Evaluation of Need and Distribution of National Essential Medicines List in Village Clinics:A Cross-sectional Study Based on the Perspective of Village Doctors in China

This study aimed to evaluate the satisfaction of village doctors to essential medicines list (EML) and accessibility of essential medicines (EMs) distribution to improve the implementation of EML in village clinics.A total of 422 village doctors from five counties in three provinces of China were surveyed by questionnaires.Logistic regression analysis was conducted to identify the main factors associated with village doctors' evaluation of EML.The results showed that village doctors had a negative evaluation in satisfaction level of EML to village-based care and accessibility of EM distribution.The government should adjust EML regularly based on the actual health status of local villagers in China and focus on adding appropriate drugs that meet the needs of villagers with chronic disease.The local government should also attach importance to the distribution of EMs and maintain their supply in village clinics.

Impact of Tobacco Smoking on Health Care Utilization and Medical Costs in Chronic Obstructive Pulmonary Disease,Coronary Heart Disease and Diabetes

Objective To determine the impact of smoking on disease-specific health care utilization and medical costs in patients with chronic non-communicable diseases(NCDs).Methods Participants were middle-aged and elderly adults with chronic NCDs from a prospective cohort in China.Logistic regressions and linear models were used to assess the relationship between tobacco smoking,health care utilization and medical costs.Results Totally,1020 patients with chronic obstructive pulmonary disease(COPD),3144 patients with coronary heart disease(CHD),and 1405 patients with diabetes were included in the analysis.Among patients with COPD,current smokers(β:0.030,95%CI:−0.032-0.092)and former smokers(β:0.072,95%CI:0.014-0.131)had 3.0%and 7.2%higher total medical costs than never smokers.Medical costs of patients who had smoked for 21-40 years(β:0.028,95%CI:−0.038-0.094)and≥41 years(β:0.053,95%CI:−0.004β0.110)were higher than those of never smokers.Patients who smoked≥21 cigarettes(β:0.145,95%CI:0.051-0.239)per day had more inpatient visits than never smokers.The association between smoking and health care utilization and medical costs in people with CHD group was similar to that in people with COPD;however,there were no significant associations in people with diabetes.Conclusion This study reveals that the impact of smoking on health care utilization and medical costs varies among patients with COPD,CHD,and diabetes.Tobacco control might be more effective at reducing the burden of disease for patients with COPD and CHD than for patients with diabetes.

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.

Effect of Physical Activity on Hospital Service Use and Expenditures of Patients with Coronary Heart Disease: Results from Dongfeng-Tongji Cohort Study in China

The intervention of behaviors, including physical activity (PA), has become a strategy for many hospitals dealing with patients with chronic diseases. Given the limited evidence available about PA and healthcare use with chronic diseases, this study explored the association between different levels of PA and annual hospital service use and expenditure for inpatients with coronary heart disease (CHD) in China. We analyzed PA information from the first follow-up survey (2013) of the Dongfeng-Tongji cohort study of 1460 CHD inpatients. We examined factors such as PA exercise volume and years of PA and their associations with the number of inpatient visits, number of hospital days, and inpatient costs and total medical costs. We found that the number of hospital days and the number of inpatient visits were negatively associated with intensity of PA level. Similarly, total inpatient and outpatient costs declined when the PA exercise volume levels increased. Furthermore, there were also significant associations between the number of hospital days, inpatient costs or total medical costs and levels of PA years. This study provides the first empirical evidence about the effects of the intensity and years of PA on hospital service use and expenditure of CHD in China. It suggests that the patients' PA, especially the vigorous PA, should be promoted widely to the public and patients in order to relieve the financial burden of CHD.

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.

Living status and support system of children orphaned by AIDS in central China—Description and policy recommendations

This study aimed to research the living status and support system of children orphaned by AIDS in rural Henan Province. The approach of face-to-face questionnaires research was used to assess 501 children’s current situation while in-depth interview was conducted for the support system research. The age range of the children orphaned by AIDS was 2 - 15 years old and the mean age was 11.10 years. Most children among 2 - 6 years had communication skills with temper control and psychological problems. Children of 7 - 15 years old had the ability to take care of themselves and family members but could not do self-regulation. The support system for children orphaned by AIDS included social support, policies support, education support, and health care support but improvement are needed in the future. Support system can be improved through much more feasible and concrete policies and strategies to guarantee these children’s basic needs and comprehensive development.

Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme

Summary:Throughout the duration of the New Cooperative Medical Scheme(NCMS),it was found that an increasing number of rural patients were seeking out-of^county medical treatment,which posed a great burden on the NCMS fund.Our study was conducted to examine the prevalence of out-of^county hospitalizations and its related factors,and to provide a scientific basis for follow?up health insurance policies.A total of 215 counties in central and western China from 2008 to 2016 were selected.The total out-of-county hospitalization rate in nine years was 16.95%,which increased from 12.37%in 2008 to 19.21%in 2016 with an average annual growth rate of 5.66%.Its related expenses and compensations were shown to increase each year,with those in the central region being higher than those in the western region.Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region(XI),rural population(X2),per capita per year net income(X3),per capita gross domestic product(GDP)(X4),per capita funding amount of NCMS(X5),compensation ratio of out-of^county hospitalization cost(X6),per time average in-county(X7)and out-of-county hospitalization cost(X8).According to Bayesian network(BN),the marginal probability of high out-of^county hospitalization rate was as high as 81.7%.Out-of^county hospitalizations were directly related to X8,X3,X4 and X6.The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors,economy factors,regional characteristics and NCMS policy factors was 95.7%,91.1%,93.0% and 88.8%,respectively.And how these factors affect out-of-county hospitalization and their interrelationships were found out.Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations,and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.

Patient Safety Education among Chinese Medical Undergraduates: An Empirical Study

Patient safety education is conducive to medical students＇ cognition on patient safety and to improvement of medical quality and safety. Developing patient safety education for medical students is more and more widely recognized by World Health Organization and countries all over the world. However, in China, patient safety courses aiming at medical students are relatively few, and there are few reports about the effect of patient safety courses. This paper explored the influence of patient safety curriculum on medical students＇ attitude to and knowledge of patient safety. The patient safety curriculum was carried out for 2011-grade undergraduates of Tongji Medical College, Huazhong University of Science and Technology. The students participated in the class according to free choice. After the curriculum, the information of gender, major, attended course, attitude toward patient safety, and knowledge of laws and regulations of the 2011-grade undergraduates were collected. After rejecting invalid questionnaires, the number of undergraduates that participated in the survey was 112（61 students did not take part in the curriculum; 51 took part in）. Chi-square test was applied to analyze patient safety education＇s influence on medical students＇ attitude to patient safety and their knowledge mastery situation. The influence of patient safety education on the attitude of medical students to patient safety was not significant, but that on their knowledge of patient safety was remarkable. No matter male or female, as compared with medical students who had not accepted patient safety education, they both had a better acquisition of knowledge after having this education（for male students： 95% CI, 4.556–106.238, P〈0.001; for female students： 95% CI, 3.183–33.238, P〈0.001）. Students majoring in Western Medicine had a relatively better mastery of knowledge of patient safety after receiving patient safety education（95% CI, 6.267–76.271, P〈0.001）. Short-term patient safety education cannot change medical students＇ stereotyped cognition on matters related to patient safety, but it can effectively enhance their knowledge of laws and regulations of patient safety.

Maternal smoking status during pregnancy and low birth weight in offspring:systematic review and meta-analysis of 55 cohort studies published from 1986 to 2020

Background Maternal smoking during pregnancy may be associated with low birth weight(LBW)in offspring and global risk estimates have not been summarized previously.We aimed to systematically explore evidence regarding maternal smoking and the LBW risk in offspring globally and examine possible causes of heterogeneity across relevant studies.Methods Comprehensive search of PubMed,Ovid Embase,Ovid Medline(R),and Web of science from inception until October 2021 was carried out.A random-effects meta-analysis was used to estimate the pooled odds ratio(OR)and corresponding 95%confidence interval(CI).Restricted cubic spline analysis with three knots was used to further examine the dose-response relationship.Results Literature searches yielded 4940 articles,of which 53 met inclusion criteria(comprising 55 independent studies).Maternal smoking during pregnancy was significantly associated with the risk of LBW in offspring(OR=1.89,95%CI=1.80-1.98).Furthermore,an obvious dose-response relationship between the amount of cigarettes daily smoked in pregnancy and the risk of LBW in offspring was observed.The results of subgroup analyses indicated that the risk of maternal smoking on LBW was larger in more recently conducted studies(P=0.020)and longer period of active smoking during pregnancy(P=0.002).No evidence of publication bias was found.Conclusions In summary,maternal smoking in pregnancy was significantly associated with a higher risk of LBW in offspring on a global scale.The risk of maternal smoking on infant LBW seems to be increasing over time,and was higher with longer smoking duration throughout pregnancy and more cigarettes smoked daily.