Community Health Institutions Research Articles

University Governance in the Legal Entrepreneurship of Intellectual Capital Around the Implementation of the SDGs

Aim. The study's objective is to compare a theoretical model of university governance in the COVID-19 era. Since the literature consulted warns of the pandemic's impact on university governance, the factor structure was confirmed. Method. An exploratory, cross-sectional, and correlational study was carried out with a sample of 180 administrators, teachers, and students from a university in central Mexico selected for their participation in the social service system and professional practices in community health institutions. The instrument was evaluated using the Delphi technique in three phases: qualifying, comparative, and reiterative- reconsidered. The University Governance Scale was applied via Zoom session. The data were captured in Excel and processed in JASP. Reliability, validity, adjustment, and residual coefficients were estimated to contrast hypotheses. Results. The three-factor structure was corroborated: identity, reputation, and image. Although the first factor explained the highest percentage of variance, only 12 of 18 indicators correlated with its factors. Conclusions. The study's contribution lies in contrasting the university governance model in a scenario of exposure to COVID-19. Still, the study's limit lies in the non-generalization of the results to the university community.

Demand of the senior citizens with different life quality for community health care in Weifang, China

Objective: It is to investigate the situation of life quality of the senior citizens in Weifang and demand of the senior citizens with different life quality for community health care. Methods: The cluster sampling is used in the questionnaire survey for 1208 old people in Weifang who are older than 60 years old in Weifang. Result: The average age of 1208 elderly people in the communities of Weifang is 69.19, including 532 males and 676 females. Among the community, the most demanding needs of these old people for community health care are regular physical examination (97.3%), general disease care (84.5%) and establishing health records (79.2%), safe medication guidance (78.5%), health monitoring guidance (73.5%), and hotline health consultation (72.3%). There are significant differences in the demand for community health programs among the elderly with different quality of life. Conclusion: There are significant differences in the needs of the elderly with different quality of life for community medical services, which requires the community and related medical and health institutions to provide differentiated services for the elderly people, improve their satisfaction with health services, and ultimately promote the overall improvement of the health situation of the elderly people.

Traditional Chinese and Mongolian Medicine Utilization Among Hypertensive Older Adults: Community Health Institutions, Hohhot, China

Traditional Chinese medicine (TCM) and traditional Mongolian medicine (TMM) systems treat hypertension in community health institutions within China's Inner Mongolia autonomous region. This paper aims to investigate the use and influence of TCM and TMM among hypertensive older Chinese adults receiving treatment at these community health institutions. A cross-sectional survey method was used in Hohhot, Inner Mongolia Autonomous Region. A total of 1,499 completed questionnaires were collected from eight community health service centers in four municipal districts of Hohhot between May and June 2022. In all, 662 (44.2%) respondents had used community hypertension treatment services in the last year. Of the 662 respondents, 213 (32.2%) used TCM hypertension treatment services, and 64 (9.7%) used TMM treatment services less frequently and at a lower cost. Chinese herbal medicine (63.5%) and Mongolian herbal medicine (74%) were used more than other treatments. Cognition, attitude, and service provision were the main factors that affected service utilization. Ethnicity also had an impact on TMM’s service utilization. Older Chinese adults with hypertension did not fully utilize the TCM and TMM services provided. Further promotion and expansion of traditional medicine are needed from relevant government and health institutions.

Taking on the Challenge: A Case Study on a Community Health Club for Noncommunicable Disease Control.

