Objective To provide basic data for further application of national essential medicine list (EML) in Chengdu, through a survey of key-workers or persons, who attended the lecture of EML, in charge of village town hospitals or community medical service centers, and to find out their awareness of and attitudes to the essential medicine and requirements and suggestions for EML training. Methods Based on principles and methods of modern cognitive psychology, we designed the questionnaire and carried out the survey face to face. Two people input the data independently and verified them. Proportions were used to analyze the data through the Excel software. Results (1) The proportions ofcorrect answers to the questions of essential medicine conception, use range of EML and the relationship between EML and essential insurance medicines list were 89%, 91% and 87%, respectively. (2) 46% of the persons investigated (117 persons) chose “always consider preferentially using the essential medicine when prescribing”, 31% (81 persons) “consider using the essential medicine in most cases”. (3) 41% of the persons investigated (103 persons) chose “comparatively welcome” for the EML. (4) Problems of implementing EML in village town hospitals or community medical service centers, in the order of importance decreasing, were: “income and compensation”, “awareness of the essential medicine and prescribing habit of the doctor”, “patient’s cognition of essential medicine and preference to drug use”, “safety and effectiveness of the essential medicine”, “the applicability of essential medicine ” and “the purchase and delivery of essential medicine”, respectively. (5) The ways of getting information of essential medicine were 19.6% (187 person-time) through documents, 18.6% (177 persontime) through conferences and 15.3% (146 person-time) through lectures. (6) 60% of the persons investigated (154 persons) attended training of the essential medicine once or twice. (7) 77% of the persons investigated (196 persons) were trained for less than one week for essential medicine. (8) Requirements and suggestions on the training of essential medicine: 42% (71 person-time) enlarging the targeted people, 22% (38 person-time) increasing the training time,16% (27 person-time) improving practicability and specificity of training contents, 11% (18 person-time) diversifying training ways, 9% (15 persontime) requiring “training according to needs ” which addresses specific problems after investigation. Conclusion Training of essential medicine should be strengthened for medical workers in the village town hospitals or community medical service centers, and researches should be carried out on evaluation of EML applicability, performance of EML implementation, financial aiding, income of medical worker, procurement and reimburse, etc.
摘要:目的: 探讨基层医院急诊“120”院前救治水平的影响。 方法 :分析301例死因,年龄及百分比。 结果 :急诊致死原因疾病病谱前9位分别是交通事故,猝死,溺水,意外伤害,自杀,电击伤,刀伤,一氧化碳中毒及呼吸道梗塞,“无名氏”群体86例占285%,这部分给临床和社会带来了新问题,这仍有待今后继续探讨。 结论 :完善基层医院“120”体系,提高救治水平。Abstract: Objective: To explore the factors relate to prehospital“120”Emergency Medical Services cases death. Methods : Analysis the cause for death, ages and percentage of the age in 301 cases. Results : Traffic accident, sudden death, drowns, accident, suicide, electric burn, knife trauma, anthracemia and respiratory tract obstruction were the leading cases in the diseases spectrum of the cause for death in emergency cases. 86 cases were anonym, which brought new problems to clinic treatment and provoked social issue, accounting for 285% in total cases. These remain us to study henceforth. Conclusion : Consummate the “120” Emergency MedicalServices system in grassroots hospital and enhance the level of cure.
This article takes the regional cooperative medical service practice provided by the West China Hospital of Sichuan University as example, analyzes several problems with regional medical service practice in western region based on the introduction of the general situation and system of regional cooperative medical service provided by the West China Hospital. The problems are:lack of motivation to promote regional collaborative medical care, serious lag of policies, and lack of stratified configuration of tests/exams quality standards and construction standards of medical information system platform. This article puts forward the key point to promote western regional medical collaboration:strengthening government dominance, and establishing suitable medical insurance system and regional laboratory examination centre.
ObjectiveTo 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. MethodsWe 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. ResultsThere 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). ConclusionsTownship 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.
Objective To understand the residents’ demands and utilization of the community health services and provide a basis for the construction of reasonable medical service system. Methods From July to September 2015, a purposive sampling questionnaire survey on general team mode service to bring benefits to the community residents was conducted in 20 provincial-level administrative regions of the country. SPSS 13.0 software was used for data analysis. Results A total of 1 300 questionnaires were distributed, and 1 273 valid questionnaires were recovered. In the 221 residents who were aware of the composition of general team, the awareness rate of general team composed of traditional Chinese medical doctors and gynaecologists/pediatricians was low (70.14%, 75.11%, respectively). The awareness rate of medical services including disease diagnosis and treatment, health consultation, health education and prescription in the 1 273 residents was 70.46%, 61.19%, 59.62% and 67.56%, respectively; the residents’ top five willing to accept medical services was prescribing medicine (77.77%), infusion (74.08%), health consultation (73.21%), health education (70.54%), and planned immunization (64.49%). The biggest change of the 433 patients with chronic diseases before and after treatment in the community was the increase in self-health management (70.67%) and the healthy lifestyle improvement (56.35%). Conclusion Community general team should be oriented by the objective needs and real demands of the residents; based on the ability of medical services supply, the adjustment of the key points of medical services should be made and the rational use of medical services should be guided for the residents.
