February 2013, Volume 16, No.4 Abstracts

 Comprehensive Reform of Community Health Service in Different Regions in China under Perspective of Patients

WU Ning,LIU Han,ZHANG Li-fang,et al.China National Health Development Research Centre,Beijing 100191,China

Abstract Objective From the perspective of the patents to study the changes of comprehensive reform community health service (CHS) in East,Central and West China,and the service conditions of CHS institutions and the issues that need to be improved.

Methods Twelve CHS centers were selected randomly from each of the eight typical cities in East, Central and West China, The questionnaire survey was conducted among patients seeking medical care in these centers that very day.

Results 1The percentage of patients from the West regions who held that there had been improvement in medical surroundings, service attitude and technical skills of the medical staff was higher than that form the East regions; but the percentage of patients from the East regions who held hat the drug price had lowered was higher than that from the West regions, the differences were of statistical significance P0.0125.2 The satisfaction percentages of the patients in the West regions on that very days medical surroundings, service attitude and technical skills of the medical staff were 88.9%,91.5% and 81.6% respectively, being higher than those in the East and Central regions. The reimbursement satisfaction of the patients in the East regions was 58.5%,being higher than that in the West and Central regions. The satisfaction on the categories of drugs and prevention care service were 51.5% and 65.9% for the patients from the West regions, being higher than those from both East and Central regions P0.0125.3About the items that need to be further improved, the first three ones were the variety and quality of drugs 25.3%,price of drugs 21.8%,and medical skills 18.2% in the East cities; essential facilities and equipment 28.2%,price of drugs21.8%,and variety and quality of drugs 21.2% in the Central cities; essential facilities and equipment 30.8%,variety and quality of drugs 28.1% and percentage and categories of imbursement of medical fees 27.9% in the West cities.

Conclusion The comprehensive reform of CHS should be improved based on the wishes of the patients from different regions in China. The essential drug system should be continually consolidated. Cooperation with the health insurance organization needs to be actively enhanced so as to promote the reform of medicare payment system.

Key words Community health services; Comprehensive reform; Patients; Satisfaction; Comparative research

Structural Equation Model on Influencing Factors of Job Satisfaction of Community Health Service Staff

HUANG Zhen-xin,ZHANG Ying,JIN Juan.School of Public Health,Guangdong Pharmaceutical University,Guangzhou 510310,China

Abstract Objective To find out the influencing factors of job satisfaction of community health services (CHS) staff, and then suggest the advices for improving the job satisfaction.

Methods Among 1 198 CHS staff, a questionnaire survey on job satisfaction was conducted about their job satisfaction. Data were analyzed by a structural equation model for determining the influencing factors.

Results The work itself was of the largest effect to the overall satisfactionβ=0.378, P0.01,work environment was of next β=0.356, P0.01,and team cooperationβ=0.177, P0.01 and hospital managementβ=0.052, P0.01 were of weaker effect. The important factors affecting job satisfaction included working achievement, rational allocation of equipment and staff, cooperation in and outside the department, reward and punishment system, performance appraisal mechanism, and promotion mechanism.

Conclusion Some measures should be taken to improve job satisfaction such as enhancing the sensation of working achievement, updating necessary medical equipment, developing fair mechanism of personnel management, and strengthening cooperation inside and between sectors. Key words Community health services; Job satisfaction;Influencing factors;Structural equation model

Feasibility on Broadening Health Management Function in Community Health Services

LI Jun-rong,MA Fang,LI Xiao-ye.School of Management,Jiangsu University,Zhenjiang 212013,China

Abstract By drawing on the foreign successful experience and analyzing the existing problems in the operation of the current health management,this paper proposes the mode and suggestion of broadening health management function in community health services based on the advantages of developing community health management in China.The role of general practitioners in health management should be brought into full play and it is totally feasible to broaden health management function in community health service in China.

