September 2013, Volume 16, No.25 Abstracts

WANG Jian,LI Yi-tong,ZHANG Mei-zhi,et al.Dongfang Hospital,Suqian 223800,China 

【Abstract】 This study identified the characteristics of the poor physician-patient relationship in China through a systematic review of literature and case studies. The historical evolvement of physician-patient relationship in China was compared with that in Australia. The purchase-exchange arrangement, unequal power, and defensive relationship between physicians and patients are important reasons for causing physician-patient conflicts. The Australian experience shows that general practitioners can play a very important role in establishing harmonized physician-patient relationship through delivering and coordinating appropriate health care services on behalf of their patients. Besides, it is also an important prerequisite to enhance the universal coverage of health insurance and improve health literacy of consumers for the improvement of physician-patient relationship.

【Key words】 General practice;Physician-patient relations;Comparative study

Resolution of Two-way Referral Problem in China by Studying British National Health Service System

LIU Xiao-xi,CHEN Yu-wen,BI Kai-shun.Shenyang Pharmaceutical University,Shenyang 110016,China 

【Abstract】 Two-way referral in Chinese health care system has three major problems: First, patients prefer major hospitals and suspected the diagnosis and treatment capacity of community health service (CHS) centers; secondly, various hospitals are unwilling to take the initiative to transfer the patients as driven by financial interests; and last,the government investment is not enough and relevant supporting policies are still not perfect.By studying key elements in the implementation of two-way referral system from the British National Health Service,here the advices are proposed:improving the medical care insurance system,opening the price gap,and reflecting advantages of CHS centers;increasing government investment and improving material and human resources of CHS centers;establishing highly efficient computer network for medical services,facilitating the patients′ treatment and referral;establishing urban medical groups so as to virtually and radically eliminate interest-driven obstacles.

【Key words】 Two-way referral system;British national health service;Health policy

Impacting Factors to Implementation of the Two-way Referral System

ZHAO Guang-bin，DU Guang-hui，LIN Min.Sichuan Provincial Academy of Medical Science,Sichuan Provincial People′s Hospital，Chengdu 610072，China 

【Abstract】 Objective To explore and discuss contradictions and problems existing in the two-way referral system through analyzing the situation of patients′ referral between Sichuan Provincial People′s Hospital and 21 community health service centers in Chengdu，and propose measures and methods to further improve the two-way referral system.

Methods Totally 3 652 patients required referral from April 2010 to March 2011 (2 635 patients from the hospital to community medical service centers and 1 017 in a opposite direction) were selected.The reasons for referral and the factors for successful and unsuccessful referral were analyzed.The on-site interviews were conducted among doctors,department directors,and medical administrators from both the hospital and the centers.The talking topics included the design of bi-directional referral system,policy support from the government,current status of two-way referral and the main factors restricting the implementation of bi-directional referral system.

Results Among the 2 635 patients needed to have a referral from the hospital to centers (downward referral) for rehabilitation only 50 were successfully transferred,with a successful referral ratio of 52.7∶1.However,concurrently 1 017 patients were transferred from the 21 centers to the hospital (upward referral).The ratio of upward referral to downward referral was 20.3∶1.There are a total of 1 623 beds in all the 21 centers,however,the average utilization rate of beds was only 70.65%,as contrasted with that of 112.35% in the hospital.Majority of the interviewers believed that the factors impacting the implementation of two-way referral included un-smooth communication of medical information,no criteria and process of referral so far,shortage of mutual trust between the two referral parties,and non-full consideration of the two-way referral factors by the medical authorities in formulating the local health plan.

Conclusion Although the two-way referral system has been implemented in Chengdu area,the rate of successful transfer is still lower,especially for the patients needing downward referral.

【Key words】 Two-way referral；Constraint factors；Community health services

Establishment and Implementation of Two-way Referral Mechanism for Health Management of Menopausal Women in Community

TONG Xiu-mei,DU Xue-ping,SUN Yan-ge.Fuxing Hospital Yuetan Community Health Service Center,Beijing 100045，China 

【Abstract】 Objective To establish the two-way referral mechanism for general practitioners to manage menopausal women in community,to assess the feasibility of the mechanism and to make adjustment for the referral plan through implementation.

Methods The two-way referral plan was set by experts in general practice and gynecology.Totally 160 menopausal women visited the Yutan community health service center and two of its affiliated stations from January 2011 to January 2012 were enrolled.According to the referral plan they were given two-way referral between general practitioners and gynecologists.

Results The rate for successful referral was 48.1% (77/160).Reasons for unsuccessful referral were regularly physical examination in 39 (47.0%),un-necessary consideration of referral in 31 (37.3%),and troublesome belief of referral in 13 (15.7%).Among the 77 successful referral women,30 (39.0%) were confirmed to have bone mass reduction,18 (23.4%) to have senile vaginitis,17 (22.1%) to have menopausal syndrome,13 (16.9%) to have uterine myoma,6 (7.8%) to have osteoporosis,and 1 (1.3%) to have cervical intraepithelial lesion.

