ObjectiveTo systematically review the willingness rate of the first consultation in primary health care institutions among Chinese residents.MethodsCNKI, WanFang Data, VIP, PubMed, Web of Science and EMbase databases were electronically searched to collect cross-sectional studies on the willingness rate of the first consultation in primary health care institutions of residents in China from January 2006 to November 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; meta-analysis was then performed using Stata 14.1 software.ResultsA total of 26 cross-sectional studies involving 36 430 subjects were included. The results of meta-analysis showed that the willingness rate of Chinese residents for the first consultation in primary health care institutions was 61.4% (95%CI 54.5% to 68.3%). The results of subgroup analysis showed that for the willingness rates of the first treatment at the grassroots level in male and female residents were 65.6% and 64.9%; urban and rural residents were 49.9% and 58.9%; <60 and ≥60 years old residents were 60.5% and 71.6%; primary school and below, junior high school, high school or technical secondary school, junior college or above educational level residents were 72.8%, 68.1%, 64.2%, and 52.8%; employees, residents, and other types of insurance residents were 74.1%, 75.9%, and 64.4%; residents with monthly income <3 000, 3 000-5 000, and >5 000 yuan were 65.8%, 65.3%, and 58.5%; high, medium, and poor levels of health status residents were 56.8%, 52.6%, and 48.8%; with and without chronic diseases residents were 61.0% and 56.9%; with and without spouse residents were 63.9% and 64.6%; with and without contracted family doctor residents were 87.1% and 62.6%; on duty, retired, and other employment status residents were 70.7%, 69.9% and 71.5%; primary medical institutions residents those were satisfied, average, and dissatisfied were 77.3%, 60.7%, and 49.4%.ConclusionsCurrent evidence suggests that it remains room for improvement in the level of willingness of Chinese residents for first consultation in primary health care institutions. Residence, age, educational level, type of medical insurance, income level, health level, family doctors contracted status, and satisfaction with primary medical institutions have an impact on residents' willingness to receive first treatment at primary hospitals. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
Objective To investigate the influencing factors in the service volume of primary health care institutions in Chengdu, and provide references for promoting the hierarchical diagnosis and treatment. Methods A self-administered questionnaire was used to investigate the service volume of a total of 390 primary health care institutions (including community health service centers and township hospitals) across 22 districts and counties of Chengdu from October to November 2016. Rank sum test, rank correlation analysis and multiple linear regression model were used to analyze the influencing factors of outpatient visits in the institutions. Results The median annual amount of outpatient visits was 60 493 in community health service centers and 31 374 in township hospitals. Between community health service centers and township hospitals, the difference in median daily visits per doctor was not significant (14.41 vs. 13.29), but the median daily visits per doctor in general practitioners (12.22 vs. 8.16), rehabilitation physicians (10.10 vs. 6.34) and traditional Chinese medical doctors (4.82 vs. 6.17) varied considerably. Multiple linear regression analysis showed that the amount of outpatient visits in community health service centers was related to the amount of intermediate physicians, while the amount of outpatient visits in township hospitals was related to the setup of dental clinics, the amount of primary physicians, the amount of beds and population to be served (P<0.05). Conclusions Differences exist in the service volume among primary health care institutions in Chengdu. It’s necessary to make proper plans for the management of administrative offices and the allocation of personnel, so as to improve medical services of primary health care institutions.
Objective To provide basis to improve the ability of primary care services in Chengdu by comparatively analyzing inpatient medical service of primary medical institutions (community health service centers and township health centers). Methods From October to November 2016, the data of inpatient services in primary medical institutions in Chengdu, including 390 primary medical institutions in 22 districts (cities) and counties, were investigated by questionnaire. SPSS 19.0 was used for data collection and analysis, while the univariate logistic regression and multiple logistic regression were used to analyze the influencing factors. Results It was more common for rural primary medical institutions to carry out inpatient medical services than urban (96.18% vs. 53.84%). The coverage rate of insurance in urban areas was higher than rural areas (98.41% vs. 90.87%), while the rate of adopting clinical pathway of single disease was quite low both in urban areas (23.81%) and rural areas (18.25%). Primary medical institutions in urban areas launched more special projects of inpatient services than those in rural areas (14.29%–17.46% vs. 3.57%–7.54%). The total amount of inpatient medical services in 2015 in rural areas was larger than urban areas (529 611 vs. 103 912), the total number of inpatient services in rural was 5.09 times that in urban primary medical institutions, the average inpatient services in 2015 per one rural primary medical institution was 1.27 times that in urban, per 10 000 residents in rural areas consumed 3.01 times more inpatient medical services than those in urban areas in average, the median beds utilization efficiency in rural areas was better than in urban areas (74.47% vs. 22.47%); work intensity of inpatient medical service in rural areas was greater than in urban areas (234.57 vs. 81.74 cases per year per doctor). The number of inpatient services was positively related to population in service (when less than 100 000 residents), inpatient beds, the number of drugs, the number of medical staff. Conclusions For inpatient medical service, there are obvious differences between urban and rural areas in Chengdu. Therefore, above differences should be taken into full consideration in the allocation of resources in primary medical institutions. Thus more targeted management measures should be formulated.