From 2013 to 2021, the University of the Philippines Community Health and Development Program (UP CHDP) was in partnership with Cavite and its five municipalities of Alfonso, Mendez, Indang, General Emilio Aguinaldo, and Amadeo (AMIGA). They aimed to improve the control of hypertension and diabetes through interventions such as the organization of community health clubs, as recommended by the Department of Health in 2016. Currently there is limited information on the experiences and outcomes related to this strategy. Data on this can help the community and public health institutions in understanding and maximizing the benefits of organizing community health clubs for noncommunicable disease control. This study aimed to determine a community health club's membership profile, its organization and maintenance processes, and the benefits, challenges, and enabling factors experienced. This case study-mixed method was done in 2020 on the Challengers Health Club in Alfonso, Cavite. Group interviews of the club officers and barangay health workers were conducted to explore the club processes, their perceived benefits, challenges, and enabling factors. Health records were reviewed to determine the club's membership profile. The community health club showed an increase in membership since it was established. Most members are elderly, female, non-smoker, and hypertensive. There was increase in proportion of members with controlled hypertension after two years. However, this was not observed among those with diabetes. Perceived benefits for members were free, regular, and accessible services, improved knowledge and better control of their condition, and opportunity to socialize with others. Enabling factors were partnership with UP, teamwork and dedication of club leaders, effective management, and community support. The limited funding and supply of medicines, discontinuation of deployment of UP partners, and the COVID-19 pandemic were the challenges identified by the club. This study described the experiences of a community health club established to control hypertension and diabetes. Benefits of this intervention were reported despite the challenges they encountered because of the support mechanisms that were in place.

The impact of COVID-19 prevention and control policy adjustment on anxiety, depression and coping behavior in China: a cross-sectional online survey, 21–28 December, 2022

BackgroundFollowing external situation reports, individuals perceive risks, experience different emotional reactions, and further change their behaviors. Therefor people’s psychology will also be affected by adjustment of COVID-19 epidemic prevention and control policy, but it remains unknown what kind of coping behaviors will be produced due to psychology. This study defines coping behavior as “medical behavior and irrational consumption behavior after the adjustment of COVID-19 epidemic prevention and control policy in China”, assesses the prevalence of negative emotions in the Chinese population after policy adjustments, and explores how negative emotions affect people’s coping behaviors, conducts baseline research, provides references and suggestions for policy formulation.MethodsA cross-sectional online survey was conducted during 21–28 December 2022, included sociodemographic characteristics, COVID-19 infection and irrational purchase behavior, psychological assessment, and opinion polling. Depression and anxiety status are assessed by PHQ-9 and GAD-7. The relationship between anxiety, depression and coping behavior was analyzed by Pearson χ2 test, Fisher’s exact test and logistic regression.ResultsA total of 3995 infected participants were included in this study, of which 2363(59.1%) and 1194(29.9%) had depression and anxiety. There was a significant difference in clinical treatment and irrational purchase behavior between different level of depression and anxiety. Depression was a risk factor for self- medication (OR = 1.254), seeking professional treatment (OR = 1.215), using online services of medical institutions (OR = 1.320), large-scale purchases of medicines (OR = 1.154) and masks (OR = 1.096). Anxiety was a risk factor for seeking professional treatment (OR = 1.285) and large-scale purchases of masks (OR = 1.168).ConclusionAfter the adjustment of COVID-19 epidemic prevention and control policy, patient risk perception can increase depression and anxiety. We found that associated with depression, COVID-19 patients are more likely to have medical behaviors such as self- medication, seeking professional treatment, using online services of medical institutions, and storage behaviors of medicines and masks; and anxiety associated with the coping behavior of patients to seek professional treatment and store masks in large quantities. We should improve people’s mental health, and on the other hand, we should give people effective psychological education during the epidemic. Therefore, we should set up psychological outpatient clinics in community health institutions, expanding mental health screening and guidance; relying on the psychological outpatient clinic, establish groups of people with depression or anxiety to carry out COVID-19 health education and peer education, to reduce adverse drug reactions, avoid panic seeking professional treatment and irrational purchase behavior, and protect public mental health.Trial registrationThis study has been approved by the Medical Ethics Committee of Capital Medical University (2023SY086), and informed consent was obtained from the study subjects before the investigation.

Current status and time trends of lipid and use of statins among older adults in China-real world data from primary community health institutions.

