In August 2011,the Sangzhi County government,Hunan Province,adopted a series of new health care policies as a national pilot of the New Cooperative Medical Scheme(referred to as 2011 NCMS).These policies were designed...In August 2011,the Sangzhi County government,Hunan Province,adopted a series of new health care policies as a national pilot of the New Cooperative Medical Scheme(referred to as 2011 NCMS).These policies were designed to further resolve illness-led poverty and the poor state of health care in the local area.The program had a positive impact and spread to other regions in Hunan Province.This paper will discuss the progress made as a result of the policies and several issues that challenge the scheme in practice.A total sample of 1212 individuals and 303 households were included in the analysis,and98 interviews were conducted with people related to the scheme.Our major findings indicate that the 201!NCMS has significantly reduced the out-of-pocket medical payment of rural residents,and also increased the township hospitals'patient flow.However,the medical scheme still faces many challenging issues during the implementation.With the increasing interest among the Chinese policy makers in strengthening and promoting the Sangzhi Model,the impacts of the scheme deserve greater attention in practice so as to further improve NCMS in rural China.展开更多
目的分析单中心维持性血液透析(maintenance hemodialysis,MHD)患者在不同药物治疗模式下矿物质和骨代谢异常(mineral and bone disorder,MBD)的生化指标、临床事件及相关药品使用费用情况,探讨透析患者MBD优化治疗管理方案。方法根据...目的分析单中心维持性血液透析(maintenance hemodialysis,MHD)患者在不同药物治疗模式下矿物质和骨代谢异常(mineral and bone disorder,MBD)的生化指标、临床事件及相关药品使用费用情况,探讨透析患者MBD优化治疗管理方案。方法根据北京医院血液透析中心不同时期MBD相关药物使用情况,纳入相应时间段的MHD患者。选取2017年1月1—31日151例患者为传统药物按需治疗组,2019年1月1—31日151例患者为新型药物受限治疗组,2020年1月1—31日153例患者为新型药物按需治疗组。3组患者均随访1年,比较3组生化指标、骨痛、临床事件和药品使用费用的情况。结果传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组患者性别、年龄、透析龄和合并糖尿病的比例比较,差异均无统计学意义(P>0.05)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组血钙水平[2.30(2.15,2.43)mmol/L、2.20(2.11,2.34)mmol/L和2.21(2.12,2.30)mmol/L]比较,差异有统计学意义(P<0.001),按照K/DOQI标准的达标率分别为49.0%、57.6%和65.4%,组间比较差异有统计学意义(P=0.016);血磷水平[(1.74±0.51)mmol/L、(1.76±0.50)mmol/L和(1.65±0.44)mmol/L]比较,差异无统计学意义(P=0.081),按照K/DOQI标准的达标率分别为45.0%、43.7%和58.8%,差异有统计学意义(P=0.014);钙磷乘积[49.25(40.13,58.46)、47.42(38.59,55.95)和43.44(35.41,52.62)]比较,差异有统计学意义(P=0.024)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺激素(parathyroid hormone,PTH)水平比较,差异无统计学意义(P=0.465),按照K/DOQI标准PTH达标率分别为24.5%、35.8%和36.6%,按照KDIGO标准PTH达标率分别为51.0%、60.3%和66.0%,组间比较差异均有统计学意义(P=0.042和P=0.048)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组分别有109例(72.2%)、101例(66.9%)和87例(56.9%)患者使用含钙的磷结合剂,有0例(0.0%)、76例(50.3%)和87例(56.9%)患者使用不含钙的磷结合剂,有0例(0.0%)、35例(23.2%)和47例(30.7%)患者使用拟钙剂,差异均有统计学意义(P<0.05)。随访期内3组骨折和心脑血管事件发生率比较,差异均无统计学意义(P=0.703和P=0.889),传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺切除手术分别有2、0和0例次。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组CKD-MBD治疗相关药物月均费用分别为100.2(11.1,322.9)元、361.6(50.1,866.9)元和633.3(121.5,1323.4)元,组间比较差异有统计学意义(P<0.001)。结论新型药物按需治疗模式能明显提高MHD患者MBD生化指标的达标率,减少甲状旁腺切除手术需求,但增加了MBD相关治疗药物的费用。展开更多
目的比较腹膜透析(peritoneal dialysis,PD)患者和血液透析(hemodialysis,HD)患者的静息能量消耗(resting energy expenditure,REE)的差异。方法选取北京市2家三级医院临床稳定的105例PD和35例HD患者,进行REE测定。结果本研究纳入患者...目的比较腹膜透析(peritoneal dialysis,PD)患者和血液透析(hemodialysis,HD)患者的静息能量消耗(resting energy expenditure,REE)的差异。方法选取北京市2家三级医院临床稳定的105例PD和35例HD患者,进行REE测定。结果本研究纳入患者的平均年龄(52.5±11.9)岁,平均体质量(68.6±15.1)kg,其中男性86例(57.7%),糖尿病61例(43.6%)。HD患者和PD患者REE水平没有显著性差异(r=1.731,P=0.086)。HD和PD患者的REE均与身高(r=0.399、0.574,P=0.018、<0.001)、体质量(r=0.756、0.730,均P<0.001)、性别(男性:r=0.481、0.582,P=0.003、<0.001)、握力(r=0.584、0.551,P<0.001)和瘦体质量(r=0.674、0.677,均P<0.001)呈正相关,与年龄(r=-0.432、-0.254,P=0.010、0.009)、透析龄(r=-0.356、-0.289,P=0.036、0.003)和透析充分性(Kt/V)(r=-0.786、-0.326,P<0.001、0.002)呈负相关。结论年龄、性别、体质量和是否糖尿病相当的HD和PD患者,REE水平无显著差异。展开更多
文摘In August 2011,the Sangzhi County government,Hunan Province,adopted a series of new health care policies as a national pilot of the New Cooperative Medical Scheme(referred to as 2011 NCMS).These policies were designed to further resolve illness-led poverty and the poor state of health care in the local area.The program had a positive impact and spread to other regions in Hunan Province.This paper will discuss the progress made as a result of the policies and several issues that challenge the scheme in practice.A total sample of 1212 individuals and 303 households were included in the analysis,and98 interviews were conducted with people related to the scheme.Our major findings indicate that the 201!NCMS has significantly reduced the out-of-pocket medical payment of rural residents,and also increased the township hospitals'patient flow.However,the medical scheme still faces many challenging issues during the implementation.With the increasing interest among the Chinese policy makers in strengthening and promoting the Sangzhi Model,the impacts of the scheme deserve greater attention in practice so as to further improve NCMS in rural China.
