Objective In light of problems related to the accessibility and affordability of healthcare, we aimed to investigate the status and causes for the shortage of qualified health human resources in the rural and primary health care setting, and to propose solutions to these problems at the level of health policy system. Methods The principles and methods of evidence-based medicine were applied. We developed the study selection criteria on the basis of the proposed questions, and identified relevant literature from biomedical databases and other additional sources. We graded eligible studies, extracted data, and summarized the data to draw conclusions. In addition, we conducted a survey to refine the proposed solutions. Results We identified 147studies from PubMed and CNKI, of which 30were in English. After summarizing the information, and using knowledge about the human resources for health in primary healthcare in China, we proposed a model of resident doctor aid healthcare. The survey that we conducted to assess such a model included interviewees of top level policy makers, medical students and staff in medical universities. Most of the interviewees (85%) thought it was feasible to develop an aid healthcare system. Among those who disagreed, the lack of corresponding policy was the most common factor. Conclusions It is suggested that the government develop relevant policies and make an attempt to practice the aid healthcare system. Emerging problems could be identified and addressed in practice.
目的 系統評價單獨應用齊多夫定（zidovudine，ZDV）阻斷HIV母嬰傳播的有效性和安全性。方法 采用Cochrane系統評價方法，計算機檢索Cochrane圖書館（2007第1期）、PubMed、EMbase、CINAHL、AIDSearch、AIDSLINE、AIDSTRIALS、AIDSDRUGS、AIDSinfo、CRD（center of review and dissemination）、CBMdisc，VIP和CNKI等數據庫，以及全球或地區性AIDS相關的會議論文集、政府或非政府組織的相關文件等，檢索日期截至2007年4月30日，全面收集全球抗艾滋病病毒藥物預防HIV母嬰傳播的隨機對照試驗。由兩名評價員獨立篩查文獻、評價質量和提取資料，然后交叉核對，若遇分歧則征求第三方意見討論解決。使用RevMan軟件進行Meta分析。結果 共納入8個RCT，包括24篇全文和13篇摘要，其方法學質量的Jadad評分≥3分。Meta分析顯示：① ZDV與安慰劑比較共納入4個RCTs（2385例），無論長短療程、母乳或非母乳喂養人群，ZDV預防HIV母嬰傳播的效果均優于安慰劑組，降低HIV母嬰傳播風險43%～50%，且兩組死產率、嬰兒死亡率、母親死亡率、早產、低體重兒、出生缺陷、母嬰不良反應發生率和母親產前、產時和產后并發癥發生率差異均無統計學意義（Pgt;0.05）。② 1個大樣本RCT（1437例）比較了ZDV不同療程的效果，結果顯示ZDV“長–長療程”（從孕28周開始到產后6周）比“短–短療程”（從孕35周開始到分娩后3天）降低HIV母嬰傳播風險61%［RR=0.39，95%CI（0.19，0.82）］。長–長療程與長–短療程（從孕28周開始到產后3天）及短-長療程（從孕35周開始到產后6周）比較，其預防HIV母嬰傳播的效果差異均無統計學意義（P gt;0.05）。各組死產、新生兒死亡、1年內嬰兒死亡、母親死亡、早產、低體重兒、出生缺陷、母嬰不良反應發生率相似（Pgt;0.05）。③ 1個大樣本RCT（1 200例）顯示：人工喂養+短程ZDV預防HIV母嬰傳播的效果優于母乳喂養+長程ZDV，可降低嬰兒HIV感染風險的35%～39%，但提高了嬰兒7個月時的死亡率（9.3% vs 4.9%；P=0.003）；兩組嬰兒早產率、低體重兒出生率、出生缺陷率、不良反應發生率相似（Pgt;0.05）。④ 2個直接比較短程或超短程ZDV與單劑量奈韋拉平（Nevirapine，NVP）預防HIV母嬰傳播效果的RCT（702例）顯示，NVP可降低HIV母嬰傳播風險的44%～48%，兩組死產、6月內嬰兒死亡、母親死亡、低體重兒、母嬰不良反應發生率相似（Pgt;0.05）。結論 無論長短療程、母乳或非母乳喂養人群，ZDV預防HIV母嬰傳播的效果均優于安慰劑，且其妊娠結局和不良反應發生情況相似。ZDV“長–長療程”比“短–短療程”預防HIV母嬰傳播效果更好，但長–長療程與長–短療程、短–長療程預防HIV母嬰傳播的效果相似；各組安全性相似。人工喂養+短程ZDV預防HIV母嬰傳播的效果優于母乳喂養+長程ZDV，但提高了嬰兒7個月時的死亡率。單劑量NVP預防HIV母嬰傳播效果優于短程和超短程ZDV，且安全性相似。
Objective To investigate the spectrum of diseases and the current situation of antibiotic use in rural hospitals and community health service centers in Chengdu, so as to provide evidence for selecting essential medicines and promoting rational use of antibiotics. Method We selected 7 township/community health institutions, from which we collected inpatient and outpatient information. Information about antibiotic use was also collected, including categories, cost, and dosage. A standard questionnaire was used to investigate physicians’ prescription behavior for principal diseases. Result Urban and rural areas had different spectrums of diseases. The major diseases in urban areas included diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and respiratory tract infection; while those in rural areas were infectious diseases of the respiratory system, digestive system, and urinary system. The physicians’ prescription behavior was mainly based on their personal experience. Antibiotics accounted for 30-50% of the total medicine cost. The top four types of antibiotics with the highest cost were cephalosporins, penicillin, quinolones, and macrolides. Conclusion Based on the different spectrums of diseases, essential drug lists and standard treatment guidelines appropriate for rural health care should be developed to improve the rational use of drugs. Factors such as the average cost of daily dose and the course of treatment should be taken into consideration to reduce the overall cost of medicine. An antimicrobial resistance monitoring system and special training courses on rational use of antibiotics should be utilized in the rural health institutions.