Elevated serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels are established risk factors for cardiovascular diseases, a leading cause of death in China, especially in aged population. We sought to assess the latest levels of serum lipids, prevalence of dyslipidemia and achievement of LDL-C lowering targets among Chinese aged population. The data was obtained from the annual health check and medical records in primary community health institutions of Yuexiu District, Guangzhou, Southern China. A sample of approximately 135,000 participants provides comprehensive estimates of the status of cholesterol level and statins use in older adults in China. Clinical characteristics were compared by different age grades, genders and years. Independent risk factors associated with statin use were determined by stepwise logistic regression analysis. The mean levels of TC, HDL-C, LDL-C, TG were 5.39, 1.45, 3.10, and 1.60 mmol/L, respectively, while the prevalence of high TC, high TG, high LDL-C, and low HDL-C were 21.99, 15.52, 13.26, and 11.92%, respectively. Although statin use showed an increasing trend in both participants > 75 years and ≤75 years of age, the achievement of treatment goals fluctuated between 40.94 and 48.47%, and even seemed to have a downward trend. Stepwise multiple logistic regression analysis further indicated that age, medical insurance, ability of self-care, hypertension, stroke, CAD, and high LDL-C were shown to be associated with statins use (P < 0.05). Those aged ≤75 years old seemed to be less likely to use statin, and those without medical insurance or ability of self-care seemed to be less likely to use statin, too. Patients with hypertension, stroke, CAD and high LDL-C were more inclined to use statins. Chinese aged population currently experienced high serum lipid levels and prevalence of dyslipidemia. Although an increasing trend was shown in the proportion of high CVD risk and statin use, the achievement of treatment goals seemed to have a downward trend. Improvement of lipid management is necessary in order to reduce the burden of ASCVD in China.

Antibiotic Use among Patients Visiting Primary Hospitals in Northwest Ethiopia: A Multicenter Cross-Sectional Survey.

Antimicrobial medications are becoming ineffective because of the surge in antimicrobial resistance. Poor knowledge and inappropriate beliefs combined with the misuse of antibiotics may be common in the community and public health institutions. This study assessed the knowledge, belief, and antibiotic use practice among patients visiting rural hospitals in Northwest Ethiopia. A facility-based multicenter cross-sectional survey was conducted in Northwest Ethiopian primary hospitals from August to September 2020. The data are presented as frequencies and means (±SD) of our findings. The independent samples T test and One-Way Analysis of Variance (ANOVA) were used to explore the mean knowledge differences of antibiotic use among respondents. A pvalue of <0.05 with 95% CI was considered significant. More than half of the participants (57.2%) were males, and the mean age was 34.8 ± 13.4 years. The mean (±SD) knowledge score of the respondents was 3.69 (±1.7) (range: 0 to 10), and the majority (69.7%) had poor knowledge. The mean (±SD) belief score (acceptance towards antibiotic use) of the respondents was 20.08 ± 4 (range: 7 to 35) and most (70.1%) of the respondents had moderate levels of perception regarding antibiotic use. The majority (69.5%) of respondents took antibiotics over the past year. Participants practiced inappropriate uses of antibiotics such as medication discontinuation (49.5%), keeping unused antibiotics for future use (35.5%), and sharing medications with/from others (30.1%). Diploma holder participants had significantly higher mean knowledge scores on antibiotic use than those who were unable to read and write (p=0.047). Similarly, students had higher mean knowledge scores compared with farmers (p=0.024), merchants (p=0.031), and housewives (p=0.047). Our study showed a widespread misuse of antibiotics in Northwest Ethiopia. Malpractice such as dose interrupting, sharing of antibiotics for/from the others, and keeping leftover drugs for future use were common among the respondents. These findings suggest that a greater effort is required in public education related to proper and safe uses of antibiotics and that greater efforts are needed to enforce the control of antibiotic use to overcome the emergence of antibiotic resistance.

Investigation on the Operation Status of Community-Based Rehabilitation Station in a District of Chongqing.

Objective Investigate and analyze the current operation status of the community-based rehabilitation station in a district of Chongqing to provide some reference schemes for improving the construction of the community-based rehabilitation system for Chongqing. Methods Self-designed questionnaires were issued to 36 community-based rehabilitation stations in a district of Chongqing to investigate the human resources status, service projects, service methods, and other aspects of the community-based rehabilitation stations. Results The community-based rehabilitation station lacks the participation of medical rehabilitation personnel, and only 33.3% of the community-based rehabilitation stations are composed of multidisciplinary human resources of medical and community staff. Community-based rehabilitation services focus on supply education and publicity (86.11%), and rehabilitation treatment services are not fully involved in the community-based rehabilitation service (44.44%). The methods of community-based rehabilitation services are mainly posters and other publicity activities (94.44%), and the community-based rehabilitation service methods are not highly goal-oriented. Conclusion The survey found some problems to be improved in the construction and operation of grass-roots community-based rehabilitation stations in Chongqing. Community-based rehabilitation stations should enrich the human resources and technology of medical rehabilitation, become an extension of the restoration of community health institutions, and promote the high-quality development of community-based rehabilitation.

