Analysis of the Influencing Factors for Tiered Medical Service in Dog-bite Clinic of Dujiangyan City_West China Medical Journal

Authors：

 YangDingjun ^1,2 ,  CaoYu ¹ , FuLezhang ² , YangXiaoyan ²

1. West China School of Medicine/Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Emergency Department, Dujiangyan People's Hospital, Dujiangyan, Sichuan 611830, P. R. China;

Corresponding author：

CaoYu, Email: yuyuer@126.com

Keywords：

Dog-bite clinic; Tiered medical service; Comprehensive hospital

DOI：

10.7507/1002-0179.201600551

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Objective To explore the possible factors which can influence the tiered medication situation in dog-bite clinic in comprehensive hospitals and village (community) health service centers, in order to provide references for the standardization of the diagnosis and treatment for dog-bite exposed patients. Methods We conducted a retrospective observational study, searched the database of Dujiangyan Center for Disease Control and Prevention, and collected all the information of dog-bite patients administrated by village (community) health service center or hospital from January 2012 to December 2015.Then we investigated the patients' satisfaction and clinical workers' familiarity of dog-bite injury treatment protocols by questionnaires in March 2016.The data were analyzed with statistical description and chi-square test, to explore the possible factors which might influence the tiered medication situation for patients exposed to dog bite in Dujiangyan city. Results There was one comprehensive hospital and 27 township (community) health centers included in this study.During the study period, the total number and proportion of dog-bite injury patients admitted in the comprehensive hospital decreased year by year, especially for the number of grade-two dog-bite exposure patients.One the contrary, the total number and proportion of patients administrated by township (community) health service centers increased year by year, especially for the number (proportion) of grade-two and grade-three dog-bite exposure patients, which increased to 1 944(44.10%) and 1 248(28.31%), respectively.The results also showed that there were significant differences between the comprehensive hospital and township health centers in the satisfaction and familiarity investigation (P < 0.05). Conclusions Township and village (community) health service centers are treating many more patients than the comprehensive hospital, but with a lower satisfaction rate.The distribution of dog-bite exposure patients visiting different degrees of hospitals are generally consistent with tiered medication policy.However, township and village (community) health service centers are recommended to strengthen the staff training about how to deal with dog-bite injuries standardly in order to improve patients' satisfaction.

Citation： YangDingjun, CaoYu, FuLezhang, YangXiaoyan. Analysis of the Influencing Factors for Tiered Medical Service in Dog-bite Clinic of Dujiangyan City. West China Medical Journal, 2016, 31(12): 2013-2016. doi: 10.7507/1002-0179.201600551 Copy

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1. WHO. WHO expert consultation on rabies[J]. World Health Organ Tech Rep Ser, 2005, 931:1-88, back cover.
2. 杨绍基, 任红.传染病学[M]. 7版.北京:人民卫生出版社, 2008:109.
3. Jibat T, Hogeveen H, Mourits MC. Review on dog rabies vaccination coverage in Africa:a question of dog accessibility or cost recovery?[J]. PLoS Negl Trop Dis, 2015, 9(2):e0003447.
4. Lewis KT, Stiles M. Management of cat and dog bites[J]. Am Fam Physician, 1995, 52(2):479-485, 489-490.
5. 杨鼎君, 付乐章, 代蓉.我国犬伤门诊的设置和运行情况[J].健康必读:中旬刊, 2013, 12(8):29-30.
6. 夏咸柱, 俞永新, 侯云德, 等.加强我国狂犬病防控[J].中国病毒病杂志, 2011, 1(3):161-162.
7. World Health Organization. WHO hosts milestone international conference to target global elimination of dog-mediated human rabies[EB/OL].[2016-06-06]. http://www.who.int/rabies/international_conference_dog_mediated_human_rabies/en/.
8. 王军.狂犬病暴露预防处置工作规范[J].中国工作犬业, 2010(2):60-61.
9. 岳勇, 奚川, 张亚兰, 等. 2010年成都市居民犬伤规范处置情况调查[J].寄生虫病与感染性疾病, 2013, 11(3):133-137.
10. 李师耿, 罗培培, 涂旭升. 2015年广州地区部分犬伤暴露病例的回顾性分析[J].中国现代药物应用, 2016, 10(9):290-291.
11. 徐涛, 李彦, 宋瑛, 等. 2009年四川省疾病预防控制中心犬伤门诊病例流行病学调查[J].预防医学情报杂志, 2010, 26(6):474-476.
12. Giesen A, Gniel D, Malerczyk C. 30 Years of rabies vaccination with Rabipur:a summary of clinical data and global experience[J]. Expert Rev Vaccines, 2015, 14(3):351-367.
13. 尹和平, 霍建国.狂犬病暴露者狂犬病疫苗免疫失败的原因分析[J].泸州医学院学报, 1996, 19(6):411-413.
14. Ellis R, Ellis C. Dog and cat bites[J]. Am Fam Physician, 2014, 90(4):239-243.
15. 李靖, 羊海涛, 孟繁岳, 等.强化狂犬病暴露处置门诊健康教育的必要性与可行性[J].职业与健康, 2012, 28(19):2312-2315.
16. Crowcroft NS, Thampi N. The prevention and management of rabies[J]. BMJ, 2015, 350(14):g7827.
17. Millien MF, Pierre-Louis JB, Wallace R. Control of dog mediated human rabies in Haiti:no time to spare[J]. PLoS Negl Trop Dis, 2015, 9(6):e0003806.
18. 李腾辉, 石应康.提高医院门诊服务魅力质量的对策研究[J].华西医学, 2015, 30(7):1334-1336.
19. 欧志梅, 杨梅, 李志春, 等.成都市主城区犬伤门诊977名服务对象满意度调查[J].现代预防医学, 2013, 40(1):82-85.
20. 郑志方, 朱乃庚, 张青黄, 等.蚌埠市某三级医院患者满意度影响因素调查分析及对策研究[J].中华全科医学, 2012, 10(2):274-275.

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Analysis of the Influencing Factors for Tiered Medical Service in Dog-bite Clinic of Dujiangyan City

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