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.

Interpretation of WHO Guideline:Assessing and Managing Children at Primary Health-care Facilities to Prevent overweight and Obesity in the Context of the Double Burden of Malnutrition

Along with the transitions of social and economic development,dietary patterns and physical activity and life-styles,the prevalence of childhood overweight and obesity has increased at an astonishing rate in the past decades,and has become one of the most serious public health challenges.Meanwhile,the stunting rate has declined with slowly pace,while millions of young lives are still be threatened by wasting all over the word.The present situation of Double Burden of Malnutrition should be recognized clearly and addressed seriously,which refers to,the common presence of both obesity and underweight in the same populations,communities and even families.In order to provide guidance on the appropriate assessment and management of infants and children presenting to primary health-care facilities,to reduce the risk of overweight and obesity among children,the Guideline Assessing and Managing Children at Primary Healthcare Facilities to Prevent Overweight and Obesity in the Context of the Double Burden of Malnutrition was developed and released by WHO in 2017 using the procedures outlined in the WHO handbook for guideline development.The WHO Guideline(2017)is intended primarily for use in low-and medium-resource settings where both under-nutrition and obesity are prevalent.In this guideline,there are three prioritized speci c areas and questions for infants and children presenting to primary health-care facilities:anthropometric assessment,care of infants and children with acute or chronic malnutrition,and care of children who are overweight or obese.It is recommended that for infants and children aged<5 years presenting primary health-care facilities,weight and length/height should be measured and evaluate adequately,general nutrition and physical activity counselling should be provided for related caregivers and families,identi cation and appropriate management plan should be developed at primary health-care level.The discrepancies of the recommendation on the three prioritized areas in di erent guidelines are compared in this paper.All the related guidelines emphasize the important of anthropometric measurement and monitor of growth for primary care workers and suggest dietary and physical activity counselling for obese people.Almost all the guidelines provide recommendations on breastfeeding and continued feeding counselling from the aspect of improving the status of acute or chronic malnutrition.The setting condition should be carefully considered when taking the guidelines of di erent organizations and countries into application.

Examining the Burden Reduction Policy for Primary and Secondary School Teachers in China:A Framework Analysis Centered on the Rational Selection of Institutional Doctrine

The“burden reduction”policy aims to reduce the workload of primary and secondary school teachers to alleviate their burdens.While it has improved the quality of teachers,implementation challenges still exist.This study utilizes rational choice institutionalism and Ostrom’s institutional analysis and development framework to examine the policy.By considering the preferences of the Ministry of Education,local governments,schools,and teachers,it explores interactions and outcomes,identifies challenges,and provides policy suggestions.

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.

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.

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.

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.

SELF-DEVELOPMENT IS THE PRIMARY TARGET IN INTERNA- TIONAL COOPERATION FOR A RESEARCH INSTITUTE

In the current context of reform, "open-door" and the initiation of the socialist market economy,one of the key aspects in our ceaseless exploration and practice is to promote international cooperation and academic exchange with foreign scholars as a supplementary means of our institute’s survival,development and winning against overseas competition.

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。

陕西省基层医疗机构氨酚待因使用情况调查分析

目的调查分析陕西省基层医疗机构氨酚待因使用情况,为促进氨酚待因的规范、合理使用提供证据支持。方法按照整群分层随机抽样的方法,在陕西省全部10个省辖市中随机各选取1个区、1个县(或2个区)的基层医疗机构2020-2023年开具的所有氨酚待因处方,采用国际疾病分类(ICD)编码对现有临床诊断进行归类,对搜集的处方用药信息进行描述性分析,并采用SPSS 25.0软件对数据进行单因素分析和Logistic回归分析,找出影响用药疗程>10 d的关键因素。结果本研究共收集到氨酚待因有效处方7375张。使用氨酚待因的主要以女性(52.11%)、年龄19~64岁(66.73%)的患者为主。基于ICD编码,氨酚待因的使用涉及最多的疾病类别为肌肉骨骼系统或结缔组织疾病或症状、体征(43.48%);排名前3位的临床诊断为关节病(25.59%)、骨折(9.95%)、牙痛(8.58%)。药品用法用量明确的7175张处方中符合氨酚待因说明书推荐的处方有3366张,有5.63%的处方对乙酰氨基酚日使用量超2.0 g/d的极量限制。处方用药疗程超常规限制(7 d)的处方有4051张,超使用疗程限制(10 d)的处方有1336张。影响用药疗程>10 d的因素主要为医疗机构所属区域、类型以及患者性别、年龄,基层医疗机构中的陕南地区、乡镇卫生院以及老年人、女性患者用药疗程>10 d的现象偏多。结论陕西省基层医疗机构氨酚待因的临床应用存在一定的不合理,主要表现在药品用法用量、临床诊断以及用药疗程不适宜;医疗机构所属区域、类型以及患者年龄、性别均会影响该类药品的用药疗程。

