摘要:目的: 了解綿竹市社區衛生服務系統震后現狀,同時分析社區醫療震后居民滿意度和社區衛生服務機構震后災害干預能力,以期為社區衛生服務體系地震應急恢復和重建提供參考意見。 方法 :采用隨機抽樣的方法,抽取綿竹市劍南社區衛生服務中心和天河社區衛生服務中心進行訪談,采取方便抽樣的方法,抽取24‰的綿竹城區居民采用面對面訪談的方式用自制問卷進行調查,并用Epidata30 進行數據錄入、SPSS130進行統計分析。 結果 :共發放問卷240份,收回有效問卷229份(有效回收率954%)。當地社區衛生服務系統在地震中受損嚴重。社區衛生服務系統災后工作居民滿意度為454%,社區衛生服務機構對居民進行抗災/防災知識教育的比例為336%,災后是否有持續而足夠的常見病藥品供應及是否有持續而足夠的慢性病藥品供應是影響當地居民對當地社區衛生服務體系災害應急工作的滿意度的影響因素(P 值分別是0033,0001)。 結論 :震后社區衛生服務居民滿意度較低,服務體系地震災害干預能力不足。居民在在災前接受抗災教育的比例較低,加強藥品儲備能提高社區衛生機構災害應急工作的效果。在社區衛生服務體系重建的過程中,應注重社區醫療基礎工作的恢復,基礎設施的重建和健全社區急救體系。Abstract: Objective: To investigate the reality of community health service system after earthquake in Mianzhu, the satisfaction of community residents to the community health service as well as the postdisaster emergency response capability of community hospital in order to provide decisionmaking suggestions on better reconstruction of community health service system. Methods : Jiannan and Tianhe community hospital were randomly selected for visiting and 24‰ of community residents in the city zone of Mianzhu were selected by convenience sampling for a facetoface interview using a questionnaire. Data entry and statistically analysis were completed by Epidata30 and SPSS130 respectively. Results :A total of 240 questionnaires were conducted to facetoface interviews, and 229 questionnaires were returned (response rate 954%).The community health service system was badly injured. Residents’ satisfactory degree of the community health service after earthquake was 454%. The proportions of disaster / disaster prevention education was 336%,medicine supply for familiar diseases and the chronic were the main factors which influenced judgements of residents to the emergency response capabilities of community hospitals(〖WTBX〗P =0033,P=0001,respectively). Conclusion :The community health services after earthquake had not been widely satisfied and the emergency response capability of community hospital was far from enough. The proportions of disaster / disaster prevention education were far from enough. The effectiveness of emergency response work of community hospitals can be enhanced by reinforcing medicine preparation.In the course of the reconstruction, community health service system should pay attention to the resumance of basic community health service,reconstruction of basic establishment and construction of firstaid system.
Object To investigate the constitution and expense of inpatient diseases in Jili Community Health Service Center (JCHSC) in Liuyang City of Hunan Province from 2008 to 2010, so as to provide baseline data for further study. Methods The questionnaire was applied and inpatient records in JCHSC between 2008 and 2010 were collected. The diseases were classified and standardized according to the International Classification of Disease, 10th Edition (ICD-10) based on the first diagnosis extracted from discharge records. Such information as general condition, discharge diagnosis and medical expenses etc. were analyzed by using statistic software of Microsoft Excel 2003 and SPSS 13.0. Results a) There were 9 chronic diseases and 6 acute ones among the top 15 single diseases, and both the average hospital stay and per-average hospitalization expense of chronic diseases were higher than those of acute ones (7.8 days vs. 5.6 days; ?2 733 vs. ?1551); b) Per-average expense of drugs as for both acute and chronic diseases accounted for nearly 50% of the total/general expense; c) There were 3 types of treatment models in JCHSC. Model A was only the internal medicine therapy, Model B was internal medicine assisted with surgery, and Model C was surgery assisted with internal medicine therapy; d) In detail, the total per-average expenses in JCHSC between 2008 to 2010 as for each single disease were as follows: coronary heart diseases (CHD, ?2 374 to ?2 680), urinary calculi (?3 268 to ?3 337), chronic bronchitis (?2 452 to ?2 488); e) Per-average hospitalization expenses in internal departments were ?1 719 to ?1 942 for acute diseases and ?2 386 and ?2 523 for chronic ones. Among surgical departments, the per-average hospitalization expenses as for acute diseases and chronic diseases were ?1 438 to ?1 579 and ?3 044 to ?3 607, respectively; and f) The average hospital stay for acute diseases in internal departments were 5.5 to 5.8 days for acute diseases and 6.9 to 7.3 days for chronic ones. By contrast, those in surgical departments were 5.9 to 6.2 days for acute diseases and 8.3 days for chronic ones, respectively. Conclusion a) In JCHSC, a total of 7 inpatient diseases among the top 15 single diseases in 2010 are all chronic with per-average total expense over ?2 000, which is higher than the average level of national CHSC (?2 357.6); b) According to the features of expense constitution models of the inpatient single diseases, the hospitalization expense should be controlled specifically; c) There are 3 kinds of diseases with yearly-increasing per-average total expenses as CHD, hypertension and pulmonary infection during recent 3 years; meanwhile, 4 diseases are with yearly-decreasing per-average total expenses as chronic bronchitis, cholecystolithias or accompanied with cholecystitis, diabetes and inguinal hernia; d) The per-average expenses of chronic diseases in surgical departments are higher than those in internal departments, but those of the acute diseases in surgical departments are lower. Meanwhile, the per-average total expenses as for both chronic and acute diseases in surgical departments present a decline trend year by year. Although the per-average expense on drugs as for both acute and chronic diseases in internal departments show a decline trend, the per-average total expenses indicate an ascending trend; and f) The average hospital stay of chronic diseases is longer than acute ones, while that of the surgical diseases is also longer than internal ones.
