Objective To critically appraise and systematically reviewe the economic evaluations of all alternative interventions for hepatitis B in China. Methods We searched MEDLINE and the four largest Chinese electronic databases. The references of eligible studies were also screened. Economic evaluations of any type, which studied interventions for hepatitis B, were eligible for inclusion. A 25-item quality checklist modified from a BMJ checklist was used to appraise the quality of studies. The overall quality score was calculated against 100 points to indicate the risk of bias. Quality appraisal and data extraction were conducted by two independent reviewers. Results Nineteen full economic evaluations and two cost studies were included of which fourteen studies were scored 25-44 points, and seven scored 45-61 points. Most studies adequately documented effectiveness of interventions. However, the costs of interventions were not well reported in over 50% of studies. Many studies inadequately conducted data analysis, particular in sensitivity analysis and discounting. Ten studies compared lamivudine with interferon or conventional therapy for 1-year (or 6-month) effects, which indicated that lamivudine was generally cost-effective. Three evaluations studied 30-year outcomes of interferon compared with conventional therapy, which suggested that interferon usually saved additional costs and years of life. Another three studies compared interferon with less frequently used antiviral agents, however the comparative cost-effectiveness varied. Two cost studies showed the total costs and the percentage of medical costs increased rapidly in proportion to disease severity.Conclusions Of alternative interventions, lamivudine is cost effective for short-term effects. Interferon is superior to conventional therapy for long-term outcomes. However, the long-term economic outcomes cannot be justified by the current evidence. Quality of methods, particularly, that of costing and analytical methods, is a major limitation. There remains a b need to improve the quality of reporting. Careful considerations should be paid before applying the results to decision making.
Objective To investigate current situation of medical service and management in Gaozha Central Township Health Center (GzC), so as to provide baseline data for township health centers in both key techniques research and product development of drugs allocation and delivery. Methods A questionnaire combined with a special interview was carried out, which included the general information, human resources, medical service and management, and the practice of essential medicine list. Results a) The hardware condition of GzC was not good enough, and the economic status of the service recipients was lower than the average level of both Wuzhong City and China mainland; b) The constituent ratio of general practitioner (GP) and nurse, and GP and laboratorian were all lower than those of national level, while, the constituent ratio of GP and technician was a little bit higher. GzC was in short of medical technical personnel and, especially, the professional pharmacists. The logistics technical workers were as the same proportion as the nurses. The medical technical personnel without professional education background accounted for 3.4%, and about 38% of the staff members had no college degree, about 86.2% had at most primary profession titles. There was no personnel turnover of GzC in recently years; c) The bed utilization ratio was lower than national level (46.4% vs. 60.7%), while the average duration of stay and the in-patient and out-patient service workload of GP were longer or heavier than national level (8 vs. 4.8, 9 vs. 8.3, 4 vs. 1.3); d) The out-patient service in 2010 decreased 26.9% compared to 2009; and the in-patient service in 2010 decreased 42.4%; e) The average medical expense per outpatient and per inpatient increased 127.3% and 56.2%, respectively in 2010 compared to 2009; and f) Essential medicine list was put into practice in April 1st of 2010 and there was only 195 species available in GzC, which has not met the requirements of the national essential medicine list. Conclusion In order to meet the standards of general rural township health center in western China, GzC needs to cope with challenges of insufficient hardware conditions, short of staff, unreasonable personnel structure, low educational background and professional title of the staff, none human resources flow and low technical level of medical service. GzC dose well in drug expenses control, and the hospitalization costs are lower than those of the national level. However, it increases rapidly in 2010. The management of GzC may be influenced by zero-profit sale of the essential drugs, and appropriate subsidy and policy support are necessary to maintain its service quality. And it is required to complement the medicine based on the evidences, to carry out staff training and usage guidance of essential medicine, and to finally guarantee the safe and reasonable use of medicines.