我国城市社区医生医疗服务能力现状问题与对策研究

背景:随着新医改的推进,社区卫生服务机构的首诊、双向转诊等分级诊疗措施的开展已成为我国分级诊疗制度落实的重要载体,要实现社区首诊,重点在于社区医生的医疗服务能力建设。目的:通过调查我国城市地区基层医生医疗服务能力现状,探讨提升社区卫生服务机构医疗服务能力的策略。方法:采用多阶段分层抽样和典型抽样相结合的方法,选取我国东中西部城市社区卫生服务机构的2372名医生开展线上问卷调查,使用课题组既往开发的基层医生卫生服务能力体系指标,选取其中医疗服务部分的指标为依据设计问卷调查,了解社区医生对常见病、多发病诊治,危急重症处置,医疗服务协同,社区康复服务以及中医药服务等5个方面的医疗服务综合能力具备情况。结果:共回收问卷2473份,将涉农区的村卫生室和乡村医生从本次调查中剔除101份,实际参与分析问卷为2372份,问卷有效率为95.91%。2372名社区医生中,以本科及以上学历为主,占67.7%(1606名),其次是大专学历,占24.6%(583名)。年龄以30~44岁为主,共1391名占58.6%。有1860名(78.4%)、1686名(71.1%)、1400名(59%)1276名(53.8%)、1330名(56.1%)社区医生具备常见病、多发病诊治,危急重症处置,医疗服务协同,社区康复服务以及中医药服务能力。在医疗服务能力具备率方面,社区医生在医疗服务综合能力方面尤其是危急重症应急处置能力、社区康复服务以及中医药服务等能力具备方面相对薄弱。结论:我国社区医生队伍素质总体水平需进一步提升,常见病、多发病诊治能力具备情况较好,社区医生医疗服务存在短板与不足,各地区应从完善政策和加强培训等方面有针对性地进行“短板”集中“补钙”,使其能承担起社区医疗服务的责任。

河北省基层医疗卫生机构科研水平的现状及科技查新助推对策

基层医疗卫生机构的科研水平作为医学科技创新体系的重要组成部分,其科研水平事关医学科技创新水平的大局。本研究首先对提升基层科研水平的迫切需求进行了阐述,包括“健康中国”规划背景下基层医疗卫生机构的科研水平需要大幅度提升,国家对基层医药服务能力的日益重视对科研管理工作提出了挑战,也对提高基层医疗机构核心竞争力具有重要意义。本文调研了河北省基层医疗卫生机构科研水平的现状,包括科研能力呈明显降低的趋势、申报项目呈明显减少的趋势、中医药学申报项目呈逐渐升高的趋势、民营医疗卫生机构科研能力较弱、不同地区申请项目分布不均。针对上述特点,本文从医学科技查新扶贫专家团队组建、多个基层科研管理交流微信群建立、对中医药学课题验收的指导力度加大、对民营医疗卫生机构科研的扶持力度加大、每个地区专门科研管理人员负责制建立这5个方面进行了探索。

基层疾病预防控制机构复合型人才评价指标体系构建

目的 构建基层疾病预防控制机构复合型人才评价指标体系,为基层疾控机构评价复合型人才提供参考。方法 根据冰山模型理论、德尔菲法和层次分析法,对甄选的专家进行咨询和问卷调查,计算各评价指标的权重并排序,建立基层疾控机构复合型人才评价指标体系。结果 共进行两轮专家咨询,协调系数分别为0.633和0.743,建立7个一级指标、17个二级指标在内的基层疾控机构复合型人才评价指标体系,符合一致性检验要求。一级指标分别为人员基本情况、学识水平、专业知识与技能、学习与创新能力、组织力与执行力、沟通协作能力、抗压能力与特殊成就,权重分别为0.083 01、0.089 03、0.093 79、0.125 30、0.223 08、0.205 30和0.180 49。其中二级指标位列前3位为处理疫情及重大事件能力、团队意识及协作能力、现任岗位工作能力。结论 基层疾控机构复合型人才评价工作中评价权重应向组织力与执行力指标倾斜,沟通协作能力指标也应给予重视;研究指标具有一定的科学性和实用性,为基层疾病预防控制机构选拔人才提供参考。

以问题为导向的基层医疗机构超声专业住院医师培养与探索

超声医学专业住院医师的培训总体目标是以六大核心胜任力为导向,培养具有良好的职业素养、专业能力、病人管理、沟通合作、教学能力和学习能力,能够独立、规范地从事临床常见病多发病诊疗工作的超声医师。超声医学专业住培学员来源有多个层次,其中基层医疗机构委派的住院医师培养需求及目标有其自身特点,本文旨在探索有针对性培养基层医院来源的住院医师,使其将来在基层工作岗位中更好地发挥应有的作用。