Conclusion Early diagnosis and treatment of diseases can be made through the health management of two-way referral mechanism for menopausal women in community.It is necessary to raise the levels of gynecological theory and practice for general practitioners,and further to clarify the criteria of two-way referral so as to increase referral rate.

【Key words】 Menopausal women;Health management;Two-way referral

Construction of General Practitioner Service Team in Local Community:A SWOT Analysis

HUANG Yan-hui,YU Chang-ze,WANG Jia-ji,et al.Department of Epidemiology,School of Public Health and Tropical Medicine,Southern Medical University,Guangzhou 510515,China

【Abstract】 It is effective for general practitioner service team to carry out "Six in One" function of the community health service so as to satisfy the requirement of community residents of basic medical services and public health services.In this paper by using the Strength-Weakness-Opportunity-Threat (SWOT) analysis,we analyze systematically both the inner conditions (strengths and weaknesses) and outer environment (opportunities and threats) of general practitioner service team in local community,meanwhile,we put forward strategies for construction of general practitioner service team suitable for the development of local community health service,so that to provide scientific evidence for construction and development of general practitioner service team in local community.

【Key words】 General practitioner service team;SWOT analysis;Community health services

Performance Appraisal Method under General Practitioner Team Model

WANG Xin，YU Chang-ze，WANG Jia-ji.School of Public Health，Guangzhou Medical University，Guangzhou 510182，China 

【Abstract】 General practitioner team is the core and soul of community health services net.Performance appraisal as a vital component of performance management and main distribution basis of salary benefits its improvement of working efficiency.In this paper,based on the status of development and performance appraisal of general practitioner team both in China and abroad,we attempt to explore the feasible performance appraisal method under the model of general practitioner team,with a purpose to provide a theoretical basis for improving the service function of the general practitioner team and raising the efficiency and quality of service.

【Key words】 Community health services；General practitioner team；Performance appraisal

Establishment of Evaluation Index System for General Practitioner Service Team in Guangdong Province

YU Chang-ze，ZHOU Zhi-heng，HUANG Yan-hui，et al.School of Public Health，Guangzhou Medical University，Guangzhou 510182，China 

【Abstract】 Objective To investigate how to establish an evaluation index system for general practitioner service team in Guangdong province.

Methods The Delphi consultation was conducted for two rounds.

Results An evaluation index system consisted of 4 first-grade indicators and 49 second-grade indicators was established.The 4 first-grade indicators were team human recourses,team system management,quality and quantity of team service,and satisfaction degree of suppliers and demanders,with weight of 0.2788,0.2432,0.2453,and 0.2327,respectively.The active coefficient was 82.50% and 90.91% respectively for the two rounds of Delphi consultation,the authoritative coefficient was 0.842 and 0.843 respectively,and the harmonious coefficient of importance of the evaluation index was 0.231 and 0.451 respectively.

Conclusion The index system is comprehensive and credible.It can provide a theoretical basis for the evaluation of general practitioner service team.

【Key words】 General practitioner service team;Community health services；Evaluation index system；Delphi method

Prevalence and Risk Factor Analysis of Exercise Induced Desaturation in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease at Stable Stage

HOU Gang，LI Peng，LI Wen-yang，et al.Institute of Respiratory Disease，the First Affiliated Hospital of China Medical University，Shenyang 110001，China 

【Abstract】 Objective To investigate the prevalence rate of exercise induced desaturation (EID) in patients with chronic obstructive pulmonary disease (COPD) at stable stage and whose pulmonary function classification was level II or above,and to evaluate the influence of EID on their quality of life (QOL) and body mass index,airflow obstruction,dyspnea and exercise capacity (BODE) index.

Methods The COPD patients at stable stage and with the pulmonary function classification of level II or above were selected.The pulmonary function test,6 minute walking test (6MWT)，St.George′s questionnaire (SGRQ) and BODE index were performed for all the patients.Then the patients were divided into EID group and non-EID group according to the existence of EID in 6MWT.The QOL and BODE index of the two groups were compared to evaluate the risk factors of EID in COPD.

Results Totally 52 eligible patients were enrolled,with their average age being (63±8) years.The prevalence rate of EID was 40.1% (21/52).The prevalence rates of EID in patients with pulmonary function of level II,III,and IV were 18.2% (4/22),54.5% (12/22),and 62.5% (5/8),with the prevalence rate of EID being highest in patients with pulmonary function of level IV (P＜0.05).Compared with COPD patients without EID,those with EID showed no significant difference in ages,body mass index (BMI),predictive percentage of inspiratory capacity (IC%pre),modified British medical research council (MMRC) score,baseline oxygen saturation and SGRQ score;however the differences in FEV1%pre,6MWD,minimum of the oxygen saturation in 6MWT,BODE index and activity limitation score of SGRQ revealed significant (P＜0.05).Correlation analysis showed that the occurrence of EID was correlated with predictive percentage of FEV1 (FEV1%pre) ( r =-0.329),6MWD ( r =-0.655),activity limitation score of SGRQ ( r =0.328),minimum of the oxygen saturation ( r =-0.445),and BODE index ( r =0.290).Logistic regression analysis revealed that 6MWD<350 m is a risk factor of EID 〔 OR =18.77，95% CI （2.13，165.45），P=0.008〕.