Objective To investigate the current situation of sterile supply management in primary healthcare institutions in Pudong New Area of Shanghai, analyze the existing problems, and provide a scientific basis for formulating and implementing follow-up improvement measures. Methods The primary healthcare institutions in Pudong New Area were surveyed from June to July 2024. The contents of the questionnaire included the nature of the institution, sterile supply mode, personnel, facilities and equipment configuration, quality monitoring and sterile supply management. Results A total of 71 valid questionnaires were collected, including 25 public institutions and 46 non-public institutions; 29.6% used the sterile supply mode outside the hospital, and 70.4% used the sterile supply mode inside the hospital. In primary healthcare institutions with in-hospital sterile supply mode, part-time staff accounted for 46.1%, staff under the age of 40 accounted for 69.5%, professional qualification holding rate was high (94.3%), and their education was mainly junior college (60.3%). Healthcare institutions were all equipped with steam sterilizers, and the configuration rate of cleaning and disinfection machines (92.0%) were high, but the configuration rate of water treatment and drying equipment (70.0%), information traceability system (48.0%) and low-temperature sterilizers (10.0%) were low. Disinfection and sterilization quality monitoring had been widely carried out (96.0%), but the cleaning quality monitoring rate was low (88.0%). The implementation rate of multiple requirements exceeded 96%, but the utilization rate of information traceability system was low (36.0%). The proportion of primary healthcare institutions with out-of-hospital sterile supply mode that conducted quality monitoring, requested quality reports and carried out on-site inspection on the goods provided by the service provider were less than 80%. The proportion of healthcare institutions with full-time personnel, contaminated equipment collection and temporary storage room and sterile goods handover and distribution room did not exceed 80%, and the utilization rate of information traceability system was also less than 50%. Conclusions There are still deficiencies in personnel allocation, equipment and facilities, quality monitoring and system implementation of sterile supply management in primary healthcare institutions in Pudong New Area.
ObjectiveTo evaluate the current status of primary healthcare system reform in Xinjin county, in order to provide baseline data for improving the healthcare service system and population health in Chengdu. MethodsPrimary health care services and population health in Xinjin county were quantitatively described and compared. Resultsa) Eleven township hospitals (100%) and 89 village clinics (66.42%) were upgraded according to the national standards. The management of 60 village clinics were integrated with township hospitals. And 417 and 76 essential healthcare services were provided by township hospitals and village clinics, respectively. b) In 2010, the number of outpatients and inpatients in Xinjin county were increased by 24.2% and 46.3% respectively compared to those of 2009, while the costs per outpatient visit and inpatient discharge were reduced by 21.5% and 18.6% respectively. c) In 2010, health records of 98.2% of population in Xinjin county have been established; 96.3% of pregnant women were managed systematically; 98.8% of children immunization programs were implemented; 100% patients with severe mental disorders and about 78% with hypertension and diabetes were in follow-up and treatment; and 28.8% of total population got the free physical exams in 2010. d) The essential medicine accounted for 96.7% of total types of medicines and 97.8% of total expenditure of medicines in primarily healthcare institutions in Xinjin. The cost of medicine management was reduced from 8.5% to 4.2% while the medicine turnover rate was increased by 50%. e) Average life expectancy in Xinjin county was 77.97 years, infant mortality rate was 6.82‰ in 2010; and there was no maternal death in recent 8 years. f) The regional healthcare information system was established covering three-tier rural health care network spanning the county, township and village. Conclusiona) The primary healthcare system reform in Xinjin county improves the infrastructure of primary care system, the utilization of essential medical care, essential public health service, and essential medicines. b) Life expectancy, infant mortality rate and maternal mortality of Xinjin county are better than the average levels in Sichuan province and China. Xinjin county is a representative pilot county for healthcare service system reform in Chengdu city and a nice model to successfully promote healthcare system reform based on regional healthcare information system.
ObjectivesTo investigate the utilization of essential medicines and antibiotics in primary healthcare system of Xinjin county of Chengdu city from 2009 to 2011. MethodsThe data of utilization of all the medicines, essential medicines and antibiotics was collected from 17 hospitals of Xinjin primary healthcare system. Microsoft Excel 2003 was used to analyze the data. ResultsCompared with 2009, the total costs of medicines and essential medicines increased by 72.27% and 135.4% respectively in 2010. After the implementation of essential medicine policy in 2010, the proportion of essential medicines accounted for more than 90% in community healthcare centers (CHCs) and township hospitals (THs) and over 50% in county-level hospitals in 2011. In 2010, the average cost per prescription among outpatients increased by 3.51% in total, but deceased by 16.23% in CHCs/THs (RMB 15.09 yuan per prescription). In July of 2011, the policy to control the use of antibiotics was implemented in Xinjin county. The use of antibiotics decreased, but still accounted for over 30% in 9 out of 13 CHCs/THs. The use of bigeminy antibiotics and trigeminy antibiotics accounted for 0.42 to 5.56% and 0 to 0.44%, respectively. ConclusionsThe use of essential medicines increases in Xinjin county and met the national requirements. The average cost per prescription among outpatient decreases in THs and CHCs. After controlling the use of antibiotics, the proportion and cost of antibiotics is still very high, and irrational use of antibiotics probably still exists. The training and guide for evidence-based rational use of medicine should be enhanced in future.
ObjectiveTo analyze the accessibility of primary care in Sichuan Province from both the perspective of doctors, patients, and field workers, and then make some policy recommendations.MethodsBased on the Quality and Costs of Primary Care in Europe primary care questionnaire, we surveyed 48 primary care facilities from six cities / states in Sichuan by multi-stage stratified random sampling method, taking in account of the regional development level from November 2017 to December 2018. Then integrated accessibility score for primary care was calculated based on the question items for both doctors and patients.ResultsThis study effectively surveyed 319 primary care doctors and 641 patients. In general, the integrated accessibility score for primary care for these areas was 0.25. The accessibility of primary care was worst in less-developed regions (0.23), while it was much better in medium-developed area (0.30) and developed area (0.28).ConclusionsWe can do lots of things to improve accessibility of primary care. Evidence based policies are needed to promote this goal that everyone will have access to basic medical and health services.