分级诊疗下不同基层医疗卫生机构医疗器械使用与管理现况调查

目的:调研分级诊疗下不同基层医疗卫生机构医疗器械使用及管理现况。方法:采用分层随机整群抽样法,对2023年5—8月份石家庄市辖区的50所乡镇及城市基层医疗卫生机构中的450名医务人员,进行医疗器械使用及管理现况问卷星网络调查,调查内容包括基层医疗机构常用医疗器械使用情况、维护保养情况和质量控制管理情况3个维度16个条目,对比分析不同基层医疗卫生机构医疗器械使用管理的差异。结果:发放450份问卷星调查问卷,回收有效问卷450份,其中乡镇基层问卷239份,城市基层问卷211份。211份城市基层问卷结果显示,城市基层医疗卫生机构医务人员使用医疗器械前进行培训和考核、了解器械参数和及时发现器械故障的构成比分别为62.6%(132/211)、77.7%(164/211)和70.1%(148/211),均高于乡镇基层医疗卫生机构,差异有统计学意义(x^(2)=17.750、29.649、22.384,P<0.05);城市基层医疗卫生机构有维护保养制度、有检查维护标准、有定期校验规定和有器械校验标准的构成比分别为64.0%(135/211)、53.6%(112/211)、55.9%(118/211)和55.0%(116/211),均高于乡镇基层医疗卫生机构,差异有统计学意义(x^(2)=5.834、34.728、6.004、25.540,P<0.05)。在质量控制管理情况的各个条目上,城市基层与乡镇基层差异均无统计学意义(P>0.05)。结论:石家庄基层医疗卫生机构需要在医疗卫生人员使用医疗器械前加强培训和考核,完善医疗器械维护保养相关制度和标准,制定常用医疗器械质量控制管理制度,加强质量控制后的分析讨论,促进医疗器械质量管理持续改进。

中国基层医疗机构基础胰岛素的使用现状和选择的新思路

近年来,国家越来越重视基层医疗机构的服务质量,但是目前糖尿病的基层医疗现状并不令人十分满意。这与我国基层医疗机构的医护人员对基础胰岛素的认识不足有一定关系。本文从基础胰岛素在中国基层医疗机构的应用现状、使用障碍原因分析入手,重点比较基础胰岛素类似物(包括德谷胰岛素与甘精胰岛素)的有效性和安全性。结合近几年胰岛素集中采购的介绍,希望本文为中国基层医疗机构的基础胰岛素选择提供新的思路,从而更好地改善中国基层医疗机构的血糖控制。

基于SHA 2011的天津基层医疗卫生机构基本公共卫生服务开展情况分析

[目的]强化经常性卫生费用核算数据政策分析,为基本公共卫生服务项目后续开展提供依据。[方法]以天津市2016-2019年基层医疗卫生机构预防服务费用核算结果为基础,分析基层医疗卫生机构基本公共卫生服务项目开展情况和存在问题。[结果]2016-2019年,天津市基层医疗卫生机构预防服务费用呈逐年增长趋势,由2016年的14.25亿元增加至2019年的18.04亿元。预防服务费用主要流向预防接种项目、慢性病管理和老年人健康管理项目;预防服务费用筹资来源仍以政府筹资方案为主,但家庭卫生支出占比呈快速增长趋势,主要是由于二类疫苗接种费用的快速增长所致。[结论]天津市基层医疗卫生机构预防服务费用流向与其基本公共卫生工作重点一致,但基层医疗卫生机构传染病防控投入程度与其职能不匹配。基层医疗卫生机构二类疫苗接种服务家庭卫生支出负担过重。

基层疾病预防控制机构2017—2022年政务热线案件特征分析

目的通过分析2017—2022年某基层疾控机构政务热线诉求反映的问题,为基层疾控机构政务热线处理提供参考。方法回顾性对比分析2017—2019年(常态化防控期)与2020—2022年(动态化防控期)受理的市民热线政务工单,通过比较诉求原因分类及受理科室分布,探讨不同时期市民诉求的变化情况。结果该基层疾控机构在动态化防控期(6974件)受理热线工单量较常态化防控期(284件)增加了23.6倍。常态化防控期“公共卫生服务质量”类(7.75%)、“公共卫生服务可及性”类(49.30%)诉求引发的案件占比高于动态化防控期同类型案件占比(3.63%和19.29%)。动态化防控期“管理措施”类(27.37%)案件占比低于常态化防控期同类案件(33.10%),“数据信息化”类案件受理量在动态化防控期间更为突出。结论动态化防控政策直接影响了市民获得公共卫生服务的体验,导致市民诉求原因的变化。基层疾控机构应通过完善公共卫生服务能力建设,以诉求问题为导向,加强沟通培训等措施提高政务热线处理能力。

中小学教师工作负担过重:问题识别、制度根源与治理方略

中小学教师工作负担过重是因教师工作量过大、教师资源错误配置和违背教师工作意愿而导致的一种不合法、不合理、不合情的教师管理现象。从合法性、合理性、合情性三个标准考察,我国中小学教师负担过重问题具有普遍性、复杂性、风险大等特征,需要引起各级政府和全社会的高度重视。造成中小学教师工作负担普遍偏重的根本原因在于制度缺失,如教师相关法律制度缺失、教师管理行政化、学校管理机制僵化、教育改革的强制性等。治理中小学教师工作负担过重,需要从国家层面、学校管理层面及教师自身层面进行综合治理:加强顶层治理,完善教师劳动权利保护相关法律体系;严格源头治理,多方协同减少教师非教育性事务;探索精准治理,建立教师工作负担清单管理制度;优化系统治理,建构刚柔相济的教师管理制度;创新校本管理,建立赋能增效的教师支持体系。

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。