Objective To investigate the rebuilding status of community health service (CHS) system after Wenchuan earthquake in Mianzhu, improve service ability and provide data for better reconstruction of CHS system after natural disaster. Methods The interview was conducted with local health system officials, and self-designed questionnaire for face-to-face interview was distributed to 508 community residents in Mianzhu who were selected by convenience sampling. Data entry and statistical analysis were completed using Microsoft Office Excel 2007 and SPSS 16.0 respectively. Results A total of 508 questionnaires were distributed, and then 486 questionnaires were retrieved effectively (response rate 95.7%). The analysis on 486 respondents in CHS after rebuilding showed the rate of respondents with health files rose from 20.1% to 43.8%, the rate of having regular health check-up rose from 7.4% to 46.7%, the rate of health education rose from 20.1% to 39.7%, the rate of chronic disease monitoring rose from 0.9% to 35.4%, the rate of knowing referral pattern rose from 15.7% to 51.2%, the rate of propaganda for disaster relief rose from 33.6% to 58.6%, and the rate of doing disaster emergency response exercise was 21.8% currently. 62.3% of residents chose CHS on the first visit. The satisfactory degree to CHS rose from 45.4% to 76.1% after earthquake. Both popularization of regular health check-up and propaganda for disaster relief were major factors with influence on residents’ satisfaction to CHS (Plt;0.001, P=0.010, respectively). Conclusion The residents’ satisfactory degree to the rebuilding status of CHS system is encouraging. It is necessary to strengthen the popularization of regular health check-up and propaganda for disaster relief in order to improve the quality of community health service.
ObjectiveTo know about equipment of pulmonary function tests (PFTs) in community health service centers and the knowledge of pulmonary function in general physicians.MethodsThis questionnaire survey was carried out sponsored by Shanghai Basic Alliance for Respiratory Diseases Prevention and Treatment from June to December in 2016. Most community health service centers in 16 districts of Shanghai participated the survey. The questionnaire included education background, professional qualification, PFTs equipment, and knowledge about PFTs.ResultsThere were 963 general physicians in 131 community health service centers completed the questionnaire. There were 27 (20.6%) community health service centers equipped with simplified pulmonary function test device and 910 (94.5%) physicians knowing PFTs. Out of these 910 physicians, 458 physicians (50.3%) gave the correct answer on question about the items of PFTs. The accuracy of question about the diagnosis of chronic obstructive pulmonary disease (COPD) was 24.0% (218/910).ConclusionsThe rate of community health service centers with equipment on PFTs is low and the knowledge on pulmonary function in general physicians is insufficentt in Shanghai. Training on pulmonary function is essential to adapt the stratified treatment of COPD.
ObjectiveTo get known of the knowing and utilization of essential public health services among community residents for clinical visits in Nanchang city, and to provide evidence for promoting the effective use of public health services. MethodsA total of 20 community health services (CHS) organizations were finally selected by stratified random sampling method from 5 administrative regions in Nanchang city. Questionnaire survey about the knowing and utilization of public health services was performed to the 500 residents. We used EpiData 3.0 software to establish the database and SPSS 17.0 software for statistical analysis. ResultsThe awareness rate about essential public health services among them was 77.6% in Nanchang, which was highest to 91.0% in Wanli district and lowest to 47.0% in Xihu district. The differences between the administrative regions were significant (χ2=75.893, P=0.000). The archiving rate in CHS organizations among visits was 59.2%, which was up to 84.0% in Wanli district and lowest to 40.0% in Qingshanhu district. It also showed statistical significance between the regions (χ2=110.493, P=0.000). The total utilization rate about essential public health services was 95.8% in the population, which was no significant difference between the regions (χ2=7.772, P=0.100). However, the utilization rate in different populations was statistically significant (P < 0.05). ConclusionThe awareness rate and archiving rate about essential public health services among the residents in CHS organizations in Nanchang was not high, but the utilization rate was much higher, which was different among the administrative regions. The CHS organizations should strengthen the publicizing of essential public health services knowledge for the people in different regions to improve the co-development of the regions. In addition, it is also necessary to improve the use of community health services among the populations to achieve the goal about the equalization of essential public health services.
