Objective To understand the current situation of medical service and management in Luxi township health center (LxC) in Yongxin county of Jiangxi province, so as to provide baseline data about drug allocation, logistic key techniques research and products development for township health centers. Methods By means of questionnaire and focus interview, the LxC was investigated from the following aspects: general information, human resources, medicine list, basic device configuration, medical service and management, as well as service efficiency. Results a) Yongxin county including 13 village committees covers an area of 86 km2, with the population of 22 300 in 2009, and it pertains to a backward area with the annual per capita income of RMB 4 100 yuan; b) Among the total 28 staffs in LxC, 78.6% were health workers; the general practitioner (GP)/nurse ratio was about 1?0.58; the proportion of GP, nurses, medical technicians, other staffs was 54.55%, 31.82%, 9.09% and 4.54%, respectively; the proportion of bachelor degree, junior college graduation and secondary technical school graduation was 9.1%, 13.6%, and 77.3%, respectively; and the ratio of elementary, middle, and high professional title of health workers was 15?5?1; c) There were 625 species of drugs in LxC in 2009, and the hospital beds approved by government were 0.69 per thousand agricultural persons, which, however, were 1.15 in fact. The rate of 51 basic equipments shown in national regulation was actually 76.5%, and the readiness and utilization rate of existing 40 equipments was 92.5%; and d) In 2009, the outpatients were 12 150 person-time, with the average cost of RMB 29.39 yuan; the hospital discharge was 1 589 person-time, with the average stay of 12 days and the average cost of RMB 490.05 yuan; the vaccine inoculations were 5 053 person-time; among the total income, the medical service income accounted for 73.2%, while the drug income accounted for 53.7%; the personnel expenditure was 31.0% of the total, and the balance of income and expenditure was RMB –263 500 yuan. Conclusion The hardware condition of LxC is not so good owing to the financial difficulties of Yongxin county and Jiangxi provincial government. In comparison with the whole country, although the professional title structure is ok, health workers are still not enough, with unreasonable specialty structure and low educational background. The rate of basic equipments and the approved hospital beds per thousand agricultural persons are low. There are 625 species of drugs, containing 218 species shown in 2009 national essential medicine list. And the other conditions are as follows: no information system, lack of public health service, short of financial input, high ratio of “running hospital by selling drugs”, and low efficiency of medical service. So the top priority of LxC construction should be figuring out all of the above issues, and better serving the people.
Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan, Gansu province, and to discuss its scientificity and rationality. Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county. The investigation contained three parts as follows: basic information of respondents, general information of clinical decision-making evidence, and comparison between respondents’ decision-making situation and current best clinical evidence. Results Among the total 108 questionnaires distributed, 89 valid were retrieved. The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks; 53% took curative effect into consideration in the first place; 33% failed to consider patients’ willingness properly when making clinical decisions; and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence. Conclusion While making clinical decisions, doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis, and fail to take patients’ value and willingness into consideration properly. It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.
Objective To understand the current situation of medical service and management in Xintian Central Township Health Center (XtC) through on-the-spot investigation, and to provide references for development of key techniques and products for township health centers in medicine allocation and delivery. Methods The questionnaire and the focus interview were carried out, which included the general information, human resources, medical service and management, as well as the practice of essential medicine list. Results a) The hardware conditions of XtC were not good enough, and the income of Lintao county and Gansu provincial government fell short of their needs; b) The General Practitioner (GP)/nurse ratio was higher than that of the national level, the GP/pharmacist ratio was a little bit lower, and the GP/laboratorian ratio reached the national level. There was only one medical technician. There was about 27.5% staff members having no college degree, and about 81% having at most primary profession titles. There were 26 medical workers allocated to XtC in recent two years and only one GP left; c) In 2009, the bed utilization ratio was a little bit higher than the national level (109% vs. 60.7%), while the average length of stay was longer than the national level (6 vs. 4.8); d) The outpatient service in 2010 increased by 17.6% compared to 2009 and the inpatient service in 2010 decreased by 17%; e) The average medical expense per outpatient and per inpatient increased by 23.5% and 14.9%, respectively, in 2010 compared to 2009; f) The essential medicine list (EML) was put into practice in June, 2010. The current count of medicine in hospital was 767, far beyond the EML demand. Conclusion XtC, as a basic rural Township Health Center in Western China, overtakes the burden of healthcare service for local population. The policy of “selecting graduates to work in Township Health Center” made by Gansu government ensures sufficient personnel reserve for rural Township Health Center. XtC needs to cope with challenges of insufficient hardware conditions, unreasonable personnel structure, low educational background and profession title of the staff, and low technical level of medical service. XtC has a big ratio of medicine income and the expense of outpatient is lower than that of the national level. The management of XtC may be influenced by zero-profit price of the essential medicine, and appropriate subsidy and policy support are needed to maintain its service quality. And it is necessary to carry out evidence-based selection of the essential medicine account and develop staff training and essential medicine usage guidance, so as to support the medicine used safely and rationally.
