THE HEALTH PROMOTION PROGRAM FOR INDIVIDUALS AT RISK FOR CARDIOVASCULAR DISEASES AND DIABETES IMPLEMENTATION IN MUNICIPALITY: THE STAKEHOLDERS’ PERSPECTIVE

BackgroundThe problem posed by therapeutic injection is a clinical practice issue that influences health care quality and patient safety. Although sufficient government subsidy was one of the 12 key interventions to promote rational drug use initiated by WHO (World Health Organization), limited information is available about the association between government subsidy and injection use in primary health care institutions. In 2009, National Essential Medicines System (NEMS) was implemented in China. The subsidy policy plays an important role in maintaining primary health care institutions. This study explores the impact of government subsidies on the injection use in primary health care institutions in China.Methods126 primary health institutions were included in this study. Institutions were divided into two groups (intervention and control groups) according to the median GS (General subsidy per personnel). Propensity score matching (PSM) was used to minimize the observed covariate differences in the characteristics of the primary institutions between the two groups. Kappa score was calculated to determine the consistency between the groups. Paired chi-square test and Relative Risk (RR) were calculated to compare the differences in injection use between the groups.ResultsAmong all the investigated prescriptions, the overall percent of people who received an injection prescribed was 36.96% (n = 12600). PSM showed no significant covariate difference among the 34 groups obtained through this analysis. Kappa score (k = −0.082, p = 0.558) indicated an inconsistency between groups and paired chi-square test revealed a significant difference (p < 0.05) in injection use between the two groups. Relative Risk = 0.679 (95%CI [0.485, 0.950]) indicate that high General subsidy per personnel is a protective factor for primary health care institutions to prescribe injections properly. The intervention group obtained a higher possibility of using injection properly.ConclusionsThe overall effect of government subsidy on the use of injection was positively significant. However, the mechanism by which government subsidy influence injection administration remains unclear, and thus requires further study.

BackgroundThe allocation of health resources in primary health care institutions (PHCI) is crucial to health reform. China has recently implemented many reform measures emphasizing the provision of primary health care services, with equity as one of the major goals. The aim of this study was to analyze the quantity, quality, and distribution of health resources in Liaoning Province from 2005 to 2017.MethodsData were drawn from the annual financial report from 2005 to 2017 and information from the Liaoning Province Department of Statistics. Numbers of beds and physicians were used as indicators of health resources. Capital assets per bed, value of medical equipment per bed, operational space per bed, and number of physicians with different educational levels were used as indicators of quality of health resources. Concentration indices (CI) and Gini coefficients were calculated.ResultsThere was a steady rise in health resources in PHCI. From 2005 to 2017, the quality of health resources improved. The CI of beds showed an overall downward trend, indicating an improvement in the disparity among PHCI. There was a similar trend in the CI of fixed assets per bed. The Gini coefficients of physicians overall and physicians with different educational levels were almost always < 0.3, showing preferred equity status. There was a decreasing trend in the Gini coefficients of PHCI physicians with bachelor’s degrees or higher and physicians with associate’s degrees. The proportion of health resource of PHCI in health system increased from 2005 to 2009, before decreasing from 2009 to 2017 and the percentage of physicians overall and physicians with bachelor’s degrees or higher in PHCI declined after 2011.ConclusionsThere was an improvement in the quantity and quality of health resources in PHCI from 2005 to 2017. The distribution of health resource allocation in PHCI also improved. The findings revealed that the measures for the improvement of PHCI physicians’ educational level has been successful and the measures taken by the government in health reform to strengthen the primary health care system have not been successful.

A competitive advantage in health care institutions can be cultivated by marketing activities and value creation for patients with chronic diseases in primary health care. Type 2 diabetes mellitus (T2DM) is a major challenge in primary health care, as managing risk factors and managing patient knowledge can help to prevent a number of major of complications. This study reveals the expectations and attitudes of patients with T2DM regarding marketing mix elements in the management of their condition. To explore the perspectives of patients with T2DM on marketing mix elements in the primary health care institutions of Lithuania. The design of the national study was based on a survey of patients with T2DM that was conducted after consultation with a family physician in primary health care institutions in Lithuania. The survey was conducted from October 2017 to January 2018, and involved 510 patients with T2DM. Data analysis included factor analysis and linear logistic regression. A hypothetical model was built, defining the relationships between marketing mix elements and both perceived value (emotional, functional, and social) and satisfaction with primary health care services. The marketing mix element of 'Service' is statistically significantly dependent on the gender of the respondents, and is expressed more frequently by women (rcr = 0.118, P = 0.007). The occupation of respondents with T2DM (rcr = 0.151, P = 0.009) and affiliation to primary health care institution (rcr = 0.091, P = 0.040) statistically positively affect the marketing mix element of 'Price'. The marketing mix elements of 'Promotion' and 'People' do not statistically significantly depend on the sociodemographic characteristics of the respondents. Only a weak correlation between the sociodemographic characteristics of the respondents and the marketing element of 'Place' was found. The 'Process' element is statistically significantly more relevant to patients with an average monthly income of €350 (rcr = 0.104, P = 0.019). The element of 'Physical evidence' is more statistically significantly related to respondents with an average monthly income of €350 (rcr = 0.092, P = 0.038). Marketing mix analysis provides information about patients' expectations of primary health care services and identifies areas of improvement for the health services provided by primary health care institutions. The competitiveness of primary health care services is strengthened by enhancing value for patients, by using elements of the health care marketing, and by increasing patient satisfaction.