Objective To evaluate the effect of maternal and child health care training at the primary levelin Chongqing, and to detect and solve the existing problems so as to provide evidence for the further training andmonitoring. Methods The rural maternal and children health staff of Rongchang County, Chongqing were trained. A test and, in-depth interviews and field observation wereused to evaluate the training process and results. Results Seventynine members of the Clinical Skill Group (CS) and 73 members of Health Education Group (HE) have taken the test. The median score of CS before training was 11 while it was 23 after training (Plt;0.01); the median score of HE was 18 before training while it was 25 after training (Plt;0.01). The scores change of thetest before and after training showed that the training had a good result. Conclusion Primary level health staff members had poor knowledge of maternal and children health care. This training enhanced their knowledge of maternal and child health care improved their skill. Organizers should ensure that the training contents are rich,novel, and varied. Maternal and child health staff should be willing to join the training.
Objective To systematically review the current situation, dilemmas and countermeasures of the regulation of health care integration services in China, and provide reference for the research on the regulation of health care integration services in China. Methods Studies and policies on the regulation of health care integration services were systematically searched from the inception of the databases to October 2022, and the included studies and policies were coded and analyzed by using the qualitative analysis software NVivo12. Results A total of 12 research articles and 15 policy announcements were included. The theoretical framework, regulatory dilemmas and regulatory countermeasures for the regulation of health care integration services were obtained through open coding, axial coding and selective coding. The regulatory framework of health care integration services was divided into five aspects: regulatory basis, regulatory subject, regulatory object, regulatory content and regulatory methods. The lack of regulatory basis led to dilemmas in the remaining aspects accordingly. Conclusion The regulation of health care integration services needs to start from the regulatory basis, introduce and improve the health care integration laws and policies, and gradually form a health care integration service regulatory model with institutional self-regulation as the priority, government regulation as the main body, and the public, third parties and other social regulation as the auxiliary.
Objective To investigate the influencing factors in the service volume of primary health care institutions in Chengdu, and provide references for promoting the hierarchical diagnosis and treatment. Methods A self-administered questionnaire was used to investigate the service volume of a total of 390 primary health care institutions (including community health service centers and township hospitals) across 22 districts and counties of Chengdu from October to November 2016. Rank sum test, rank correlation analysis and multiple linear regression model were used to analyze the influencing factors of outpatient visits in the institutions. Results The median annual amount of outpatient visits was 60 493 in community health service centers and 31 374 in township hospitals. Between community health service centers and township hospitals, the difference in median daily visits per doctor was not significant (14.41 vs. 13.29), but the median daily visits per doctor in general practitioners (12.22 vs. 8.16), rehabilitation physicians (10.10 vs. 6.34) and traditional Chinese medical doctors (4.82 vs. 6.17) varied considerably. Multiple linear regression analysis showed that the amount of outpatient visits in community health service centers was related to the amount of intermediate physicians, while the amount of outpatient visits in township hospitals was related to the setup of dental clinics, the amount of primary physicians, the amount of beds and population to be served (P<0.05). Conclusions Differences exist in the service volume among primary health care institutions in Chengdu. It’s necessary to make proper plans for the management of administrative offices and the allocation of personnel, so as to improve medical services of primary health care institutions.
ObjectiveTo systematically review the willingness rate of the first consultation in primary health care institutions among Chinese residents.MethodsCNKI, WanFang Data, VIP, PubMed, Web of Science and EMbase databases were electronically searched to collect cross-sectional studies on the willingness rate of the first consultation in primary health care institutions of residents in China from January 2006 to November 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; meta-analysis was then performed using Stata 14.1 software.ResultsA total of 26 cross-sectional studies involving 36 430 subjects were included. The results of meta-analysis showed that the willingness rate of Chinese residents for the first consultation in primary health care institutions was 61.4% (95%CI 54.5% to 68.3%). The results of subgroup analysis showed that for the willingness rates of the first treatment at the grassroots level in male and female residents were 65.6% and 64.9%; urban and rural residents were 49.9% and 58.9%; <60 and ≥60 years old residents were 60.5% and 71.6%; primary school and below, junior high school, high school or technical secondary school, junior college or above educational level residents were 72.8%, 68.1%, 64.2%, and 52.8%; employees, residents, and other types of insurance residents were 74.1%, 75.9%, and 64.4%; residents with monthly income <3 000, 3 000-5 000, and >5 