Community Health Institutions Research Articles

A Feasibility Survey to Develop check list on the Practices Regarding Biomedical Waste Management in Community Health Institutions in a District of Haryana, India

A Feasibility Survey to Develop check list on the Practices Regarding Biomedical Waste Management in Community Health Institutions in a District of Haryana, India

PRM42 - Analysis on the Utilization Status of Essential Medicines in Beijing's Community Health Institutions

To evaluate the utilization status of essential medicines in community health institutions, and identify problems hindering the implementation of the Essential Medicine System at community service centres in China. Twenty community health centers and community health stations in Beijing were surveyed during September 2014 (one year after implementation of the new essential medicines list) regarding stocking situation and utilization status of essential medicines at these centers. Simulatneously, opinions about the utilization of essential medicines were solicited through sem-structured interviews from the clinical staff at these centers. Average outpatient health expenditure information was obtained from Beijing Municipal Health Bureau to evaluate the financial impact. During our study, an average of 377 species of essential medicines were stocked by the community health institutions, only accounting for 53.9% of Beijing Essential Medicine List, and average 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 year by year from 2009 to 2013. Feedbacks from medical staff showed that some patients have negative perception of the essential medicines’ brands and major concerns about its quality. Our study found both the list and supplies of essential medicines could not meet the clinical need of patients at community health centres adequately. Furthermore, some existing essential medicine policies in practice had restricted the service capacity thus affecting the function of community health institutions, and brought additional negative impacts on the utilization of essential medicines. From the financial perspective, the inadequacy of essential medicine to meet clinical need and poor supply condition of many low-price drugs contributed much to the rise of average drug expenses, limiting the role of essential medicines to alleviate the problem of high financial costs of getting treatment.

PHS86 - Analysis on the Utilization Status of Essential Medicines in Beijing’s Community Health Institutions

PHS86 - Analysis on the Utilization Status of Essential Medicines in Beijing’s Community Health Institutions

Analysis on the utilization status of essential medicines in Beijing .CENT.s community health centers

Objective To evaluate the utilization status of essential medicines at community health centers, and analyze problems existing in the stocking and application situation of such medicines, hence to provide references and suggestions for the implementation of the Essential Medicine System. Methods The investigation method was used to analyze the actual stocking situation of essential medicines at community health centers, and existing problems in implementing the Essential Medicine System. Results An average of 377 species of essential medicines were stocked by the community health institutions, accounting for 53.9%of Beijing Essential Medicine List, and average 61.6% of the total medicines in these institutions.There were insufficiencies existing both in the list and supplies of essential medicines.First-aid and low-price essential medicines are out of stock.Lack of confidence by some patients on the drug brands and their quality covered in the essential medicines. Conclusions The list and supplies of essential medicines could not meet the demand of patients at community health centers adequately.The method of evidence-based practice should be applied to each area in implementing of the Essential Medicine System. Key words: Essential medicine; Community health centers; Utilization status; Analysis

Health seeking behavior of patients with chronic heart failure in community

Total 1 500 subjects aged over 60 years were selected from 10 community health service centers with cluster sampling method. A questionnaire survey and physical examination were performed in all subjects. Sixty five patients with chronic heart failure were detected. The questionnaire showed that 77.6% (38/49) patients were diagnosed in tertiary hospitals, and 12.2% (6/49) were diagnosed in community hospitals. When heart failure occurred, most patients (37.7%, 20/53) chose to take a taxi to the tertiary hospital directly, and less patients (17.0%, 9/53) contacted community doctors. When a heart attack happened, 68.8%(33/48) of the patients could reach the hospital within 30 min, and 55.3% (26/47) within 60 min. 45.7% (21/46) elderly patients were hospitalized for heart failure once a year; 31.1% (14/45) were in hospital for less than 10 d each time. 46.0% (23/50) heart failure patients had received health education and 40.0%(16/40) had taken drugs under supervision; the majority health educators were community doctors and majority supervisors were family members. The results suggest that the confirmed diagnosis and treatment of heart failure patients still rely on tertiary hospitals, community health institutions play an important role in health education and management of heart failure patients outside hospitals. But the utilization of community health services is still not enough in community health service centers. Key words: Disease management; Heart failure