Introduction: Chronic pain presents a public health priority, however its assessment and management remains problematic in the country posing serious obstacles in effective pain relief and improving quality of life in pain patients, in general, and in palliative patients, in particular. We aimed to study chronic pain relief quality and pain assessment and management knowledge level in primary health care institutions, being a gateway to palliative care. Methods: Cross-sectional survey was conducted in 2013-2014 on 232 randomly selected patients in palliative care clinic and 304 physicians in primary health care institutions in different regions of the country. Pain assessment tools such as Visual Analog Scale (VAS) and numeric pain rating scale along with questionnaires, composed of 20 (for patients) and 40 (for physicians) with both: open and closed questions were used. Study results were processed in SPSS software. Results: Response rates were 83% for patients and 87% for physicians. The vast majority of patients suffered of unrelieved pain at the admission to the clinic. Almost all patients (98%) were coming from primary health care institutions. Perception and expression of pain by majority of patients (85%) didn't correspond to the pain intensity, measured by the VAS and consequently, by the numerical scale (t=3.4). Pain intensity was in linear correlation with the disease stage (r=0.6). It was increasing along with the disease progression. Fifty percent of physicians in the selected primary health care facilities were unaware of WHO pain leader, 90% of them didn't use tools for evaluating of pain intensity. 89.8% prescribed opioids without a prior determination of causes and risk factors. None of the physicians knew about the role of patients in chronic pain management, resulted in the unawareness of patients toward self-management and preventive potential of chronic pain. Conclusion: 1: Majority of palliative patients are admitted to specific tertiary clinic with unrelieved pain; 2: Chronic pain assessment and management level is mainly inadequate in primary health care institutions; 3: Chronic pain education along with the enhancement of knowledge level of family physicians is of critical importance for effective pain relief.

BackgroundThe serious shortage of human resources for primary health care (PHC) is a common issue in health reforms worldwide. China has proposed that it is an effective way to encourage and guide qualified medical personnel to work in primary health care institutions (PHCIs). However, few studies have been conducted on the willingness and influencing factors of medical personnel to seek employment at PHCIs.MethodsBased on implicit theory and lexical approach, pre-investigation was conducted to collect the items that influence the medical personnel to seek employment at PHCIs from the perspective of guided objects. Through a three-phase investigation of 1160 doctors in 29 public hospitals in 9 cities, the items were categorized, and a structural equation model was established and verified to explore the interrelationship of influencing factors.ResultsA total of 6 factors were rotated, including Sense of Gain (SG), Internal Organization Development (IOD), Remuneration and Development (RD), Condition of the City Where the PHCI Is Located (CCPL), Job Responsibilities (JR) and Family Support (FS). The results of the model showed that IOD, RD, JR and FS had a significantly positive effect on the SG. In addition, the FS, RD and JR significantly mediated the relationship between the internal and external environment of PHCIs and SG. The values of the fit index indicated an acceptable-fitting model.ConclusionFamily, remuneration, individual development, and job responsibility are closely related to the willingness of medical personnel to seek employment at PHCIs, and the internal and external environment of PHCIs is also an important factor. Therefore, the development of PHC providers can be promoted by paying attention to the family members of medical personnel, establishing a reasonable remuneration system, providing suitable development opportunities, arranging work rationally and improving the internal construction of PHCIs.