000 yuan were 65.8%, 65.3%, and 58.5%; high, medium, and poor levels of health status residents were 56.8%, 52.6%, and 48.8%; with and without chronic diseases residents were 61.0% and 56.9%; with and without spouse residents were 63.9% and 64.6%; with and without contracted family doctor residents were 87.1% and 62.6%; on duty, retired, and other employment status residents were 70.7%, 69.9% and 71.5%; primary medical institutions residents those were satisfied, average, and dissatisfied were 77.3%, 60.7%, and 49.4%.ConclusionsCurrent evidence suggests that it remains room for improvement in the level of willingness of Chinese residents for first consultation in primary health care institutions. Residence, age, educational level, type of medical insurance, income level, health level, family doctors contracted status, and satisfaction with primary medical institutions have an impact on residents' willingness to receive first treatment at primary hospitals. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
Objective To understand the current situation of medical service and management in Xintian Central Township Health Center (XtC) through on-the-spot investigation, and to provide references for development of key techniques and products for township health centers in medicine allocation and delivery. Methods The questionnaire and the focus interview were carried out, which included the general information, human resources, medical service and management, as well as the practice of essential medicine list. Results a) The hardware conditions of XtC were not good enough, and the income of Lintao county and Gansu provincial government fell short of their needs; b) The General Practitioner (GP)/nurse ratio was higher than that of the national level, the GP/pharmacist ratio was a little bit lower, and the GP/laboratorian ratio reached the national level. There was only one medical technician. There was about 27.5% staff members having no college degree, and about 81% having at most primary profession titles. There were 26 medical workers allocated to XtC in recent two years and only one GP left; c) In 2009, the bed utilization ratio was a little bit higher than the national level (109% vs. 60.7%), while the average length of stay was longer than the national level (6 vs. 4.8); d) The outpatient service in 2010 increased by 17.6% compared to 2009 and the inpatient service in 2010 decreased by 17%; e) The average medical expense per outpatient and per inpatient increased by 23.5% and 14.9%, respectively, in 2010 compared to 2009; f) The essential medicine list (EML) was put into practice in June, 2010. The current count of medicine in hospital was 767, far beyond the EML demand. Conclusion XtC, as a basic rural Township Health Center in Western China, overtakes the burden of healthcare service for local population. The policy of “selecting graduates to work in Township Health Center” made by Gansu government ensures sufficient personnel reserve for rural Township Health Center. XtC needs to cope with challenges of insufficient hardware conditions, unreasonable personnel structure, low educational background and profession title of the staff, and low technical level of medical service. XtC has a big ratio of medicine income and the expense of outpatient is lower than that of the national level. The management of XtC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are needed to maintain its service quality. And it is necessary to carry out evidence-based selection of the essential medicine account and develop staff training and essential medicine usage guidance, so as to support the medicine used safely and rationally.
Objective To investigate the situation of human resources of primary health care institutions in Chengdu and provide references for rational allocation of health personnel in primary health care. Methods From October to November 2016, self-administered questionnaire was used to investigate the situation of the human resources of health workers in a total of 390 primary health care institutions in the three circles of Chengdu (including the subsidiary counties, towns, and districts) during 2015. The Health Resources Density Index (HRDI) was calculated and its equilibrium was analyzed. Frequency and constituent ratio were used for descriptive analysis. Results Three hundred and seventy valid questionnaires were recovered. The number of clinical doctors, general practitioners, and registered nurses per 10 000 residents in Chengdu was 5.32, 1.38, and 4.32, respectively. Doctors’ and nurses’ HRDI was 0.52 and 0.42 respectively. The number of intermediate and junior professional titles accounted for 15.91% and 52.13% respectively. The ratio of doctors to nurses was 1∶0.81, and the ratio of general practitioners to nurses was 0.32∶1. Structure rationality of distribution density and professional titles of healthcare personnel showed a decreasing trend from the first circle to the third circle. Conclusions The personnel troop of primary health care service in Chengdu has been formed. However, the professional title structure and the distribution of professional categories still need to be improved. The situation of primary health workers in the third circle is relatively backward compared with other circles in Chengdu. It is suggested that the number of nurses and general practitioners should increase properly, and rational intervation should be carryed out in the distribution of primary health workers, so as to balance and develop the grass-root health personnel in the three circles of Chengdu.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.
This paper introduces the development and changes of clinical practice guidelines based on the enlightenment of the Reporting Items for Practice Guidelines in Health Care (RIGHT), and provides policy recommendations.