Conclusion The prevalence of EID increases with the increase of the pulmonary function levels.The patients with EID present with lower 6MWD,BODE index and SGRQ activity limitation score.

【Key words】 Pulmonary disease，chronic obstructive；Hypoxia；Quality of life

Clinical Analysis of the Short-term Prognosis of Ischemic Stroke According to Chinese Ischemic Stroke Sub-classification

FU Na-na，YUAN Wei，SHI Zheng-hong.Department of Neurology，the Second Hospital of Lanzhou University，Lanzhou 730030，China 

【Abstract】 Objective To explore the relationships between ischemic stroke etiological subtypes and short-term prognosis.

Methods Totally 249 patients with acute ischemic stroke were recruited in this study.They were sub-classified into 5 subtypes according to the Chinese Ischemic Stroke Sub-classification （CISS） criteria.The degrees of their neurological function impairment were evaluated by the National Institutes of Health Stroke Scale（NIHSS） on admission and at discharge.The clinical short-term prognosis was estimated with the improvement rate of neurological function.

Results The proportion of the penetrating artery disease was the highest（40.2%）.Compared with the other etiological subtypes,the mean NIHSS score on admission of the penetrating artery disease was the lowest（4.71±1.58）,however the rate of neurological function improvement at discharge was also the highest （50±13）%,with a statistically significant difference （P＜0.01）.The mean NIHSS score on admission of the cardiogenic stroke was the highest（14.56±5.06）,but the rate of neurological function improvement at discharge was the lowest （25±7）%,with a statistically significant difference （P＜0.05）.

Conclusion The penetrating artery disease is the most common etiological subtype of the ischemic stroke,which is of the lightest condition on admission and the best clinical short-term prognosis.While cardiogenic stroke is the most serious in admission condition and its clinical short-term prognosis is the worst.

【Key words】 Stroke；Chinese ischemic stroke sub-classification；Prognosis

Reliability and Validity of the Public Assessment Scale on Meteorological Service of Heat Emergency

HUA Jing，PENG Li,WU Zhuo-chun，et al.The First Affiliated Matemal and Child Health Hospital,Tongji University & Shanghai Women′s Health Institue，Shanghai 200135，China 

【Abstract】 Objective To assess the validity and reliability of Public Assessment Scale on Meteorological Service of Heat Emergency so as to provide the valid and reliable tools for assessing the meteorological service of heat emergency in Shanghai area.

Methods Four hundred thirty five valid questionnaires were included in the analysis using the come-across investigation.The methods of Cronbach′s α coefficient,split-half coefficient,item-level content validity index (I-CVI) and confirmatory factor analysis (CFA) were used for assessing the internal consistent reliability,content validity and construct validity.

Results The total Cronbach′s α coefficient of the scale were 0.699.And the Cronbach′s α coefficient was 0.613-0.711 after each item was deleted.The split half coefficient was 0.521.The I-CVI index was 0.75-0.88,and the average I-CVI was 0.84.The results of construct validity showed that the factor loadings of the most items were more than 0.4 according to both Exploratory Factor Analysis and Confirmative Factor Analysis,and the average variance extracted was more than 0.5.There were statistical differences between high-score group and low-score group in every item score（P<0.05）.

Conclusion The internal consistent reliability,content validity and construct validity of the Public Assessment Scale on Meteorological Service of Heat Emergency meets the basic psychometric demands.The adjusted scale（10 items） could be used as a quantitative tool to assess the Heat Emergency Service in Shanghai.

【Key words】 Meteorological service of heat emergency；Validity；Reliability；Scale

Changes of Blood Gas Analysis and Electrolyte in Patients with Severe and Critical Influenza A（H1N1）

ZHANG Xue-jun，ZHANG Qing，XING Zhi-li，et al.Department of Respiratory Disease，Affiliated Hospital of Chengde Medical College，Chengde 067000，China 

【Abstract】 Objective To investigate the changes of blood gas analysis and electrolyte levels in patients with severe and critical influenza A (H1N1).

Methods Totally 53 patients with A H1N1 influenza,confirmed by positivity rt-PCR of throat swab,were classified into severe group (n=28) and critical group (n=25).The tests of blood gas analysis and electrolyte were performed,and the results were studied.

Results Compared with the severe group,in the critical group pH value was higher but with no significant difference (P＞0.05);the levels of PaO2 [ (68±26)mm Hg vs.(87±21)mm Hg] and PaO2/FiO2 〔(190±67)vs.(381±47)〕were lower significantly (P＜0.01);the levels of serum Ca2+〔