文摘目的分析单中心维持性血液透析(maintenance hemodialysis,MHD)患者在不同药物治疗模式下矿物质和骨代谢异常(mineral and bone disorder,MBD)的生化指标、临床事件及相关药品使用费用情况,探讨透析患者MBD优化治疗管理方案。方法根据北京医院血液透析中心不同时期MBD相关药物使用情况,纳入相应时间段的MHD患者。选取2017年1月1—31日151例患者为传统药物按需治疗组,2019年1月1—31日151例患者为新型药物受限治疗组,2020年1月1—31日153例患者为新型药物按需治疗组。3组患者均随访1年,比较3组生化指标、骨痛、临床事件和药品使用费用的情况。结果传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组患者性别、年龄、透析龄和合并糖尿病的比例比较,差异均无统计学意义(P>0.05)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组血钙水平[2.30(2.15,2.43)mmol/L、2.20(2.11,2.34)mmol/L和2.21(2.12,2.30)mmol/L]比较,差异有统计学意义(P<0.001),按照K/DOQI标准的达标率分别为49.0%、57.6%和65.4%,组间比较差异有统计学意义(P=0.016);血磷水平[(1.74±0.51)mmol/L、(1.76±0.50)mmol/L和(1.65±0.44)mmol/L]比较,差异无统计学意义(P=0.081),按照K/DOQI标准的达标率分别为45.0%、43.7%和58.8%,差异有统计学意义(P=0.014);钙磷乘积[49.25(40.13,58.46)、47.42(38.59,55.95)和43.44(35.41,52.62)]比较,差异有统计学意义(P=0.024)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺激素(parathyroid hormone,PTH)水平比较,差异无统计学意义(P=0.465),按照K/DOQI标准PTH达标率分别为24.5%、35.8%和36.6%,按照KDIGO标准PTH达标率分别为51.0%、60.3%和66.0%,组间比较差异均有统计学意义(P=0.042和P=0.048)。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组分别有109例(72.2%)、101例(66.9%)和87例(56.9%)患者使用含钙的磷结合剂,有0例(0.0%)、76例(50.3%)和87例(56.9%)患者使用不含钙的磷结合剂,有0例(0.0%)、35例(23.2%)和47例(30.7%)患者使用拟钙剂,差异均有统计学意义(P<0.05)。随访期内3组骨折和心脑血管事件发生率比较,差异均无统计学意义(P=0.703和P=0.889),传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组甲状旁腺切除手术分别有2、0和0例次。传统药物按需治疗组、新型药物受限治疗组和新型药物按需治疗组CKD-MBD治疗相关药物月均费用分别为100.2(11.1,322.9)元、361.6(50.1,866.9)元和633.3(121.5,1323.4)元,组间比较差异有统计学意义(P<0.001)。结论新型药物按需治疗模式能明显提高MHD患者MBD生化指标的达标率,减少甲状旁腺切除手术需求,但增加了MBD相关治疗药物的费用。
文摘目的比较腹膜透析(peritoneal dialysis,PD)患者和血液透析(hemodialysis,HD)患者的静息能量消耗(resting energy expenditure,REE)的差异。方法选取北京市2家三级医院临床稳定的105例PD和35例HD患者,进行REE测定。结果本研究纳入患者的平均年龄(52.5±11.9)岁,平均体质量(68.6±15.1)kg,其中男性86例(57.7%),糖尿病61例(43.6%)。HD患者和PD患者REE水平没有显著性差异(r=1.731,P=0.086)。HD和PD患者的REE均与身高(r=0.399、0.574,P=0.018、<0.001)、体质量(r=0.756、0.730,均P<0.001)、性别(男性:r=0.481、0.582,P=0.003、<0.001)、握力(r=0.584、0.551,P<0.001)和瘦体质量(r=0.674、0.677,均P<0.001)呈正相关,与年龄(r=-0.432、-0.254,P=0.010、0.009)、透析龄(r=-0.356、-0.289,P=0.036、0.003)和透析充分性(Kt/V)(r=-0.786、-0.326,P<0.001、0.002)呈负相关。结论年龄、性别、体质量和是否糖尿病相当的HD和PD患者,REE水平无显著差异。
