Objective To understand the current situation of Chengdu primary health workers’ performance baseline, and to provide decision-making proof and policy recommendations for Chengdu Coordinated and Balanced Urban-rural Development as well as improve primary health workers’ performance in China. Method See the second study in this series. Result The number of the patients of the Chengdu seven Rural Hospitals / Centers showed a trend of slow increase, and all was higher than the national rural hospital average level except the 2 most remote rural hospitals(“Renhe” and “Bailu”). The seven Rural Hospitals / Centers could provide data about the “Six in One” work, and the performance was generally better than that of the world and the national average level , but showed a decreasing trend from the first circle to the third circle in Chengdu. The rate of patients’ satisfaction and very satisfaction for the Rural Hospitals / Centers “Six in One” work reached 65%-80%, but the rate of health workers’ job satisfaction and very satisfaction only reached 9%-46%, and also showed a decreasing trend from the first circle to the third circle. Conclusion The Chengdu primary health workers provide “Six in One” health service with a higher quality than the world and the national average levels. However, the number of the workers is less than enough; the human managerial structure is irrational; the educational and professional levels are low; their treatment and the work environment are poor. The distribution density , the academic qualification and the structure rationality of professional ranks of health personnel show a decreasing trend, and the difficulty of the service is gradually increasing from the first circle to the third circle, which causes the satisfaction rate of the workers’ job to decrease gradually from the first circle to the third circle. Suggestion: ① To make special performance assessment standard for special health institutions or personnel, and to give the continual oriented training chance for current health personnel. ② To integrate the regional health resources; to establish long-term and stable regional bilateral appointment help policy, technical and rational two-way referral system and indicator systems. ③ To take measures to solve the problems affecting the professional promotion and improvement of the grass-root health personnel.
Objective To provide references for the rational allocation of health personnel in rural hospitals through understanding the status of health human resources of rural hospitals in remote and poor areas of Sichuan Province. Methodes This study used cluster sampling method, combined with questionnaire survey and qualitative interviews. A total of 711 health workers of 29 rural hospitals in Pengzhou and Baoxing of Sichuan Province were interviewed. SPSS16.0 was used for descriptive analysis.Results The average age of rural hospitals health personnel in remote and poor areas of Sichuan Province was 30 years old. Post-secondary education accounted for 58.12%, and Bachelor degree or above accounted for 7.2%. The number of medium and senior professional titles account for 8.4 %. The ratio of doctors to nurses was 1:0.55. In the survey of health workers, those doctors with practice (assistant) license accounted for 38.5%, and those without any qualification occupied 27.1 %. Conclusions The professional titles of medical personnel of rural hospitals in remote and poor areas in Sichuan province are generally low. The distribution of professional categories is irrational. The staff in charge of prevention and care are inadequate. There exist a large number of unqualified medical workers. Therefore, the government should increase the investment in rural health and take measures to stabilize the team structure, introduce the talented, and strengthen the training for health personnel of rural hospitals to improve their overall quality.
ObjectivePublic health information collection is critical in improving the capacity of basic public health services. Our study took the "Wei Jian E Tong" APP as an example to evaluate the willingness and influencing factors of rural public health service personnel to continue using such APPs.MethodsWe applied exploratory sequential design in mixed-method research and chose Renshou county in Sichuan province as the representative region. Firstly, we used the personal in-depth interview to initially explore the status quo, applicability, continued willingness to use APP and other issues. Secondly, we used unified theory of acceptance and use of technology (UTAUT) and expectation confirmation theory (ECT) to construct a hypothetical model of influencing factors of user satisfaction. We then designed a structured questionnaire covering 7 measurement dimensions to survey all users of the APP at the survey site. Finally, we used structural equation model to verify the research hypothesis.ResultsA total of 21 individuals were interviewed in this survey, including leaders of township health centers, public health doctors, and rural doctors. Qualitative results showed the major defects were insufficient funds and policy support in the promotion and application, additionally lack of software functionalities and system incompatibility. A total of 593 valid questionnaires were collected from the quantitative survey on the satisfaction of township doctors and village doctors. Structural equation model results showed that seven direct hypotheses were established, of which compatibility had the largest effect value user satisfaction with a total effect value of 0.617, followed by facilitating condition (r=0.211), performance expectancy (r=0.137), effort expectancy (r=0.091) and social influence (r=0.068).ConclusionsTo promote the application of information collection apps in primary public health services and improve user satisfaction, the focus should be on solving software incompatibility and create interconnection among all levels of medical systems. At the same time, it is necessary to solve funding problems as a whole, optimize software functions, improve the performance evaluation system, and improve software training and promotion.
