Value-based healthcare (VBHC) is an important guideline for current and future healthcare services. In practice, VBHC should be the best goal of public welfare of healthcare service. Meanwhile, VBHC and cost-effectiveness analysis together provide scientific evidence for healthcare decision-making. Pay by value is inevitable in the next stage of the reform of the payment system of medical insurance, and the health service system should be reconstructed based on VBHC. Finally, the challenges of VBHC implementation are discussed.
ObjectiveTo investigate the drug utilization in primary healthcare system of Xinjin county of Chengdu in 2010. MethodsThe drug utilization information in regional health information platform of Xinjin county were collected. Microsoft Excel 2003 software was used to describe the types, forms and expenditure of medicines, particularly the use of antibiotics among outpatients and inpatients. ResultsThe drug utilization of 17 hospitals in Xinjin county in 2010 was summarized below:a) there were 1 507, 1 356 and 695 kinds of drugs dispended for outpatients, and 1 271, 1 023 and 317 for inpatients in county-level hospitals (CLH), township hospitals (TH) and community healthcare centre (CHC), respectively. Among which, oral biomedicine and traditional Chinese medicine (TCM) accounted for about 45% of total types, and 46% to 73% of total drug expenditure among outpatients; while oral biomedicine and the injection accounted 37% to 61% of total types of medicines dispended to inpatients, particularly injection of biomedicine accounting for over 75% of total drug expenditure among inpatients. b) The expenditure of top 30 drugs in primary care hospitals accounted for 50% of total drug expenditure among outpatients and over 85% among inpatients. c) Among the top 20 drugs, there were 15 antibiotics, which accounted for 26.5% of total drug expenditure in Xinjin county. The top 10 antibiotics were mainly cephalosporin, accounting for 59.36% and 66.27% of total antibiotics expenditure among outpatients and inpatients respectively. Conclusiona) The main forms of medicines dispended to outpatients are oral biomedicine and TCM, while oral agents and injection of biomedicine are the majority of medicines used for inpatients. b) The top 30 drugs should be monitored for rational use of drugs considering the huge expenditure. And c) the types, proportion of use and expenses of antimicrobial drugs ranked the first in CLH, CHC and TH, which may imply irrational use of antibiotics.
It is essential to improve the practice of community healthcare service for the resolution of the problem of inadequate and overly expensive medical services, to promote the harmonization of doctor-patient relationship. From the aspects of the introduction of community healthcare service and the necessity of its standard management, the civil legal relation of community healthcare and its major problems, as well as the rights and duties of community doctors, the authors discussed the importance and necessity of scientific management, right protection by law as well as sound and orderly development of community healthcare service.
Ischemic stroke can lead to disruption in the oral ecology and an overgrowth of pathogenic bacteria, resulting in periodontal disease. Meanwhile, the aspiration and pulmonary infection resulted from dysphagia can increase the unfavorable prognosis. Some studies have found that there exist oral bacteria in the thrombus in myocardial infarction and ischemic stroke patients, showing that oral flora might be associated with thrombus and stroke-associated pneumonia. There are few high quality clinical studies or evidence-based guidelines. Priority should be given to high quality research that provides oral care standards, and incorporating oral care into future stroke pathways to improve the prognosis.
ObjectiveTo investigate primary healthcare workers' knowledge, attitude and behaviour, and explore the way of guidelines' popularization, application and surveillance mechanism in primary healthcare institutions. MethodsHealthcare workers in seven township hospitals in Gaolan county, Gansu province were given a questionnaire to test their knowledge, attitudes and behaviour regarding Clinical practice guidelines. ResultsAmong the 143 distributed questionnaires, 143 valid were retrieved. The results showed that 80% of respondents knew the guidelines and 51% had used guidelines in treatment, 32% obtained guidelines mainly through distribution by affiliations. The most popular type of guidelines was self-developed by native departments. Respondents (37%) considered difficult availability of guidelines major barriers to popularization, 74% failed to receive training about guidelines, 88% looked forward to special organizations in charge of disseminating guidelines and conducting related training on how to apply guidelines. ConclusionPrimary healthcare workers report low awareness of, attention to and compliance with clinical practice guidelines. The greatest challenge for guidelines' popularization in township hospitals is difficult availability and it is of vital importance for primary institutions to enhance guidelines' implementation and strengthen learning and conduct training.