Association of professional identity, job satisfaction and burnout with turnover intention among general practitioners in China: evidence from a national survey

BackgroundThe complex interrelationships between professional identity, job satisfaction, burnout, and turnover intention among general practitioners (GPs) are insufficiently understood in China. This study aimed to investigate the interrelationships between professional identity, job satisfaction, burnout, and turnover intention in China, and to examine whether job satisfaction and burnout played mediating roles between professional identity and turnover intention.MethodsA cross-sectional survey was conducted between October, 2017 and February, 2018 in China. The participants were selected using a multistage stratified random sampling method. Data were collected with a self-administered questionnaire from 3236 GPs (response rate, 99.8%) working in community health institutions in China. Professional identity was measured by the 13 items scale, and job satisfaction scale with an 11-item designed by Shi et al. was employed. Burnout was measured using a 22-item Maslach Burnout Inventory-Human Services Survey, and turnover intention was measured with a 6 items scale. Descriptive statistics were calculated and groups’ differences were estimated Student’s t-test and analyses of variance. Pearson’s correlation analysis was used to assess the degree of correlation among different dimensions of professional identity, job satisfaction, burnout, and turnover intention. Structural equation modeling analysis was applied to examine the interrelationships among these study variables based on the hypothesized model.ResultsThe proposed model achieved a good model fit. Job satisfaction had a direct negative effect on turnover intention (β = − 0.38, P < 0.001), burnout had a direct positive effect on turnover intention (β = 0.37, P < 0.001), and professional identity had an indirect negative effect on turnover intention through the mediating effect of job satisfaction and burnout.ConclusionsOur study elucidated the pathways linking professional identity, job satisfaction, and burnout to turnover intention of GPs. This revealed that turnover intention was significantly affected by job satisfaction and burnout, and the effects of professional identity on turnover intention can be mediated by job satisfaction and burnout.

Infectious Disease Prevention and Control Capacity of Community Health Institutions in Beijing: Current Status and Recommendations for Problems

Background: During the fight against the COVID-19 pandemic, Beijing's community health institutions showed some weaknesses in infectious disease prevention and control. To improve their capabilities in this aspect to fully play their role as a sentinel for monitoring infectious diseases, it is urgent to investigate and analyze their current status to find problems, then put forward recommendations. Objective: To investigate the infectious disease prevention and control level in Beijing's community health institutions, and identify and analyze the problems, with suggestions put forward. Methods: From May to July 2020, a questionnaire survey was conducted in all community health centers(CHCs) in Beijing. Information was collected, including the basic situation, departments, staff structure, infrastructure situation, the provision of public health services, and emergency response capacity for infectious diseases and public health emergencies of the CHC, and was analyzed using descriptive analysis. The above-mentioned data were checked and supplemented if necessary in accordance with the information in the China's National COVID-19 Surveillance Network and Beijing Community Health Statistics 2019. Results: Of the 342 CHCs in total in Beijing as of 2019, 90(26.32%) had a fever clinic, 102(29.82%) had a gastrointestinal clinic, and 54(15.79%) had both a fever clinic and a gastrointestinal clinic. Among the incumbent workers in the CHCs(n=28 809), 2 887(10.02%) held a position in public health, and 178(6.17%) had a senior professional title. HIV testing was carried out in 159 CHCs(46.49%). SARS-CoV-2 nucleic acid testing was accessible in 11 CHCs(3.22%). For 29 kinds of common infectious diseases, 140(40.94%) CHCs had no diagnosis and treatment capabilities, 135(39.47%) had capabilities managing 1-5 kinds, only 29(8.48%) were able to diagnose and treat >10 kinds. Conclusion: The CHCs in Beijing may have a series of problems in the infectious disease prevention and control system and mechanism, sentinel fever clinic, infectious disease diagnosis and treatment capacity, public health workforce development and other aspects. Therefore, the infectious disease prevention and control plan of the CHCs should be developed more appropriately from an overall point of view, to address the problems and improve the current status as soon as possible. Copyright © 2021 by the Chinese General Practice.