Objective To understand the situation of commonly-used drugs, medical device and their storages in rural households among model well-off township hospitals in eastern, central and western China, and to provide the basis for the guidance of reasonably using and scientifically storing drugs. Methods The methods of combining simple random sampling and cluster sampling were used to investigate and analyze the situation of commonly-used drugs, medical device and their storages in 162 households from three well-off township hospitals in Shanghai, Zhejiang, and Sichuan provinces, respectively. Results The storage rates of commonly-used drugs of rural households in well-off towns were cold medicine (72.2%), wound paste (51.9%), cooling oil (39.5%), essential balm (36.4%), antihypertensive (27.8%), iodine tincture (14.2%), anti-diabetic drugs (13.0%) and other drugs (17.3%). The storage rates of medical devices were thermometer (50.0%), cotton swab (47.5%), sphygmomanometer (9.3%), injector (1.2%) and other devices (22.2%). A total of 66% of respondent families stored drugs and medical devices in a fixed drawer. Only 3.1% families stored drugs and medical devices in the special portable medical kit. Conclusion Rural families have a higher rate of household drugs among model well-off township hospitals in eastern, central and western China, and most drugs are OTC drugs. The storage rates of medical devices are not high. Many rural family-owned medical devices are linked with special chronic diseases in the family. A lot of rural families place drugs and medical devices randomly. There are many security risks, and it may affect the rational utilization of drugs.
Objective To investigate the satisfaction of participants in Wenjiang District of Chengdu regarding the New-style Rural Cooperative Medical Care (NRCMC), and to analyse its factors in order to help the decision makers optimize and improve the scheme in the future.Methods Three towns of Wenjiang District were selected for study by computer simple random sampling. Five percent of NRCMC participants were randomly selected in Wenjiang for a face-to-face interview using a questionnaire. Data entry and statistical analysis were completed by Epidata 3.0 and SPSS 11.5 respectively. Results A total of 2500 questionnaires were conducted for face-to-face interviews, and 2438 questionnaires were returned (response rate 97.6%); 58% participants were satisfied with NRCMC, and the results of stepwise multiple logistic regression analysis indicated that their desire to participation (partial regression coefficient B=-3.54, P=0.014) and the satisfaction with the present compensation proportion (partial regression coefficient B=-4.62, P=0.018) were the most important factors that influenced the total satisfaction with NRCMC.Conclusion It is of great significance to strengthen the promotion of NRCMC; reasonably establish the compensation mode and proportion; encourge voluntary participation for the sake of their benefits to improve the quality and performance of NRCMC.
ObjectiveTo understand the treatment status and economic burden of convulsive epilepsy patients in Hailin City, Heilongjiang Province, who had received an epilepsy management program that was terminated for 6 years, and to estimate the long-term effect of the epilepsy management program.MethodsFollow up the 234 patients in the program of epilepsy prevention and management in rural areas at the end of December 2011 by standardized questionnaire and interview.ResultsAmong the 234 patients who received antiepileptic drugs (AEDs) and follow-up management at the end of epilepsy prevention and management program in rural areas, 172 patients received Phenobarbitone (PB) and 62 patients received Sodium valproate (VPA). 86 patients completed the survey. Among them, 46 (53.49%) were still taking original drugs, 31 (36.05%) changed to other AEDs, 9(10.47%) gave up the treatment due to the closure of the program. The treatment costs of patients in adherence group were also lower than that of other patients, and the average cost was only 43.61% of that of the replace group. There were statistical significant differences in annual household income, drug costs, offset seizure frequency and current seizure frequency between the two groups.ConclusionThe epilepsy management program had remarkable long-term effects and short-term effects, it had advantages in treatment effect and reducing drug costs. It could be recommended throughout rural China.