Distinguishing Nontuberculous Mycobacteria from Multidrug-Resistant Mycobacterium tuberculosis, China

BackgroundChina’s primary health care system has undergone major changes since the new round of medical reform in 2009, but the current status of primary health care institution service efficiency is still unsatisfactory. The purpose of this study is to compare and evaluate the China’s primary health care institution service efficiency and provide a reference for improving the efficiency and promoting the development of primary health care institution.MethodsBased on panel data of 31 provinces (municipalities directly under the central government and autonomous regions) in mainland China from 2011 to 2020, using the super efficiency slack-based measure-data envelopment analysis model, to analyze the data from a static perspective, and the changes in the efficiency of primary health care services were analyzed from a dynamic perspective by using the Malmquist index method. Spatial autocorrelation analysis method was used to verify the spatial correlation of primary health care service efficiency among various regions.ResultsThe number of Primary health care institutions increased from 918,000 in 2011 to 970,000 in 2020. The average primary health care institution service efficiency in the northeastern region including Jilin (0.324), Heilongjiang (0.460), Liaoning (0.453) and northern regions such as Shaanxi (0.344) and Neimenggu (0.403) was at a low level, while the eastern coastal regions such as Guangdong (1.116), Zhejiang (1.211), Shanghai (1.402) have higher average service efficiency levels. The global Moran’s I showed the existence of spatial autocorrelation, and the local Moran’s I index suggested that the problem of uneven regional development was prominent, showing a contiguous regional distribution pattern. Among them, H–H (high-efficiency regions) were mainly concentrated in Jiangsu, Anhui and Shanghai, and L-L regions (low-efficiency regions) were mostly in northern and northeastern China.ConclusionThe service efficiency of primary health care institution in China showed a rising trend in general, but the overall average efficiency was still at a low level, and there were significant geographical differences, which showed a spatial distribution of “high in the east and low in the west, high in the south and low in the north”. The northwestern region, after receiving relevant support, has seen a rapid development of primary health care, and its efficiency was steadily improving and gradually reaching a high level. The average primary health care institution service efficiency in the northeastern region including the northern region of China was at a low level, while the average efficiency in the eastern coastal region and some economically developed regions was high, which also verifies the dependence and high symbiosis of primary health care institution service efficiency on regional economy.

BackgroundChina’s standardized training for residents of General Practitioners (GPs) is aimed at providing the postgraduate training for family doctors who will serve the primary health care institutions. The aim of this paper is to investigate the standardized training situation, satisfaction with standardized training, work situation, intention, satisfaction and attitude of GPs who have finished standardized training.MethodsThis study was undertaken in 6 training hospitals in Gansu province using a questionnaire with 45 questions.ResultsApproximately 275 residents of GPs were enrolled. Finally, 263 residents completed the questionnaire (95.64% response rate), including 133 females (50.57%) and 130 males (49.43%) with an average age of 28 years (standard deviation, 1.93 years; range, 25–36 years). Additionally, 56.65% were single and 43.35% were married. Of all subjects, 92.40% residents had obtained certification of standardized training for residents of GPs and only 39.54% residents were satisfied with monthly income during training. There were 171 oriented rural medical graduates, of whom, only 42.69% expressed the willing to continue working in the primary health care institutions after the serve time (6 years) expired. Around 86.31% of residents of GPs who had finished standardized training got jobs with more than half serving in the primary health care institutions. For medical institutions and sanitary bureau were clear about general medicine policies, only 29.96% subjects registered as GPs. Among the residents in general practice department, 68.42% were engaged in the diagnosis and treatment of common disease and frequently-occurring diseases as well as referral of patients. The percentage of residents who were satisfied with the job and income were 30.40 and 14.98%, respectively.ConclusionStandardized training for residents of GPs in China is gradually improving. In order to cultivate more GPs and increase their willing to serve in the primary health care institutions, it is necessary to formulate and execute better policy of GPs, publize general medicine and improve the training quality.

BackgroundPrimary health care institutions are looking for opportunities to create value for patients and to increase the competitiveness of the health care institution. Determination of competitive priorities for creation of value for patients in the management of primary health care institutions allows improving competitiveness and achieving a competitive advantage in the market.The aim of the studyTo determine the priorities in the management of public and private primary health care institutions by using the focus group discussion method with managers.MethodsThe study was exploratory with intention to find a ground for a management theory and to be the root for the development of health care reform in Lithuania. Focus group discussions were held in 10 Lithuanian counties; 10 focus group sessions were carried out. A total of 48 primary health care executives were interviewed. The participants of this qualitative study were given 8 questions related to value creation of the primary health care institution to patients and rise in competitiveness. The main question of the focus group discussion was “What are the main priorities of management of primary health care institution?” The criteria of data collection based on the deep understanding of the phenomenon and the richness of data expressed by participants of the research.ResultsQualitative research showed that the priorities of management of primary health care institutions were work management of an organization; human resources management; patient management; and health policy decision making. The participants of focus groups pointed out that effective work of primary health care institutions is ensured by the model of management, doctor-patient communication, quality and timely delivery of health care services, and financial resources. The major decisions involving the management of patients were as follows: meeting patients’ expectations, quality and timely satisfaction of patients’ needs, effective solution of patients’ problems, patient-centered services, patient satisfaction, and communication with the patient. Accessibility to services, quality, geographical accessibility, disease prevention, strengthening of patients’ health and adequate funding were mentioned as the priorities of health policy.