ObjectiveGiven the relatively limited resources available for tumor radiotherapy, the reengineering theory to the tumor radiotherapy process of a tertiary hospital is applied to improve the efficiency of medical service, shorten patient waiting time and improve patient satisfaction. MethodsThe tumor radiotherapy process of a tertiary hospital was studied from January 2017 to September 2018. The indicators such as efficiency and satisfaction were analyzed before reconstruction (from January to December 2017) and after reconstruction (from January to September 2018). ResultsAfter radiotherapy process reengineering, on the one hand, the medical efficiency was improved: the number of new patients for radiotherapy per month rose by 16.58% (P<0.05), and the number of daily radiotherapy increased by 5.80% (P<0.05). On the other hand, the patient treatment process became more concise: the preparation time was shortened from 2-3 days to 1 day, while the waiting time for radiotherapy was shortened by nearly 10 days, and the overall satisfaction of patients increased from 64.17% to 83.55%. ConclusionIt can improve the operation efficiency of tumor radiotherapy and improve patient satisfaction under the condition of relatively fixed resources through the reconstruction of the information-based tumor radiotherapy process.
The operation process of a hospital is a process of resource consumption. In order to compensate the cost of consumption, it is necessary to develop a reasonable pricing mechanism of medical services. This paper discusses the pricing mechanism of medical service from the aspects of researches on the pricing mechanism of medical service in Chinese mainland, the enlightenment of the application of the pricing mechanism of medical service in Hong Kong and Taiwan, China, as well as foreign countries, and the practice of hospital price management, so as to make suggestions on the reasonable formulation of the pricing mechanism of medical service.
ObjectiveTo compare the effects of different airway management strategies on outcomes of patients with out-of-hospital cardiac arrest (OHCA).MethodsWe searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and WanFang Data for relevant studies comparing the influence of different airway management strategies on outcomes of OHCA patients. The deadline was up to 31st May, 2019. Grading of Recommendations Assessment, Development and Evaluation system 3.6 was used for quality assessment, and RevMan 5.3 software was used for meta-analysis. Odds ratio (OR) and 95% confidence interval (CI) were used to conduct the comparison. Results A total of 20 studies were finally enrolled, including 880 567 OHCA patients. Compared with supraglottic airway (SGA), bag-valve mask (BVM) improved the rate of survival to discharge of OHCA patients [OR=1.45, 95%CI (1.01, 2.08), P=0.04], while the rate of return of spontaneous circulation (ROSC) was not improved (P>0.05); in the subgroup analysis, BVM and SGA had similar effect on the rate of ROSC and the rate of survival to discharge in Asian countries (P>0.05), while BVM performed better than SGA in the two rates in European and American countries. BVM and endotracheal intubation (ETI) had similar effect on the two rates (P>0.05). In Asian countries, ETI performed better than BVM in the rate of ROSC [OR=0.63, 95%CI (0.49, 0.81), P=0.000 3], and there was no statistically significant difference in the rate of survival to discharge between ETI and BVM (P>0.05); while in European andAmerican countries, BVM performed better than ETI in the rate of survival to discharge [OR=3.10, 95%CI (2.69, 3.56), P<0.000 01], and there was no statistically significant difference in the rate of ROSC between ETI and BVM (P>0.05). Compared with SGA, ETI improved the rate of ROSC [OR=0.68, 95%CI (0.62, 0.76), P<0.000 01] and the rate of survival to discharge [OR=0.89, 95%CI (0.81, 0.98), P=0.02]. In Asian countries, ETI performed better than SGA in the two rates (P<0.05); while in European and American countries and New Zealand, ETI performed better than SGA in the rate of ROSC (P<0.05), but there was no statistically significant difference in the rate of survival to discharge (P>0.05). Conclusions Different airway management strategies have differente effects on OHCA patients. The optimal airway management strategy when rescuing OHCA patients might be selected based on local emergency medical service system conditions.
Coronavirus disease 2019 epidemic is a serious and infectious public health event that causes physical damage and may also have an impact on mental health. West China Hospital of Sichuan University combines the internet hospital platform with the traditional telephone model, establishes a new coronavirus disease 2019 intervention integration platform, and builds a new “four-in-one” medical service system, which contains epidemic consultation, psychological consultation, self-evaluation and home prevention and control. It has established a way for the public to communicate with professional, reduced the spread of coronavirus disease 2019 in space, and effectively carried out psychological decompression and comfort work, disseminated the knowledge of fighting coronavirus disease 2019, and provided medical advice. This article mainly introduces the out-of-hospital psychological intervention model of West China Hospital of Sichuan University during the coronavirus disease 2019 epidemic, and aims to provide a reference for exploring the psychological intervention methods for major public health emergencies.
ObjectiveTo analyze the application status of Kanban management in medical service management at home and abroad and to provide a reference for lean medical management practice in China.MethodsUsing the bibliometric method, in China National Knowledge Infrastructure, Wanfang Database, CQVIP Journal Database, Springer Link, Embase and PubMed, we used “Kanban” and “Kanban management” as Chinese search terms, “Kanban system” and “two-bin system” as English search terms to search for literature published from 2009 to 2019. The number of articles published, institutions, authors, citation frequencies, key words, Kanban usage, and improved areas where Kanban was applied in were statistically described and analyzed.ResultsA total of 219 articles were retrieved. Of the 14 articles included in the study, 12 articles were published from 2015 to 2019, 8 articles were published by hospitals, and 9 articles were cited more than or equal to 3 times. The key words were basically the combinations of Kanban and related topics in the field of medical service management, such as quality control and improvement, ward service, high-quality care and process evaluation; 11 articles used Kanban alone. Kanban was used in medicine supply chain management, ward bed management, and material inventory management abroad; and was used in medicine management, emergency room patient management, medical staff performance management, operating room equipment management, and high-quality medical service management in China.ConclusionsKanban as a lean management method was introduced into the domestic medical field late, and the current research development is not balanced. Asa visual management tool, Kanban needs to be extended in the medical field. As a lean improvement tool, Kanban has positive significance in improving medical quality and patient satisfaction. It is suggested that researchers should not be limited to the existing applied research, and can study the application of Kanban in different medical service fields in combination with different lean management tools according to the actual situation of the hospital.