.2%)who usually received medical treatment from community health service institutions,including 74(38.7%)from urban areas and 117(61.3%)from suburban areas.The analysis showed that the factors which influenced urban residents in Nanjing to choose community health services for medical treatment included income,payment terms of medical fees,reasonable prices,medical fees,and expenses for medications,while factors influencing suburban residents to choose community health services for medical treatment included income,level of education,carrier,medical institutions selected when feeling severely ill,availability of preventive health services,availability of health counseling services,medical fees,and expenses for medications.Based on an analysis of the results by means of unconditioned binary logistic stepwise regression,the factors influencing whether or not the urban residents chose community health services for medical treatment included gender,age,level of education,payment terms of medical fees,treat-ment environment,and expenses for medications,while the factors influencing suburban residents included availability of preventive health services and expenses for medications.Conclusion:There was a difference between the types of community health services selected by residents in urban and suburban areas of Nanjing and factors influencing the selection of ser-vices were different.Community health service institutions in different areas should strengthen their own service capability according to the local residents’health demands.

Analysis on necessity of community health service development based on limits-to-growth archetype--taking Jiangxi province as an example

Objective:To analyze the necessity of community health service(CHS)development in Jiangxi province based on the current status of healthcare in Jiangxi Province.Method:The study did a systematic survey on the CHS development among health service organizations in Jiangxi province.The data of the survey were analyzed with system archetype analysis of Peter Senge.Results:Through system analysis,four limits-to-growth archetypes were built and analyzed.The obstacles restricting the development of healthcare systems were determined,and some effective countermeasures were proposed accordingly.Conclusion:In order to foster the sustainable development of healthcare in Jiangxi province and alleviate the problem of“difficulty and high cost to access medical services”effectively,the government should place more emphasis on the development of CHS.

An automated management system for the community health service in China

Objective:To explore a useful tool for health administrative departments to manage the com-munity health service(CHS).Methods:On the basis of existing health laws and regulations in China,we describe the design of an automated management system for the CHS with a supervision system and an evaluation system using computer technology and corresponding design software.Results:Four changes to the management of the CHS were made:repetitive work became automated,complicated work became simplified,nonregular services decreased,and obscure in-structions became clear and specific.Conclusion:The automated management system will promote the development of CHS man-agement.

Impact of community strategy package on uptake of reproductive tract infections health services among young street females in the municipality of Eldoret,Kenya

Background:Despite the intervention of free medical care services for street children by a dedicated clinic in Eldoret municipality,health care service of young street females(YSFs)is still deficient.The present study aimed to evaluate the impact of the community strategy package on the uptake of reproductive tract infections(RTI)health services among the target population.Materials and methods:A pre-test-post-test quasi-experimental with a qualitative and quantitative approach was applied among the YSFs aged 10-24 years.The study used structured questionnaires and key informant interviews to collect data from the respondents.Results:The study enrolled a total of 77 young street females in Eldoret municipality.A significantly higher proportion of respondents reportedly first sought treatment for RTI at a health facility after the implementation of the community strategy package(97.1%)when compared to the proportion of respondents who first sought treatment at a health facility in the pre-intervention phase(51.0%)(p<0.001).Early seeking of treatment improved significantly after the introduction of the intervention;72.0%and 94.1%of the respondents sought treatment early during the pre-intervention and post-intervention phase,respectively(p<0.011).Conclusion:The study recommends the adoption of the community strategy as an intervention to increase the uptake of RTIs health services and promotion of the reproductive health of young street females.

The current status of community mental health services in three northern areas of China

Objective:This study investigated and discussed the current status of community mental health service in three northern areas of China(Beijing,Harbin,and Karamay)in an effort to improve the community mental health services in China.Methods:In this study 176 residents from communities of the three northern areas of China were involved and divided into 18 groups.The study was conducted according to a self-prepared structured interview outline.Results:The analysis was conducted based on the following four perspectives:1.commu-nity residents’understanding of the mental health problems and how they treated psychiatric patients;2.community residents’access to and application of mental health information;3.com-munity residents’attitude to accept mental health services and the factors influencing community residents to seek help from mental health services;and 4.community residents’attitude and will-ingness to participate in the activities of community mental health services.Conclusion:Based on the investigation and analysis regarding the current status of the com-munity mental health services in three northern areas of China,it is concluded that the residents do not have s clear and complete understanding of mental health.The characteristics of mental health services had a regional correlation.Currently,the mental health services do not work effectively,and the residents are somewhat passive in obtaining information about mental health.Community mental health services should be offered according to different individual needs of the residents and the actual situations of each region.

General medical practice in China:evaluation of urban community health care service functions based on a rough set reduction theory

Objective:This study aims to achieve an empirical evaluation on the functional performances of urban community health care services in fi ve administrative districts of Nanchang city in China.Methods:In order to increase effectiveness,data collected from fi ve administrative districts of Nanchang city were processed to exclude redundant information.Rough set reduction theory was brought in to evaluate the performances of community health care services in these districts through calculating key indices’weighed importance.Results:Comprehensive evaluation showed the score rankings from high to low as Qing-yunpu district,Xihu district,Qingshanhu district,Donghu district,and Wanli district.Conclusion:The objective performance evaluation had actually reflected the general situation(including social-economic status)of community health care services in these administrative districts of Nanchang.Attention and practical works of community health service management were needed to build a more harmonious and uniform community health care service system for residents in these districts of Nanchang.

Service Functions of Private Community Health Stations in China: A Comparison Analysis with Government-sponsored Community Health Stations

In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical care services in urban areas. However, only limited evidence is available con-cerning the service functions of private community health facilities in China. The aim of this study was to explore the functions of private community health stations (PCHSs) to provide evidence-based rec-ommendations for policy-making and practice in the development of urban community health services systems. A total of 818 PCHSs and 4320 government-sponsored community health stations (GCHSs) located in 28 cities of China were investigated in 2008. The percentages of stations that provided health services and the annual workload per community health worker (CHW) were compared between the two types of institutions. The results showed that the percentages of PCHSs providing public health services were significantly higher than those of GCHSs (P<0.05); but no significant differences were found in the percentages of basic medical services providing between PCHSs and GCHSs (P>0.05). The annual workloads of all the public health services and basic medical services per CHW in PCHSs were lighter than those in GCHSs (P<0.05), except for resident health records establishment and health education materials distribution (P>0.05). At present, the GCHSs are still the mainstream in urban China, which will last for a long period in future. However, our findings showed that the annual workloads of CHWs in PCHSs were no heavier than those in GCHSs, and the PCHSs were willing to provide public health services. In view of current inadequacy of health resources in China, it is feasible to further develop PCHSs under the guidance of the government, given that PCHSs can perform the basic functions of community health services, which is useful for the formation of public-private partnerships (PPP) and the improvement of community health services.

Advances in the Health Training Process Quality:Links between Education,Service and Community

This study proposes to discuss the experience lived by Pró-Saúde and PET-Saúde team of FACISA/ UFRN together with the Municipal Health Department of Santa Cruz/RN from a critical-reflexive perspective about the interaction between education, service and community as well as advances in approach and the strengthening between the school and Primary Health Care. This is an exploratory study with an experience report approach of the Pró-Saúde and PET-Saúde team from 2012 to 2014. The integration of these programs in experimental scenarios of the Unified Health System and the strengthening of the proposed training of human resources capable of the current healthcare system were observed. Thus, contributions in health in undergraduate courses and practices of health services are important, since the approach to the reality of the population and their social needs contribute to the vocational training quality.