Antimicrobial resistance poses a growing global health threat and is largely driven by the inappropriate use of antibiotics. Primary healthcare institutions, particularly in low-resource settings, often face challenges, such as limited oversight and irrational prescribing practices. While progress has been made in improving antibiotic stewardship in higher-level hospitals, efforts to optimize prescription in primary healthcare institutions remain insufficient. The County Medical Community Central Pharmacy (CMCP) program was introduced as an integrated intervention to enhance pharmacy services and promote rational antibiotic use through centralized oversight, training, and pharmacist collaboration. This multicenter quasi-experimental study aimed to evaluate the effectiveness of the CMCP program in reducing antibiotic misuse and improving prescribing rationality in primary healthcare institutions in Shandong Province, China. This multicenter quasi-experimental study was conducted between July and December 2023 in six geographically and economically diverse rural regions of Shandong Province. A total of 37 primary healthcare institutions were included, with 25 voluntarily implementing the CMCP program (intervention group) and 12 continuing routine practices (control group). Data were collected at two time points via structured questionnaires and reviews of 100 randomly selected outpatient prescriptions from each primary healthcare institution. A difference-in-differences (DID) regression model was applied to estimate the impact of the intervention on antibiotic usage and irrational prescribing, controlling for institutional and staffing characteristics. Antibiotic usage rates increased in both groups, but to a lesser extent in the intervention group (from 15.726 to 18.732%; P = 0.006) than in the control group (from 17.682 to 26.582%; P < 0.001). DID analysis showed a mitigating effect on antibiotic use (DID coefficient = -0.061; P = 0.054). Irrational antibiotic use in the intervention group decreased from 50.660 to 27.655% (P < 0.001), whereas it remained largely unchanged in the control group (36.893% vs. 35.238%). The CMCP program was effective in curbing unnecessary antibiotic prescriptions and enhancing prescription quality in primary healthcare institutions. These findings support the continued implementation and scale-up of CMCP as a strategy to strengthen antibiotic stewardship at the primary care level in resource-limited settings.

In China, the primary health care institutions (PHCIs) have difficulty winning the trust of residents because of the shortage of medical personnel and the low level of skills. The government has advocated encouraging qualified doctors to work in PHCIs, but no obvious results are achieved. Based on the theory of planned behavior (TPB), this paper explores the factors affecting medical personnel seeking employment in PHCIs and then putting forward measures to improve the human resources construction of PHCIs. A three-stage survey was conducted to obtain the factors and a structural equation modeling (SEM) was applied to examine the relationship of the factors. We found that the factors affecting medical personnel to work in PHCIs include the specific conditions and work contents of PHCIs, as well as the family life and regional factors. Besides, there is a significant correlation and indirectness between these factors. Therefore, targeted measures can be proposed to improve the intention of medical personnel seeking employment in PHCIs. This study provides theoretical support for encouraging medical personnel to work in PHCIs and improving the primary health care system.

Background. In the face of competition between primary health care institutions (PHCIs), attempts are made to gain a competitive advantage in the market by creating greater value for patients. Little research has been conducted on whether the form of a PHCI’s ownership is a factor of its competitive advantage. The aim of the study. To determine opportunities for competitive advantage in the management of value creation in public and private primary health care institutions by using the method of focus group discussion with managers. Methods. Focus group discussions were held in 10 Lithuanian counties, and 10 focus group sessions were carried out overall. A total of 48 primary health care managers were interviewed. Results. The competitive advantage of a PHCI depends on its form of ownership, which makes for unfair competitive conditions. A competitive advantage is created by factors such as: the variety of services available; the health care policy in action; the function of the manager; the professionalism of the staff; and the location of the institution. Medical staff have the same opportunities to express and develop their professional skills in public and private PHCIs, but private institutions attract the most skilled staff because they have the resources to increase their motivation. Conclusions. The managers of PHCIs indicated that the competitive advantage depends on the form of ownership. In management science this study and the results can be a basis for the health care reform development and the foundation for new theories.