ObjectiveTo investigate the prevalence and risk factors of hypertension in urban and rural residents in Chengdu. MethodsA cluster random sampling survey was carried out from February to October in 2010. A total of 2 011 residents aged 35-70 years in four communities of Chengdu (two communities in urban area, two in rural area) were investigated for the incidence of hypertension. Analysis was performed using SPSS 18.0 software. ResultsThe standardized prevalence of hypertension was 31.30% among residents aged 35-70 years, which was much higher in urban than that in rural:39.03% vs. 24.90% (P < 0.05). The results of multivariate logistic regression analysis showed that, age, waist, heart rate, fasting blood glucose and education level were the major risk factors of hypertension for male; while age, waist, heart rate, fasting blood glucose, triglyceride and uric acid were the major risk factors for female. ConclusionThe prevalence of hypertension in urban is higher than that in rural in Chengdu. Prevention and intervention should be performed more for whom have increased waist circumfluence, abnormal levels of fasting glucose, and increased heart rate.
ObjectiveTo investigate the prevalence of impaired glucose regulation (IGR) and IGR combined with cardiovascular risk factors in rural areas of Chengdu City. MethodsFrom February to October 2010, we randomly sampled 1 016 patients in a rural community 100 kilometers away from the city center as the study subjects. The investigation was carried out by using questionnaire survey, physical examination and laboratory tests. The standard 75 g oral glucose tolerance test was used. ResultsA total of 1 016 subjects were investigated, among whom there were 431 males and 585 females with an average age of 56 years old. Of these subjects, 333 were diagnosed to have IGR with a rate of 32.77% (333/1 016). The age-adjusted standardized prevalence of pre-diabetes in rural areas in Chengdu was 32.52% (336/1 016), and the male and female prevalence were respectively 30.63% (132/431) and 34.36% (201/585) without significant difference (χ2=1.569，P=0.210). Impaired glucose tolerance (IGT) was the most common type of glycometabolism abnormality. Women had a significantly higher prevalence of IGT than men. In IGR population, major cardiovascular risk factors were overweight and obesity (40.8%), high low density lipoprotein cholesterol (38.4%), high triglyceride (30.3%), hypertension (23.7%), smoking (24.3%), and drinking alcohol (23.7%). The stratified analysis showed that the prevalence of overweight, obesity and low high density lipoprotein cholesterol in female was significantly higher than that in males, while the prevalence of smoking and drinking alcohol was significantly higher in males. ConclusionIn rural areas, the prevalence of pre-diabetes is high and complicated with multiple cardiovascular risk factors.
ObjectiveTo systematically review the implementation status, effectiveness and existing problems of nutrition improvement measures for vulnerable populations in rural areas of China. MethodsAll studies about the implementation status, effectiveness and existing problems of nutrition improvement measures for vulnerable populations in rural areas of China were electronically searched in VIP, CNKI, WanFang Data and CBM from inception to January 1st, 2014. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies, and then performed qualitative analysis in terms of implementation effectiveness and situation. ResultsA total of 79 studies were finally included. The results of qualitative analysis showed that:the earliest study was published in 1990; 38.0% of these studies were carried out in the southwest and northwest areas of China; 31.6% of these studies were financially supported, and most funds were provided by some international institutions; 90.0% of these research subjects focused on infants and children (under the age of 10); a variety of nutrition improvement measures had been taken, and 55.7% of these interventions measures were nutrition education which could be implemented easily; the implementation duration of 38.0% of these measures lasted less than half a year; 32.9% of these studies adopted the blood test to evaluate the outcomes of nutrition measures; all of the studies showed that nutrition levels of vulnerable populations in rural areas of China had been obviously improved by these measures. ConclusionThe nutrition improvement measures for vulnerable populations in rural areas of China have been implemented relatively earlier focusing on populations in West China where was less developed. However, an imbalance exists in the attention to target populations, especially to the elderly. Face to face nutrition education is most frequently taken; however, it could not directly reflect the changing of nutritional status. In addition, implementation duration is fairly short which indicates that more fund supports are needed from the government or institutions.
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.