Key words Community health services;Health management;Feasibility

Effect of Pooling Funds of Outpatient Service in Medical Insurance on Increasing Utilization of Primary Health Care Services for Community Residents

LUO Yan,FENG Hui,HE Guo-ping,et al.Nursing School of Central South University,Changsha 410013,China

Abstract Objective To summarize the practices and experience of the pooling funds of outpatient service in medical insurance for urban and rural community residents,and evaluate the effect of implementing the pooling funds.

Methods The cluster sampling was taken in 2011 to choose in Changsha city 10 community health service organizations where pooling funds for outpatient service had been carried out and 9 organizations where the pooling funds had not been carried out,and for each kind of organizations 3 were randomly chosen and then from each organization 100 residents were randomly chosen,totally 600 community residents were recruited.Among them the investigation was conducted about the utilization of primary medical services so as to evaluate the effect of implementing the pooling funds.

Results In the organizations where the pooling funds of outpatient service in medical insurance the average person-times of visit per month and chronic disease management rate went up monthly;the filing rate of health record was more than 80%,the residents visiting rate in two weeks was 213.6,and 91.1% of them took the community health service as their first choice.All the conditions were better as compared with those in the organizations where the pooling funds had not been carried out.The residents total satisfaction and dimensional satisfactions on supply of essential drugs,medical equipment,drug price,skills of medical staff,and attitude of staffs service were remarkably higher as compared with in the organizations where the pooling funds had not been carried out P0.05.

Conclusion The implementation of pooling funds of outpatient service promotes the residents choice of primary health services organization,and thus ensure reasonable shunt for milder diseases handled in community and severer disease in hospital.At the same time,in can ensure the service quality of primary health care,increase its utilization rate,and promote its development.

Key words Community health service organizations;Pooling funds of outpatient service;Primary health services utilization;Community residents

Evaluation on Implementation of Community Health Policies in Four Pilot Cities

LI Jian,CUI Yue-ying,FENG Rui-hua,et al.Center for Health Policy and Management,Chinese Academy of Medical Sciences,Beijing 100020,China

Abstract Objective To evaluate the implementation of community health policies,explore the existing problems and put forward reform proposals.

Methods A total of 170 health workers in community health organizations in 4 representative cities were surveyed using questionnaires.

Results About 44.7% of the health workers acknowledged the great impact of the Essential Medicine System on patients drug use;31.1% considered the public health services provided to be comprehensive and of high quality;14.1% believed a high proportion of patients need referrals;59.4% thought the government subsidy was low;and 51.1% were not satisfied with their income.

Conclusion The essential medicine list needs further adjustments,and doctors can help promote the use of essential medicine.Clear assignment of public health services among health workers is needed.Two-way referral system is affected by the patients willingness and the doctors motivation.Government subsidy is low and the health workers are not satisfied with their income.

Key words Community health services; Policy evaluation; Subjective evaluation; Implementation effect

Impact of Baoan District Community Health System Reform on Hypertension Management and Control

CHEN Li,LI Jia,XIA Ting-song,et al.School of Social Development and Public Policy,Beijing Normal University,Beijing 100875,China

Abstract Objective To evaluate the impact of community health system reform on regular hypertension management and blood pressure control.

Methods A retrospective non-randomized cohort study was conducted based on the Hypertension Management Information System.Random effect negative binomial model and double difference strategy were used.

Results Standard hypertension management rate increased by 29% (P0.05).Blood pressure control rate among hypertensive patients increased by 26% (P0.05).

Conclusion Baoan community health system reform has improved the hypertension management and control among the community hypertensive patients.

Key words Hypertension;Community health services;Effect evaluation

Impact of Diabetes Occurrence on Health Related Quality of Life

WANG Xue-yong,ZHENG Wei-jun,WANG Xiao-yan.Hecun Center Hospital,Jiangshan 324100,China

Abstract Objective To study the impact of diabetes occurrence on the condition of health related quality of life (HRQL).