In this study, we aimed to evaluate the self-reported practice of physicians working in primary health care institutions in Elazığ Province about smoking cessation counseling. The population of this cross-sectional study consisted of 262 physicians working in primary health care institutions in Elazığ. We aimed to reach the entire population without using the sample selection method and we successfully reached 95.42% (250 people) of the population. A questionnaire form was used for data collection. The data obtained were evaluated by frequency, percentage, mean ± standard deviation, median and minimum-maximum, and binary logistic regression analysis. The mean age of the physicians was 40.86 ± 10.58 years and 68.0% of them were male. Among them, 30.4% (n = 76) were current smokers, 17.6% (n = 44) were former smokers and 52.0% (n = 130) were never smokers. The physicians' frequency of applying the steps of smoking cessation counseling was as follows: 38.8% "Ask", 81.6% "Advice", 68.4% "Assess", 66.8% "Assist", 31.2% "Arrange". Additionally, 16.0% of the physicians received smoking cessation counseling training. Those who had not smoked at least 100 cigarettes in their life applied the "Advice" (p = 0.026) step more frequently. Those who received smoking cessation counseling training applied the following steps more frequently: "Ask" (p = 0.024), "Assist" (p = 0.025), and "Arrange" (p = 0.001). It is seen that the smoking frequency of primary care physicians in Elazığ Province is the same as that of the general population, and the frequency of smoking cessation counseling is far behind the target. Physician population is an important target group that should not be ignored in the fight against smoking. In order to increase the frequency of physicians' smoking cessation counseling practice, there is a need to increase the number of physicians who receive smoking cessation counseling training.

Aim: The aim of this study is to evaluate the knowledge level of breast milk and breastfeeding of health professionals working in primary health care institutions in Malatya.Material and Methods: A Cross-sectional Study’s survey prepared by using the Handbook of Breastfeeding Counseling translated by Child and Adolescent Reproductive Health Branch of the Ministry of Health of Turkey. 778 people were contacted by the interviewers by visiting the primary health care institutions in Malatya city center and districts, directly. All data was evaluated with SPSS 22 software and p0.05 was accepted as statistically significant.Results: The mean age of the participants was 36.15±8.57 years; 77.6% of them were women; 49.1% were working in Family Health Center. It was determined 80.1% of family physicians and 84.5% of midwives / nurses have been consulting about breast milk / breastfeeding in daily practice. When the respondents’ answers to the statements of knowledge about breast milk/breastfeeding counseling were assessed, there was no significant difference between the answers given by the family physicians and midwives/ nurses (p> 0.05). The participants gave wrong answers to 40% of the questions about conditions that require practical support such as insufficient breastmilk and the conditions related to the breasts. Conclusion: In our study we observed that basic subjects were well known by healthcare personnel whereas there is a serious lack of information, especially in daily practice, which should be constantly updated. We think that the training of breastfeeding and breastfeeding counseling should be updated periodically and especially emphasis should be given to new developments and practical information.

BackgroundThe availability of health care to all individuals is one of the main sustainable development goals of the modern world, and one of the main policy objectives of the World Health Organization. The aim of universal health care is to provide health security and equal access to health care to everyone while achieving an adequate level of health care quality as well. Achieving these goals is important both in terms of promoting societal equality as well as achieving higher economical productivity. Another important aspect in achieving universal health care is cost effectiveness. With the ever growing costs of healthcare, governments around the world are looking for ways to simultaneously achieve cost and care efficiency. Over the past couple of years, integrated care has been widely used as a way to achieve the somewhat contradicting goals of improving population health, managing healthcare costs and promoting new ways of healthcare organization. One of the outcomes of successful integrated care strategies should be an increase in overall health care quality. Health care quality can be defined as the degree to which health care services increase the likelihood of desired health outcomes for their users. Health care quality can be assessed both from the user and service provider perspective. Although a number of authors have analysed health care quality from the user perspective there are still ambiguous findings regarding the user perceptions of integrated care strategies implemented in their health care systems. In order to shed more light on this understudied issue, this paper will analyse the user perception of integrated health care quality in primary health care institutions in Croatia.Aims and objectivesThe aim of this paper is to analyse the understudied user perception of integrated health care quality in primary health care institutions in Croatia in order to provide recommendations for integrated care quality improvement. The aim of the authors in the future is to include healthcare providers in the questionnaire in order to be able to provide more detailed recommendations on integrated care enhancement methods.MethodsThis paper will use the SERVQUAL survey for service quality assessment in order to analyse the perception of integrated health care quality in primary health care institutions in Croatia and explore the differences between user expectations and perceptions. The research will be conducted from October to December 2019 in randomly selected primary health institutions in different parts of Croatia.Target audienceThe findings of the paper are expected to be used by health care professionals as well as policy makers in order to enhance integrated care strategies in the Croatian health care system.