Objective To investigate the inpatients’ disease constitution and cost in Xintian Central Township Health Center (XtC) in Lintao County of Gansu Province from 2008 to 2010, so as to provide baseline data for further research. Methods The questionnaire and the focus interview were carried out, the case records and the cost information of XtC inpatients in 2008, 2009 and 2010 were collected. The diseases were classified according to ICD-10 based on the first diagnosis and the cost was analyzed. Data including general information of the inpatients, discharge diagnosis, hospitalization expenses, and drug cost etc. were rearranged and analyzed by Excel software. Results a) The total number of inpatients was 1 212, 1 425 and 1 857, respectively, in 2008, 2009 and 2010. The female was more than the male in 2010 (57.68% vs. 42.32%), and their disease spectrum included 19 categories, which accounted for 90% of the disease classes of ICD-10; b) The constituent ratio of the top seven systematic diseases that inpatients suffered from in recent three years accounted for 89.18% to 92.21%, which included the digestive, respiratory, circulatory, urogenital, musculoskeletal and connective tissues disease, pregnancy, labor and puperium disease, and injury and toxicosis. Except for the injury and toxicosis, the female was more than the male in most of the rest main systematic diseases; c) The top 15 single diseases were acute upper respiratory infection, chronic tracheitis or bronchitis, gastritis or chronic gastritis, coronary heart disease, hypertension, pulmonary infection, urinary tract infection, lumbar vertebra disease, fracture, superficial injury, acute appendicitis, normal labor, cervical spondylosis, acute gastroenteritis, and cholecystolithiasis or cholecystitis; d) The main disease burden of inpatients focused on the age groups as above 65, 15 to 24 and 35 to 54 in 2010. Except for the fracture, acute tracheitis or bronchitis, and lumbar vertebra disease, the female was more than the male in most of the rest main single diseases; gastritis or chronic gastritis and lumbar vertebra disease focused on the age group above 35; acute upper respiratory infection covered all ages in 2010 and has ranked as the first during the past three years; e) In recent three years, the aggregate constitutional ratio of the top 15 single diseases accounted for 67.53% to 71.36%, including six to seven chronic diseases, and eight to nine acute diseases focusing on infection and trauma; and f) The inpatients’ average costs of chronic diseases were higher than those of acute diseases in 2010 (RMB 1 311.81 yuan vs. RMB 906.85 yuan), and were also higher than those of either Yong’an Central Township Health Center (RMB 1 150.59 yuan) or Gao Zha Central Township Health Center (RMB 1 002.99 yuan). Conclusion?a) In the recent three years, the main systematic diseases are in digestive, respiratory and circulatory system; the incidence of acute disease which mainly focuses on infection and injury is more than that of the chronic; and the acute upper respiratory infection has ranked as the first during the past three years; b) The inpatients in 2010 are mainly at the age of 15 to 24, 35 to 54, and over 65 years old as well. Except for injury and toxicosis, the female inpatients are more than the male in most of the other diseases; c) The inpatients’ average costs of chronic diseases in 2010 are higher than those of acute diseases, and also higher than those of either YaC or GzC. Consideration on rationality of hospitalization cost should be paid attention to; and d) It is urgent to strengthen the construction of infrastructure and informationization in XtC.
ObjectiveTo investigate the status and problems of facility allocation in 22 health service centers and township health centers in Fucheng District of Mianyang city, in order to provide references for improving health services in these medical units. MethodsAccording to the national guidance of facility configuration in township hospitals, the questionnaire was made to survey on the allocation of medical facilities, durable years and frequency of use in 22 medical units of Fucheng district (11 urban community health service centers and 11 township health centers) from November to December 2010. The descriptive and stratified analysis was performed for the survey results. ResultsMost equipment and facilities required in "Guide Criteria for Installation of Equipment and Facilities in Urban Community Health Service Centers" including facilities for diagnosis, treatment and health education were not installed and there were problems of poor property and low frequency of use. The medical equipment was seriously inadequate in 11 township health centers. ConclusionCommunity basic equipment resource should be improved as soon as possible.