A comparative study of pharmaceutical service before and since the ongoing health reform in community health institutions of China

Objective Understanding current situation of pharmaceutical service before and since the ongoing health reform in community health institutions of China, and providing practical evidences to the government. Methods Adopting some indicators to comparative study the pharmaceutical care in 2008 and 2011 in community health service institutions of China. Results From 2008 to 2011, pharmaceutical service quality in general has greatly improved in community health institutions of China.For example, average number of drugs per prescription descended from 2.51 to 2.23.Percentage of prescriptions with an antibiotic descended from 43.98 to 32.08.Percentage of prescriptions with a hormone descended from 7.13 to 4.67.Percentage of prescriptions with two or more antibiotics descended from 11.24 to 7.31.These four indicators before and since the reform have statistical significance(P values are: 0.003, 0.001, 0.003, 0.004 respectively). But there are still inadequacies: from 2008 to 2011, the average prescription cost descended from 59.63 to 51.18 yuan.Percentage of prescriptions with an IV drip descended from 34.84 to 30.41.These two indicators have not statistical significance(P values are 0.182, 0.236). Conclusion To improve the quality of pharmaceutical service in community health institutions, the government should increase financial input to the community health institutions. Key words: Community health institutions; Pharmaceutical service

Focus on vulnerable populations and promoting equity in health service utilization--an analysis of visitor characteristics and service utilization of the Chinese community health service.

BackgroundCommunity health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents.MethodsMultistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors.ResultsThe proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs.ConclusionsThe CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened.

Listening to community health workers: how ethnographic research can inform positive relationships among community health workers, health institutions, and communities.

Many actors in global health are concerned with improving community health worker (CHW) policy and practice to achieve universal health care. Ethnographic research can play an important role in providing information critical to the formation of effective CHW programs, by elucidating the life histories that shape CHWs' desires for alleviation of their own and others' economic and health challenges, and by addressing the working relationships that exist among CHWs, intended beneficiaries, and health officials. We briefly discuss ethnographic research with 3 groups of CHWs: volunteers involved in HIV/AIDS care and treatment support in Ethiopia and Mozambique and Lady Health Workers in Pakistan. We call for a broader application of ethnographic research to inform working relationships among CHWs, communities, and health institutions.

Performance evaluation of community health institutions of Pudong new district

Objective To evaluate the performance of community health institutions of Pudong new district.Methods According to the criteria of the Ministry of Health of China,the performance evaluation system appropriate for local area was developed.A cross-sectional survey was conducted at 44 community health centers,and data was analyzed using descriptive statistics,correlation coefficients and multi-factor linear regression.Results The average score of total performance of these 44 community health centers was 78.53.The average scoring rate for institution management,public health service,basic medical care service,CTM service,and comprehensive satisfaction was 68.49％,89.09％,63.51％,87.80％,76.32％,respectively.Degree of informationization (0.477),regional location (0.331) and participating in medical consortia(-0.309)had significant impact on the total performance.Degree of informationization(0.302)and pilots for family doctors(0.301)had significant impact on the basic medical service performance.Conclusion There is a tremendous room for performance improvement for community health institutions in Pudong.Regional location and degree of informationization were the most crucial factors affecting the performance,irrelevant to institutional sizes.Proposals were raised for strengthening the construction of informationization,expanding pilots for family doctors,perfecting the mechanism of medical consortia. Key words: Pudong new district; Community health service; Performance evaluation; Impact factor

Social cognition and interaction training for patients with stable schizophrenia in Chinese community settings

Accumulated evidence suggests that Social Cognition and Interaction Training (SCIT) is associated with improved performance in social cognition and social skills in patients diagnosed with psychotic disorders. The current study examined the clinical utility of SCIT in patients with schizophrenia in Chinese community settings. Adults with stable schizophrenia were recruited from local community health institutions, and were randomly assigned to SCIT group (n=22) or a waiting-list control group (n=17). The SCIT group received the SCIT intervention plus treatment-as-usual, whereas the waiting-list group received only treatment-as-usual during the period of the study. All patients were administered the Chinese versions of the Personal and Social Performance Scale (PSP), Face Emotion Identification Task (FEIT), Eyes task, and Attributional Style Questionnaire (ASQ) at baseline of the SCIT treatment period and at follow-up, 6 months after completion of the 20-week treatment period. Patients in SCIT group showed a significant improvement in the domains of emotion perception, theory of mind, attributional style, and social functioning compared to those in waiting-list group. Findings indicate that SCIT is a feasible and promising method for improving social cognition and social functioning among Chinese outpatients with stable schizophrenia.