Objective To provide baseline data for the Special Healthcare Program of Comprehensive Reform for Coordinated and Balanced Urban-rural Development in Chengdu. Methods We selected 7 township/community health institutions and 6 village health posts /street clinics using stratified sampling to take account of the levels of economic development and the distance from the centre of Chengdu We then performed on-site surveys and secondary research. Data were analyzed by using Epidata or Excel. Results The utilization of health institutions was generally good. The number of visits and number of inpatients in medical institutions increased steadily. The utilization rate of hospital beds and doctors’ workload were higher than the national average. The average medical expense per outpatient /inpatient was far lower than the national level. The overall condition of the health institutions that close to the centre of Chengdu was better. Conclusion We should persist in taking advantage of the rural hospitals’ construction to improve village health posts /street clinics and strengthen the national and governmental compensating mechanism for township /community health organizations (village health posts /street clinics), so as to make the basic condition of current township/ community health organizations (village health posts /street clinics) better.
Objective To investigate human resource allocation in primary health care and the essential medical service and publ ic health service status in urban and rural areas in Chengdu, so as to provide basel ine data for the Special Healthcare Program of Comprehensive Reform for Coordinated and Balanced Urban-Rural Development in Chengdu. Methods We carried out a stratified (three circles in Chengdu) sampl ing of 7 township hospitals (rural hospitals) and community health service centers; and then performed secondary research based on a comparative analysis of relevant pol icies of the World Health Organization (WHO) and Chinese governments at all levels. Results According to the WHO and national average standards, the number of staff per 1 000 rural hospitals / centers health personnel of the 7 rural hospitals / centers occupied only 1%-22% of the global average standard. There was a very large gap between the number of staff and the number of personnel required, based on the size of the population that should be served in the administrative areas in 2006 or the number of cl inic patients in 2006. The primary healthcare personnel structure was irrational. For example, the constituent ratio of health technical personnel was 4% to 33% higher than the global average level, and the constituent ratio of (assistant) physicians was also 17% to 45% higher than the global average level. However, the ratio of nurses, laboratory workers, other health professionals, administrative and supporting personnel was generally lower than the global average level. Women dominated among the primary healthcare personnel, and people aged 45 years or below counted for more than 75% (except Bailu and Wangjiang rural hospitals/centers). People with an educational background of two-year college education or secondary education or below took up 70% to 90%; while those with an intermediate title or assistant /primary title accounted for 50% to 100%. The structure rational ity of distribution density, educational background and academic titles of healthcare personnel showed a decreasing trend from the first circle to the third circle in Chengdu city. Conclusion The primary health workers in the second and third circle have been overloaded with low incomes for some time. They are facing enormous challenges in their professional skills, service awareness, as well as difficulties in continuing education and professional title promotion. It is very difficult to provide qual ified "six in one" primary health care and publ ic health services in a long-term and stable manner. It is suggested that we enroll and train more skilled people for primary health care service, and provide continuing education chances for current health care personnel. We should also adopt a mechanism to select qual ified personnel based on their performance, and take measures to solve some of the problems faced by the grass-root health personnel, such as heavy work burden, low income, poor skill and promotion. This will help us to construct a stable and qual ified primary healthcare team.
Objective The Chengdu initiative essential medicine policy is part of the Special Healthcare Program of Comprehensive Reform for Coordinated and Balanced Urban-rural Development. We aimed to investigate the current situation of medicine use in rural hospitals and community health service centers, so as to provide evidence for policy-makers to select essential medicines and facilitate rational use of medicines. Method We selected 7 township/community health institutions from which to collect medicine use information, including medicine category, number of medicine categories, cost and consumption. Descriptive analysis and the ABC classification method were applied for statistical analysis. Results The number of medicine categories used in the community health institutions was four times greater than that in the township health institutions. Traditional Chinese medicine preparations accounted for 40% of the total medicine cost. Polypharmacy, overuse of injections, and improper use of antibiotics were major manifestations of the irrational use of medicines. Conclusion The selection and use of essential medicines should be base on high quality evidence as well disease burden, the economic situation and specific demands in different areas. Drug and therapeutics committees should be set up to perform dynamic monitoring, education, evaluation and continual improvement of an essential medicines list.