Methods The 12-item short-form health survey in Chinese-version (SF-12) was taken to assess the conditions of quality of life among 1 136 persons, and their outcome of impaired glucose regulation after two years was monitored and summarized. And then the multiple linear regression model was applied to analyze the relationship between diabetes occurrence and HRQL.

Results The differences in scores of physical component summary (PCS) and mental component summary (MCS) between the occurred-disease group and the non-occurred-disease group showed statistical significance in the basic line investigation (t=5.4,4.2,P0.001),and so did in the follow-up 2 years later (t=10.9,8.6,P0.001).During the follow-up of 2 years, both PCS and MCS had altered in the occurred-disease group, but not changed in the non-occurred-disease group,the differences of PCS and MCS between the two groups presented statistical significance t=18.5,19.4,P0.001).The linear regression analysis showed that the impact of both PCS and MCS had statistical significance (P0.001) .

Conclusion The level of an individual HRQL decreases during the occurrence of diabetes, and the HRQL of a person who has impaired glucose regulation get diabetes within 2 years is also lower than one who did not suffers the disease. The occurrence of diabetes will significantly influence the HRQL both physically and mentally.

Key words Impaired glucose regulation;Diabetes mellitus;Health related quality of life;Cohort study

Use Risk Assessment Scale to Screen Obstructive Sleep Apnea Syndrome among Old Chinese People

ZHANG Jun-li,WANG Chun-mei,WANG Yan.College of Nursing,Medical University of Tianjin,Tianjin 300070,China

Abstract Objective To investigate the value of obstructive sleep apnea syndrome risk assessment scaleOSASRAS, hereafter referred as RAS in screening obstructive sleep apnea syndrome (OSAHS) among old Chinese people.

Methods RAS was used to conduct risk scoring and polysomnogram (PSG) monitoring among old Chinese people with suspected OSAHS.Relativity analysis was conducted between the results of risk scoring and PSG monitoring.Sensitivity,specificity,false negative rate (FNR),false positive rate (FPR),positive likelihood ratio (PLR),negative likelihood ratio (NLR),and diagnostic accordance rate (DAR) were calculated using fourfold table.

Results A total of 72 (50 male,22 female) cases with suspected OSAHS were included in the study.They were aged 60-80 years old with an average age of (65.8±5.8) and an average BMI of 28.4±4.1kg/m2.RAS results showed a positive correlation with apnea hypopnea index (AHI) r=0.614, P0.01, and a negative correlation with the lowest SaO2r=-0.581, P0.01.The sensitivity and specificity of RAS in predicting OSAHS was 0.859 and 0.750,respectively.

Conclusion RAS has certain value in screening old Chinese people with suspected OSAHS and could be applied as a primary diagnostic method in community health centers / stations and primary hospitals.

Key words Obstructive sleep apnea syndrome risk assessment scale for the older; Sleep apnea, obstructive; Screening

Correlation of WNK1 Gene Polymorphism with Antihyperactive Effect of Angiotensin Converting Enzyme Inhibitors

LIU Jie-lin,LIU Ya,WANG Zuo-guang,et al.Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China

Abstract Objective To investigate the correlation between the rs880054 and rs2301880 polymorphisms of the WNK1 gene and the blood pressure response to angiotensin-converting enzyme inhibitors (ACEI) in patients with essential hypertension.

Methods A total 121 patients with mild to moderate essential hypertension,who are Han nationality from a district of Beijing,were recruited.Oral Benazepril was administered to the patients for 8 weeks.Genotyping was performed to identify the polymorphisms of the WNK1 gene.

