Objectives To investigate the personnel allocation and workloads of the medical residents across the subspecialties of the Department of Internal Medicine at a tertiary hospital. Methods A cross-sectional survey was performed to investigate personnel allocation and workload. The resulting data were compared with the ministerial standard that regulates the training of medical residents. Results Aside from the subspecialty of Rheumatology, medical residents accounted for 40% to 70% of the total staff physicians. The faculty physicians accounted for only 20% to 50% of the total. When the non-faculty residents were not taken into account, each individual faculty physician took charge of between 5.3 to 15.5 beds across all the subspecialties. When only the non-faculty residents were accounted for, each individual resident took charge of 1.7 to 9.4 beds, 1.3 to 5.7 bed-days per day, and 5.8 to 17.3 patients per month. When both were accounted for, each physician was responsible for 1.3 to 5.9 beds, 1 to 3.6 bed-days per day, and 4.2 to 10.7 patients per month. In comparison with the ministerial standards, medical residents have managed more patients per month in the subspecialties of Nephrology, Respiratory Diseases, Digestive Diseases, Neurology and Infection.Fewer patients were managed in the subspecialty of Endocrinology. Conclusion The medical resident allocation is balanced across the subspecialties of the Department of Internal Medicine, although it is less stable. The total number of physicians is smaller than required, and physicians generally bear an overload of work. The number of patients managed by each individual resident is more than the requirement set by the ministerial standards, and has significant variations across subspecialties. Medical residents need to be allocated in accordance with the corresponding workloads.
【摘要】 目的 研究自贡市急救中心院前急救流行病学特征。 方法 回顾性分析2009年度自贡市急救中心出诊的院前急救数据，研究院前急救疾病谱及性别、年龄构成，并分析时刻及季节分布特点，描述院前急救转归。 结果 2009年度自贡市急救中心院前急救共4 588例，排前6位疾病依次为损伤、中毒和外因的某些其他后果（45.6%），循环系统疾病（15.0%），呼吸系统疾病（6.3%），神经系统疾病（6.0%），精神和行为障碍（5.6%），消化系统疾病（4.9%）；性别构成男性多于女性（Plt;0.05）；年龄构成以中老年较多，青少年儿童较少（Plt;0.05）；时刻分布规律高峰点为15点40分（Plt;0.05），季节分布以冬季较多（Plt;0.05）；患者转归以住院、留院观察为主，院前死亡人数占比例为3.8%。 结论 根据院前急救流行病学规律，可以合理配置急诊资源，增强应急救援能力，满足民众不断增加的医疗需求。【Abstract】 Objective To research on the epidemiological characteristics of the prehospital cases in Zigong emergency rescue center. Methods We retrospectively analyzed the database of prehospital cases in Zigong emergency rescue center in 2009, and reviewed the prehospital disease spectrum, gender composition, age structure, the circadian and seasonal distribution, and the outcomes of these cases. Results A total of 4 588 prehospital victims in Zigong emergency rescue center were enrolled. In the study, six leading diseases were injury, poisoning and certain other consequences due to external causes (45.6%), diseases of the circulatory system (15.0%), diseases of the respiratory system (6.3%), diseases of the nervous system (6.0%), mental and behavioral disorders (5.6%), and diseases of the digestive system (4.9%). Male patients were more than female patients (Plt;0.05). The proportion of the aged and the middle-aged was significantly larger than that of young population in the same districts (Plt;0.05), and the occurrence of prehospital care usually peaked at 15:40 (Plt;0.05). Prehospital care had a higher incidence in winter (Plt;0.05), and the outcome of prehospital cases was mainly in hospital and in observation ward. The proportion of deaths was 3.8%. Conclusion We can allocate emergency resources reasonably in prehospital care, and promote the ability of rescuing in order to meet people′s medical demands on the basis of the epidemiological study in our city.