Overprescribing In China, Driven By Financial Incentives, Results In Very High Use Of Antibiotics, Injections, And Corticosteroids

In appropriate prescribing is a global problem. It is especially salient in China, where drug sales constitute a major portion of health care providers' incomes, price distortions are rampant, and oversight is lax. However, few data exist on the prevalence of inappropriate prescribing in China. This study, the first of its kind in China, examined 230,800 prescriptions written between 2007 and 2009 by 784 community health institutions in 28 cities across China. The data show substantial overprescribing, including twice as many prescriptions for antibiotics as recommended by the World Health Organization and rates of injection that are three times higher than in similar countries. These findings point to the need to integrate rational prescribing into China's ongoing health care reform.

Prevalence of and influencing factors for chronic headaches among pregnant women

ObjectiveTo determine the prevalence of headaches and their influencing factors among pregnant women. MethodsA cross-sectional study was conducted from January 3 to April 29, 2005, with 1357 women receiving routine pregnancy check-ups at the obstetric clinics of the community health institutions of Kayseri, Turkey. A structured questionnaire and the Zung Depression Scale were used to collect data. ResultsOverall, 24.6% (95% confidence interval, 22.3%–26.9%) of the participants had headaches before pregnancy, whereas only 17.9% (95% confidence interval, 15.9%–20.1%) had headaches during pregnancy. Although the headache prevalence was lower during than before pregnancy, it was high among the participants aged 35years or older, those who received help in their housework, and those who were multiparous. Moreover, the Zung depression score was significantly high among those experiencing headaches. ConclusionThe significant decrease in headache prevalence observed during pregnancy may be the result of a pregnancy-specific hormonal status. However, the most significant factors influencing the frequency of headaches in the participants were related to their socioeconomic status and the severity of depression.

Mortality in young people admitted to hospital for diabetes: database study

<h3>Objectives:</h3> 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. <h3>Methods:</h3> A...

Early intervention screening for family caregivers of older relatives in primary care practices: establishing a community health service alliance in rural America.

The Maine Primary Partners in Caregiving project provides a prime example of how disparate community health, social service, and higher education institutions can build a successful rural service alliance for the purposes of screening for family members experiencing stress during the provision of care to impaired older relatives. Community primary care practices are featured as prime sites for the early identification of elder caregivers experiencing stress and burden. Initial project results and implementation challenges as well as recommended strategies for nurturing such community partnerships are presented.

Federal Block Grants and Public Health: A Call for Physician Partnership and Leadership

Current transitions in health care financing and delivery systems have significant implications for public hospitals, community clinics, and health agencies, which provide important outreach and preventive services and rely heavily on federal and state funds. Strong concerns are being raised about the consequences of abrupt and drastic changes in funding of community health institutions and the continuing deterioration of rural and urban public health infrastructures. The viability of public hospitals, clinics, and local health agencies is threatened as government officials consider proposals for defunding, restructuring, or eliminating these entities. In 1996, Congress, the Clinton administration, and state and local government officials considered federal grant proposals and reforms that had potentially far-reaching implications for medical and public health professionals, expressing strong interest in consolidating various specific and narrowly defined categorical grant programs into broader block grant programs. Although no legislation was enacted, deliberations about federal block grant proposals provided important opportunities for physicians and medical societies to support public health activities and guard against further funding reductions that could weaken community health programs and diminish existing levels of quality and access. Ultimately, such deliberations provided a stimulus for medical associations and physicians to strengthen or renew partnerships with public health agencies and officials and provide necessary leadership to ensure that public health and preventive medicine become more integral components of the nation’s health system.

Some Accomplishments and Findings of Neighborhood Health Centers

The development of neighborhood health centers in low-income communities throughout the United States in recent years has attracted widespread attention and response. An increasing number of community groups and health institutions have begun to plan and initiate similar activities. Scholars and students of medical care programs have started to devote considerable attention to analyses of the progress and problems of the movement.'