Successful aging and its influencing factors among permanent residents in Guangzhou city

Objective To estimate the prevalence and influencing factors of successful aging among permanent elderly residents in Guangzhou city, Guangdong province and to provide a reference for community health institutions in improving their services for successful aging of the elderly. Methods Using convenient sampling, we recruited 617 permanent local residents aged ≥ 60 years in a tertiary hospital, two nursing homes and two communities in Guangzhou city and conducted a questionnaire survey among the elderly from July to December 2018. Results For the 594 respondents with valid information, the mean total score of successful aging was 164.74 ± 21.69 and the average score for all successful aging items was 4.22 ± 0.56, with the mean domain scores of 4.35 ± 0.92 for health autonomy, 4.45 ± 0.83 for economic security, 4.21 ± 0.75 for life adaptation, 3.93 ± 0.80 for social and kinship relationships, 3.89 ± 0.88 for learning, and 4.63 ± 0.67 for family, respectively; 443 (74.6%) of the respondents were assessed as having successful aging based on an average score of greater than 3.95 for all the items for successful aging. Unconditional multivariate logistic regression analysis showed that the respondents with following characteristics were more likely to have successful aging: with the education of senior high school, living with spouse, having a personal monthly income of 3 000 yuan (RMB) and more, with a general or good self-rated health, and residing in nursing homes or in communities; while the respondents with rural registered permanent residence were less likely to have successful aging. Conclusion The level of successful aging is relatively high and mainly influenced by education, registered residence, personal monthly income, self-rated health, and living place among permanent elderly residents in Guangzhou city.

Barriers to Counseling on Advance Directives Based on Counselors' Experiences: Focus Group Interviews.

In Korea, since the Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life was implemented in February 2018, advance directives (ADs) have become legally effective and should be documented after sufficient explanation by a registered counselor. However, little is known regarding the adequacy of current AD counseling. This qualitative study aimed to explore the barriers to AD counseling based on counselors' experiences. We conducted focus group interviews using purposive sampling. Seven counselors working at hospitals, community health institutions, and non-profit organizations participated in this study. They were asked about the challenges and problems they encountered during AD counseling. Three themes emerged from this study; 1) issues regarding consistency in AD counseling, 2) issues regarding AD counselors' competency and work environment, and 3) issues regarding the adequacy of the service system. The interviewees stated that the lack of a manual for standardized service made AD counseling inconsistent. The limited competency and poor work environment of counselors were pointed out as major barriers. The interviewees also stated that a proper service system considering individual circumstances is absent. The goals of AD counseling should be clarified and guidance should be implemented for providing standardized services. Further efforts to enhance the competency of AD counselors and to improve their working conditions are needed. Establishing an integrated framework for an adequate service system is also essential to overcome systematic barriers to AD counseling.

Job Satisfaction and Its Associated Factors Among General Practitioners in China.

Investigation is scare on job satisfaction among general practitioners (GPs) in China. This study aimed to investigate job satisfaction of GPs in China and explore its determinants. A multistage-stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs (response rate, 99.8%) working in community health institutions in China between October 2017 and February 2018. Multiple linear stepwise regression analysis was used to analyze the associated factors with job satisfaction among GPs. Among these respondents, 1215 (37.5%), 352 (10.9%), and 1669 (51.6%) GPs were dissatisfied, moderate, and satisfied for their current job, respectively. Male GPs, a higher education level, at a higher professional title, at a lower level of income, and those with heavy work stress had a lower job satisfaction. In addition, GPs who often worked overtime, who were at a higher level of emotional exhaustion, at a higher level of depersonalization, at a lower level of personal accomplishment, and who had less occupational development opportunities reported a lower level of job satisfaction. These findings suggest that job satisfaction among Chinese GPs is at a moderate level. Region, sex, professional title, education level, working overtime, income level, emotional exhaustion, depersonalization, personal accomplishment, work stress, and occupational development opportunities were significant predictors of job satisfaction.