The increasing need for healthcare services in rural areas cannot be satisfied because of the lack of healthcare professionals, and poor medical education and training. These result in the low competency of rural healthcare workers. Therefore, the medical education system needs to be reformed in order to improve healthcare human resources in rural areas.
ObjectivesTo investigate the utilization of essential medicines and antibiotics in primary healthcare system of Xinjin county of Chengdu city from 2009 to 2011. MethodsThe data of utilization of all the medicines, essential medicines and antibiotics was collected from 17 hospitals of Xinjin primary healthcare system. Microsoft Excel 2003 was used to analyze the data. ResultsCompared with 2009, the total costs of medicines and essential medicines increased by 72.27% and 135.4% respectively in 2010. After the implementation of essential medicine policy in 2010, the proportion of essential medicines accounted for more than 90% in community healthcare centers (CHCs) and township hospitals (THs) and over 50% in county-level hospitals in 2011. In 2010, the average cost per prescription among outpatients increased by 3.51% in total, but deceased by 16.23% in CHCs/THs (RMB 15.09 yuan per prescription). In July of 2011, the policy to control the use of antibiotics was implemented in Xinjin county. The use of antibiotics decreased, but still accounted for over 30% in 9 out of 13 CHCs/THs. The use of bigeminy antibiotics and trigeminy antibiotics accounted for 0.42 to 5.56% and 0 to 0.44%, respectively. ConclusionsThe use of essential medicines increases in Xinjin county and met the national requirements. The average cost per prescription among outpatient decreases in THs and CHCs. After controlling the use of antibiotics, the proportion and cost of antibiotics is still very high, and irrational use of antibiotics probably still exists. The training and guide for evidence-based rational use of medicine should be enhanced in future.
Objective To explore the impact of community healthcare workers’ (CHWs) knowledge, attitude and practice (KAP) on the influenza vaccination among elderly people. Methods By means of simple random sampling, 1 residential quarter of each communities, 2 communities of each districts, 5 districts of Chengdu city were randomly selected, and the elderly equal to or more than 60-year-old were on-site investigated. Meanwhile, the questionnaire survey was conducted among healthcare workers in the selected communities. Results There were 4 KAP factors played a positive role in influenza vaccination among elderly people: CHWs’ affirmation of the effectiveness of influenza vaccine, explicitly knowing the focus groups for influenza vaccination, recommendation of vaccination in flu season when the elderly visits, and participation in flu-related education activities. When the accuracy rate of each factor got improved by 1%, the influenza vaccination rate would improve by 2.747%, 1.299%, 0.864%, 0.602%, respectively. Conclusion The knowledge, attitude and practice of HCWs have impacts on the influenza vaccination rates of elderly people. They are significant to improve the influenza vaccination rates of the elderly.
Integration of heterogeneous systems is the key to hospital information construction due to complexity of the healthcare environment. Currently, during the process of healthcare information system integration, people participating in integration project usually communicate by free-format document, which impairs the efficiency and adaptability of integration. A method utilizing business process model and notation (BPMN) to model integration requirement and automatically transforming it to executable integration configuration was proposed in this paper. Based on the method, a tool was developed to model integration requirement and transform it to integration configuration. In addition, an integration case in radiology scenario was used to verify the method.
ObjectiveTo systematically map the research landscape, hotspots, and evolutionary trends of Chinese-language literature on value-based healthcare (VBHC) in China, and to provide evidence for advancing localized VBHC research and practice. Methods VBHC-related publications published between January 1, 2006 and August 30, 2024 were retrieved from the China National Knowledge Infrastructure, Wanfang Data, and VIP database. CiteSpace was used for visualized bibliometric analyses, including co-authorship, institutional collaboration, keyword co-occurrence, clustering, burst detection, and timeline mapping. Results A total of 237 articles were included. Since 2017, VBHC-related publications in China have increased markedly. Collaboration networks among institutions and authors showed low density, indicating relatively weak and fragmented cooperation. High-frequency keywords included “value co-creation” “public hospitals” and “value orientation”. Burst analysis identified “healthcare costs” “value co-creation” and “medical insurance payment” as major recent research focuses. The timeline map suggested three stages in the evolution of VBHC research: initial exploration, emerging development, and rapid growth of research hotspots. ConclusionsInterest in VBHC research in China continues to grow, yet collaborative research and interdisciplinary integration remain limited. Future efforts should strengthen cross-institutional and cross-disciplinary collaboration, promote the development of shared data platforms, and build VBHC evaluation frameworks tailored to China’s institutional context.