Objective To raise policy suggestions for public health bureaus by analyzing the mental health service in Chengdu City in 2004. Methods We applied descriptive methods to analyze the mental health service. Results The mental health resources in Chengdu City were insufficient and the utilization rate of health resources was low. Conclusions Strategies to improve this may include setting up mental health management sections; increasing the funds for health service; strengthening professionals training; exploiting the service field of relevant specialties and developing community mental health.
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 evidence for the establishment of an essential medicines list, we investigated the institutional medicine supply in rural hospitals and community health service centers in Chengdu. Methods The trained investigators collected medicine sales records and information about the management of institutional pharmacies. Through in-depth interviews with the pharmaceutical personnel, we inquired into the drug supervision and supply networks in rural areas. Then we performed secondary research based on a comparative analysis of drug classification, administration and pharmacies in developed countries. Results Seven township hospitals/community health service centers had pharmacies, facilities, storage, and a clean environment. Three of them used electrical databases to manage medicine sales records. Five township hospitals and 5 village medical rooms purchased medicines from the drug supervision and supply networks every week. In this way, they ensured the quality and accessibility of drugs in rural areas. In the urban community health service centers, medicines were supplied based on the traditional commercial distribution system. Conclusion Rational allocation of health resources to set up institutional pharmacies and village medicine rooms is important. The supervision of village medical rooms must be stricter. We should expand the use of electrical databases and integrate the supervision and supply networks with the supply system of the essential medicines.
Objective To investigate the health status of residents in rural areas of China as well as their needs for health service, and to explore the effective way to improve the health status of rural residents so as to provide a basis for the training of community healthcare professionals. Methods Using the method of stratified cluster random sampling, we investigated 4190 rural residents from 1200 families, which were sampled from 13 provinces of China according to the geographical distribution. Results The 2-week prevalence rate was 27.9%. 32.7% of the patients saw a doctor, and 20.5% did not take any measures. Among those who did not take any measures, 78.4% thought their illness was mild and did not need any treatment; and the second reason for no treatment was lack of money (accounting for 36.5%). The prevalence rate of chronic diseases during the past half year was 24.9%, among which lumbar and leg pain was the most prevalent (accounting for 7.8%), followed by hypertension (accounting for 5.5%). The rates of visiting a doctor were 43.9% and 61.5% in township level and village level health institutions, respectively, during the past one year. 70.0% of the patients looked for treatment, 8.4% chose to ignore, and 20.8% took medicine by themselves. Among those who visited a doctor, 61.0% preferred hospitals near their houses, and 34.0% preferred those with lower expenses. More than half of the residents (accounting for 57.3%) did not have any physical examination during the past 3 years, and 28.3% did have a check-up but not regularly. Among the rural residents investigated, 64.2% obtained health care knowledge from television, newspapers, books and radio broadcasting, and 67.3% were desirous of regular physical examination. 56.3% and 33.1% of the rural residents considered the skill of the healthcare professionals in town-level institutions to be acceptable and satisfactory, respectively; and 61.7% and 24.6% evaluated the skill of those in village-level institutions to be acceptable and satisfactory, respectively. Conclusion The health status of rural residents is not optimistic, and their health behaviors need to be correctly guided, and the medical facilities and healthcare service quality of primary healthcare institutions should be improved. It is suggested that the government and medical colleges take the responsibility to train healthcare professionals for the primary health care in rural areas.
China is in the best period of development since modern times, and in the face of the “great changes” in the world, China’s medical and health field needs to reconstruct the medical service model actively. Under the guidance of the “Healthy China” strategy in the new era of socialism with Chinese characteristics, full life cycle health service emerged as the times require. The whole life cycle health service is based on the two focuses of the whole population and the whole life cycle, with the main characteristics of “system continuity” and “fair accessibility”, aiming to achieve the overall improvement of the health level of the whole people. This article reviews the concept, connotation and research progress of whole life cycle health service, aiming to implement the strategy of “Healthy China”, so as to provide reference for carrying out the whole life cycle health service with Chinese characteristics in the new era.