Case discussion model of general practice based on the real scene of community health institutions

In order to improve the professional competence of in-service general practitioners and improve the effectiveness of standardized residency training, it is necessary to carry out training with the specific problems encountered in the practice. Taking Gaobeidian Community Health Service Center as an example, the characteristics, process and precautions of the general practice case discussion model based on the real scene of the community health institutions are introduced in the article. It would provide reference for improving the teaching effectiveness and efficiency in the training base of general practice. Key words: Community health service center; General Practice; Case Discussion

Current status of self-management behaviors among patients with type 2 diabetes mellitus in community

Two hundred and thirty nine patients with type 2 diabetes mellitus (T2DM) managed in the community health service centers of Huai′an city were selected for survey by random sampling method between January and December 2017. A self-designed questionnaire was used to assess self-management prescription. Patients received community management for 3 months. The rates of patients with not receiving diabetes health education, with healthy diet, with regular exercise, without monitoring blood glucose, with repeated hypoglycemic attacks were 44.8% (107/239), 23.0% (55/239), 46.4% (111/239), 54.8% (131/239) and 21.3%(23/108), respectively; and 51.9% (124/239) of the participants did not adhere to medication. The awareness rate of diabetic complications was 27.2% (65/239). Only 25.1% (60/239) and 15.1% (36/239) of the participants apply oral hypoglycemic agents and insulin rationally. The survey results indicate that the current status of self-management in community diabetic patients is relatively poor, it is necessary to strengthen standardized management of diabetic patients in community health institutions. Key words: Diabetes mellitus, type 2; Community health service; Self-management prescription; Blood glucose self-monitoring

PP05 The First Choice Of Health Institutions Of Elderly In Zhejiang And Qinghai, China

IntroductionThe utilization of medical resources in China is unbalanced and insufficient. In order to find a way to maximize their utilization to face challenges in the upcoming decade, this study aims to investigate the elderly's first choice of health institutions when they were ill in the Zhejiang and Qinghai provinces, and to explore the potential pathways related to their choices, respectively.MethodsThe data used in this study was from cross-sectional surveys in Zhejiang and Qinghai. According to the Anderson Health Service Utilization Model, we applied structural equation modeling to explore the complex pathways from socioeconomic status (SES), accessibility, and health status to the elderly's first choice of health institutions.ResultsThe proportion of the elderly who selected community health institutions (CHI) as their first choice of medical institutions in Qinghai was higher than in Zhejiang. The Zhejiang model revealed a significantly negative direct effect of SES and significantly positive direct effects of accessibility to CHI and health status on the choice of institutions, and a significantly positive indirect effect of SES on choice of institutions, through the mediating factor of health status. SES played an important role in the Zhejiang model in direct and indirect ways. In the Qinghai model, only SES and accessibility to CHI had significantly direct effects on the choice of institutions, with accessibility to CHI having the biggest effects. SES had a significant and positive indirect impact on choice of institutions, through the factor of accessibility to CHI.ConclusionsA better understanding of the complex pathways from factors to elderly's choices of health institutions was essential, which may inform priorities for maximizing the utilization of CHI further and prepare to face challenges in the new decade. Through this research method, policymakers could explore the specific pathways based on their own economic and societal status.

Studi Kualitatif Persepsi Masyarakat Desa Tentang Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K)

P4K is one of the government's efforts to reduce Maternal Mortality Rate (MMR). The problem found was low community participation in P4K. This study aims to find out how people's perceptions about birth planning and complications prevention (P4K) programs. Method: This research is a qualitative study using purposive sampling technique in selecting samples. The samples used were 21 people who had met the sample criteria. Data was collected through in-depth interviews and FGD (Focus Group Discussion). Data were analyzed through several stages namely data reduction, data transcripts, data presentation, coding, categorization and conclusions. Results: 1) Most of the P4K information obtained by respondents was considered to be lacking. 2) Respondents' perception of the implementation of P4K revealed that the program had not yet reached the target. 3) The majority of respondents perceive the distribution of P4K stickers among mothers as uneven and the majority of pregnant women have a perception that the activity has no benefit for themselves.4) Respondents are more dominant in the perception of village ambulances as four-wheeled motor vehicles as usual ambulances. 5) P4K supporting facilities in the village are not yet available namely dasolin / tabulin and blood donor management. Conclusion: the perception of the village community about P4K so far both about information about the program and its implementation is still considered to be less than optimal, because socialization is not carried out thoroughly to the community. Therefore, there is a need for good collaboration between community sectors, health institutions and village governments