Results There was significant difference in antihyperactive effect between patients with rs880054 and rs2301880 polymorphisms of the WNK1 gene P0.05.There was a significant difference between patients with rs880054 polymorphisms in reduction of diagnostic blood pressure DBP P0.05,but no significant difference in systolic blood pressure SBP P0.05.There was a significant difference between patients with rs2301880 polymorphisms in reduction of DBP,but no significant difference in SBP P0.05.After the treatment there were significant correlation between these two polymorphisms and the reductions in DBP rs880054: R2=0.167, P0.001; rs2301880: R2=0.080, P=0.003,but no correlation was found in SBP.

Conclusion The rs880054 and the rs2301880 polymorphisms of the WNK1 gene may be associated with the antihyperactive effect of ACEI in patients with essential hypertension.

Key words Hypertension;WNK1 gene;Polymorphism,single nucleotide;Angiotensin converting enzyme inhibitors

Colposcope Combined with Cervical Conization for the Early Diagnosis of Cervical Cancer

CAO Shu-jun,SHI Hua-zhen,ZHU Chun-mei,et al.Department of Obstetrics and Gynecology,the First Peoples Hospital Songjiang Branch Affiliated to Shanghai Jiaotong University,Shanghai 201600,China

Abstract Objective To evaluate the value of colposcopy combined with cervical conization for the early diagnosis of cervical cancer.

Methods A total of 604 cases who were diagnosed with high grade cervical intraepithelial neoplasiaCIN,Ⅲ)or cervical cancer by pathology in our hospital between January 2005 to December 2011 were collected.Their clinical pathological data were retrospectively studied.

Results Colposcopy and biopsy suggested 35 cases of low-grade cervical lesions,306 cases of CIN,189 cases of CIN and 74 cases of invasive cervical carcinoma (ICC).A total of 371 cases of CIN received cervical conization, and 19 cases were diagnosed as ICC;49 CIN cases received hysterectomy, and 5 cases of ICC were found. Some CIN cases were further treated with hysterectomy after cervical conization, and no upgraded cases were found. The accuracy rate of colposcopy and biopsy in detecting high grade CIN was 53.9%(123/228) and 72.6%(114/157) for CINand CIN,respectively. Twenty-four cases of ICC were missed in the diagnosis by colposcopy and biopsy,and they were diagnosed as 1 case of low-grade cervical lesions,2 cases of CIN and 21 CIN.The higher the lesion grade, the higher the rate of missed diagnosis (P0.01).Ninety-three cases of ICC were detected by colposcopy combined with cervical conization with the detection rate of 94.9%,and 80.6%75/93 of them were early invasive carcinoma.

Conclusion Colposcopy combined with cervical conization has the potential to provide accurate and early diagnosis,and can avoid missed diagnosis of concealed cervical cancer.

Key words Cervical cancer;Cervical intraepithelial neoplasia;Colposcopy;Cervical conization

Efficacy of Transparent Cap-fitted Colonoscopy in Diagnosis of Colonic Polyps

SANG Hua-chao,ZHANG Chun-yan,SHENG Hong,et al.Department of Gastroenterology,the First Peoples Hospital of Xiangshan County,Zhejiang Province,Xiangshan 315700,China

Abstract Objective To explore the efficary of transparent cap-fitted colonoscopy in diagnosis of colonic polyps.

Methods The data of the patients with colonic polyps diagnosed by tandem video colonoscopy,who were received endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) by the same operator in our hospital within 60 days from April 1st 2010 to Mach 31st 2012,were analyzed.The morphology and size of polyps detected two times by the colonoscopy were recorded and statistically analyzed.

Results Among the 63 patients 301 polyps were detected at the first examination,and by transparent cap-fitted colonoscopy 373 polyps were detected.Of the 72 missed diagnosed polyps there were 2 in ileocecal part,14 in ascending colon,16 in transverse colon,12 in descending colon,23 in sigmoid colon,and 5 in rectum;the numbers of polyps with a diameter5 mm,5-9 mm,and 10 mm were 42,23,7 respectively;and the counts of Yamada type ,, and were 50,11,7,4 respectively.The detected results by transparent cap-fitted colonoscopy were better than those at the first


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