ObjectiveTo investigate the demand of pediatric health service, the current situation of resource allocation and the equity of health service, so as to provide guidelines for optimizing the resource allocation of pediatric health service in Sichuan province.MethodsA questionnaire of all healthcare institutions with legal capability from a total of 183 prefectures in Sichuan province was performed in 2015. We described the demand of pediatric health service by two-week hospital visit rate, the proportion of no-visit rate within two-weeks, hospital admission rate, and the patient required hospitalization rate. We assessed current situation of resource allocation, equity and accessibility by analyzing Gini coefficient, Lorenz curve and thermodynamic diagram.ResultsThe demand of pediatric health service in Sichuan province was huge and the current resource allocation can be shown a " inverted triangle” form. According to population distribution, the Gini coefficients of physician, bed and equipment were 0.47, 0.40 and 0.49, respectively, which represented inequality in resource allocation. By location, the Gini coefficients of physician, bed and equipment were 0.82, 0.77 and 0.81, respectively, which indicated an absolutely unfair situation.ConclusionsThe health resources of pediatric in Sichuan province are limited, the distribution is unbalanced, and the supply of pediatric healthcare is not compatible with demand. The lack of resources and waste coexist simultaneously. Furthermore, the fairness of distribution in terms of geographical areas is far less than that in terms of population. The accessibility of superior health resources is low.
ObjectivesTo evaluate the fairness of medical resource allocation in the five provinces in Northwest China from 2006 to 2017 so as to provide scientific basis for the optimal allocation of medical resources in Northwest China.MethodsThe Gini coefficient and Theil index were adopted to evaluate the fairness of medical resource allocation from the two dimensions of population and geography.ResultsThe Gini coefficient was above 0.4 in terms of population allocation and geographical distribution in the five provinces in Northwest China from 2006 to 2011, which indicated the medical resources were unbalanced in the five provinces. The Gini coefficient had gradually declined from 0.4 from 2012 to 2017, which indicated the equity of medical resource allocation in the five provinces in Northwest China had gradually become reasonable. The total Thiel index of medical resources in the five northwest provinces in Northwest China from 2006 to 2017 ranged from 0.0829 to 0.187 4. Equity of medical resource allocation: allocation by population was superior to that by geography.ConclusionsIt is necessary to optimize the structure of human medical resources in the five northwest provinces, promote the coordinated development of medical human resources allocation, and narrow the gap of medical resources among the five provinces in Northwest China.
ObjectiveTo evaluate the equity of health care resource allocation in Shanghai and the changing trends from 1995 to 2018.MethodsBeing based on the Gini coefficient and the Theil index, the equity of health care resource allocation in Shanghai from 1995 to 2018 was comprehensively evaluated from the perspective of "demographic equity" and "geographic equity", and the Mann-Kendall non-parametric test was used to predict the trends of changes.ResultsThe Gini coefficient of the distribution of medical and health resources by population in Shanghai from 1995 to 2018 was 0.225 9 to 0.411 9, and the configuration was in a normal or optimal state with an increasing trend. The Gini coefficient distributed by geographic area was 0.892 4 to 0.979 3, which was in a disadvantaged state and a decreasing trend. The overall Theil index ranged from 0.010 9 to 0.058 1, which was a more equitable configuration, but with a decreasing trend. In addition, both the Gini coefficient and the Theil index showed that equity improvements were mainly influenced by the number of health facilities and beds, with health facilities contributing the most to equity, while the disparity in health technician staffs was the main reason for the decline in equity. Inequities in the allocation of health facilities and the number of beds originated mainly within regions, while inequities in the allocation of health technicians originated mainly between regions.ConclusionsThe allocation of health care resources in Shanghai is more equitable and the equity has been on the rise in recent years. However, at the present stage, there is still a contradiction between equitable allocation by population and inequitable allocation by geographic area, and in the future, there is a contradiction between the tendency of inequitable allocation by population and the tendency of equitable allocation by geographic area. Optimizing the allocation of health technicians is the key to improving equity, and addressing regional differences in allocation is an effective way to optimize the allocation of health technicians.