Survey on management and service needs among elderly dementia patients in Beijing Yuetan community

Patients aged ≥65 years with dementia diagnosed by neurological specialists were selected in Yuetan community from March 2016 to December 2016. The basic information of patients was collected from the health and medical records; the needs for community care were obtained through a questionnaire survey. Total 91 elderly patients with dementia was included in the study, among whom 15 (16.5%) were found by community institutions, 18 (19.9%) patients got medication from the community health institutions. The survey showed that the numbers of participants who agreed that the community health service could provide treatment, drug prescription, referral service, condition assessment, regular follow-up, professional guidance for caregivers, door-to-door service and counseling services for patients and their relatives were 29 (31.8%), 18 (19.9%), 33 (36.3%), 19 (20.9%), 23 (25.3%), 24 (26.4%), 49 (53.8%) and 29 (31.9%), respectively. Results showed that 53.8% (49/91) dementia patients or their family members wanted to receive instruction of drug use in community health service, 17.6%(16/91) wanted to know about the professional care skill as caregivers. Currently the services for dementia patients in health service centers and stations of Yuetan community are less sufficient, which cannot meet the needs of dementia patients and their family members. Key words: Dementia; Disease management; Community health services

The impact of the government health funding on prescribing behaviors in community health institutions in China.

Government health funding (GHF) is a cosmopolitan problem. It is especially conspicuous in China, where drug sales become a main source of medical institutions’ incomes due to limited GHF. This is well known as China's “drug maintain medical institutions (DMMIs)” system which results directly in very high use of antibiotics, injections, and corticosteroids. However, few statistical data existed in China on the association between the GHF and the prevalence of inappropriate drug prescribing, despite widespread acknowledgment of its existence.A multistage sampling strategy was employed to select 442,100 prescriptions written between 2007 and 2011 by urban community health (CH) institutions and check the GHF in 36 key cities (districts) across China. This study examined the association between the GHF and the prevalence of inappropriate drug prescribing, which differs somewhat from previous studies.The data suggested that from 2007 to 2011, with the increase of GHF, prescribing behaviors (PB) gradually improved on the whole although doctors still prescribed a few more drugs than the recommendations from World Health Organization (WHO). This study found that there is significant negative association between GHF and main indicators of PB (correlation coefficients more than 0.5).The findings implied that government should further perfect the compensation mechanism to medical institutions for gradually weakening the compensation function of drug sales in medical institutions.

Analysis of the Utilization Status of Essential Medicines in Beijing's Community Health Institutions.

To evaluate essential medicines utilization in community health institutions to identify problems hindering the implementation of the Essential Medicine System at community level in Beijing, China. A total of 20 community health centers in Beijing were surveyed during September 2014 regarding stocking situation and utilization status of essential medicines. Opinions about essential medicines utilization were solicited from clinical staff at these centers. Average outpatient health expenditure was obtained from the Beijing Municipal Health Bureau to evaluate the financial impact. During our study, an average of 377 species of essential medicines was stocked by the community health institutions, accounting for 53.9% of Beijing Essential Medicine List, and 61.6% of the total medicines in the institutions. First-aid and low-price essential medicines were frequently out of stock. The average expense per outpatient visit increased yearly from 2009 to 2013. Feedback from clinical staff revealed patients' negative perception of the essential medicines and major concerns about its quality. Our study found both the list and supply of essential medicines could not meet the clinical needs of patients at community health centers adequately. Furthermore, some existing drug policies had restricted the service capacity, thus affecting the centers' function and bringing additional negative impact on essential medicines utilization. Financially, the inadequacy of essential medicine to meet clinical need and poor supply of many low-price drugs contributed much to the rise of average drug expenses, limiting the role of essential medicines to improve the quality of care at the community level.