Grassroots Medical Institutions Research Articles

Risk Analysis of Pneumothorax Caused by Acupuncture and its Prevention and Control

Although acupuncture therapy has a record of effectiveness and safety, the safety of acupuncture therapy requires both systematized professional skills and standardized application. In fact, acupuncture therapy has potential risk. Pneumothorax caused by acupuncture is a serious injury caused by this therapy. The causes are mainly related to improper needling depth, angle, manipulation, and selection of acupoints. In China, the medical institutions in which pneumothorax by acupuncture occurs are mainly community clinics, which reflects the lack of professional training of acupuncture practitioners in grass-roots medical and health institutions. Its prevention and control are discussed.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China.

China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China. An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform. After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = -1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09). The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

Medical behaviours and medication adherence of older hypertensive patients in different medical insurance programs in Beijing, China: a cross-sectional study

BackgroundGrassroots medical institutions are the primary “battlefield” of hypertension management based on hierarchical diagnosis and treatment policies in China. There is a considerable difference in the insured population and reimbursement ratio between different medical insurance programs. The management of hypertension directly affects the development trend of cardiovascular and cerebrovascular diseases.MethodsTo understand the difference between different medical insurance programs regarding the management of older hypertensive patients, all outpatients aged 60 and above with hypertension in the basic medical insurance database of Beijing, China, from April 1, 2019, to January 31, 2020, were included. Medical behaviours included patients’ choice of hospital level, type of hospital, number of hospitals visited, grassroots medical institutions and cross-district visits. Medication adherence was evaluated by calculating the medication possession ratio of antihypertensive medications. First, we adopted a statistical description for medical behaviours and medication adherence. Then, multivariate logistic regression was used to analyse the influencing factors of medication adherence.ResultsThis study included 1.29 million patients with Urban Employee Basic Medical Insurance (UEBMI) and 0.31 million patients with Urban‒Rural Resident Basic Medical Insurance (URRBMI). The proportions of patients with UEBMI who chose tertiary hospitals, comprehensive hospitals, grassroots medical institutions and cross-district visits were 25.84%, 56.09%, 57.34% and 39.32%, respectively, while those of patients with URRBMI were 11.14%, 60.59%, 81.28% and 6.07%, respectively. The medication adherence rates of men and women taking one medication were 61.04% and 55.86%, respectively. UEBMI patients who took their medication accounted for 62.36%, while only 40.27% of URRBMI patients adhered to their medication. The percentages of young-old, old-old and oldest-old patients who took their antihypertensive medications were 58.05%, 59.09% and 56.78%, respectively. The adherence to taking ≥ 2 medications (35.47%) was lower than that to taking one medication (58.33%). The medication adherence rates of patients with UEBMI and URRBMI for taking ≥ 2 medications were 37.21% and 27.45%, respectively.ConclusionsPatients with UEBMI were more inclined to choose tertiary hospitals and cross-district visits than patients with URRBMI. The adherence of patients with UEBMI was better than that of patients with URRBMI in China.

Investigation and discussion on the current situation of posttreatment of precision devices in 413 grassroots medical institutions.

Investigation and discussion on the current situation of posttreatment of precision devices in 413 grassroots medical institutions.

Abnormal maxillary sinus diagnosing on CBCT images via object detection and 'straight-forward' classification deep learning strategy.

Pathological maxillary sinus would affect implant treatment and even result in failure of maxillary sinus lift and implant surgery. However, the maxillary sinus abnormalities are challenging to be diagnosed through CBCT images, especially for young dentists or dentists in grassroots medical institutions without systematical education of general medicine. To develop a deep-learning-based screening model incorporating object detection and 'straight-forward' classification strategy to screen out maxillary sinus abnormalities on CBCT images. The large area of background noise outside maxillary sinus would affect the generalisation and prediction accuracy of the model, and the diversity and imbalanced distribution of imaging manifestations may bring challenges to intellectualization. Thus we adopted an object detection to limit model's observation zone and 'straight-forward' classification strategy with various tuning methods to adapt to dental clinical need and extract typical features of diverse manifestations so that turn the task into a 'normal-or-not' classification. We successfully constructed a deep-learning model consist of well-trained detector and diagnostor module. This model achieved ideal AUROC and AUPRC of 0.953 and 0.887, reaching more than 90% accuracy at optimal cut-off. McNemar and Kappa test verified no statistical difference and high consistency between the prediction and ground truth. Dentist-model comparison test showed the model's statistically higher diagnostic performance than dental students. Visualisation method confirmed the model's effectiveness in region recognition and feature extraction. The deep-learning model incorporating object detection and straightforward classification strategy could achieve satisfying predictive performance for screening maxillary sinus abnormalities on CBCT images.

Disaster Literacy Status and the Influencing Factors: A National Survey of 107997 Chinese Nurses

To study the level of disaster literacy among nurses in China and the influcing factors and to provide scientific basis for developing effective interventions to improve the disaster literacy among Chinese nurses. Between September 2021 and October 2021, an online survey was conducted among nurses from health care institutions in eastern, central, western, and northeastern China by using a cross-sectional survey design and convenience sampling. The content of the survey included the surveyed nurses' sociodemographic characteristics, occupational characteristics, disaster relief characteristics, self-efficacy, and disaster literacy level. A disaster literacy model developed previously was used to assess the nurses' disaster literacy. A total of 107997 nurses were covered in the survey and their disaster literacy score was found to be 255.62±53.92. According to the findings of multiple linear regression, the protective factors for disaster literacy among Chinese nurses included the following, being based in Eastern region (non-standardized regression coefficient [ B]=2.365, 95% confidence interval [ CI]: 1.647-3.082), male sex ( B=9.418, 95% CI: 7.892-10.944), bachelor's degree or higher level of education ( B=3.822, 95% CI: 3.195-4.450), tertiary-level hospitals ( B=3.569, 95% CI: 3.000-4.138), military/local public hospitals ( B=2.606, 95% CI: 1.750-3.463), emergency department ( B=2.921, 95% CI: 2.149-3.694), intermediate professional title ( B=2.918, 95% CI: 2.209-3.627), senior professional title ( B=5.801, 95% CI: 4.448-7.155), participation in disaster rescue ( B=5.566, 95% CI: 5.020-6.112), the institution being previously involved in disaster emergency rescue ( B=3.257, 95% CI: 2.429-4.084), the institution having set up disaster rescue team ( B=5.967, 95% CI: 5.103-6.831), having received nursing education in disaster preparedness in school ( B=6.205, 95% CI: 5.621-6.790), having received on-the-job disaster preparedness education and training ( B=8.776, 95% CI: 8.027-9.525), and self-efficacy ( B=5.117, 95% CI: 5.069-5.165). In China, disaster literacy among nurses is at a medium to low level and needs to be improved. For the next step, efforts should be focused on nurses with the following features, being based in the central and western regions, female sex, having completed junior college education or less, no nursing education in disaster preparedness in school, having junior professional titles, being from gynecology, pediatrics, and auxiliary departments, working in grassroots medical and health institutions and primary and secondary-level hospitals, neither the individual respondent nor her institution having any experience in disaster rescue, the institution having no disaster rescue team, not having any on-the-job nursing education and training in disaster preparedness, and having low self-efficacy. Measures should be taken to improve their disaster literacy level.

Automated detection of myopic maculopathy using five-category models based on vision outlooker for visual recognition.

To propose a five-category model for the automatic detection of myopic macular lesions to help grassroots medical institutions conduct preliminary screening of myopic macular lesions from limited number of color fundus images. First, 1,750 fundus images of non-myopic retinal lesions and four categories of pathological myopic maculopathy were collected, graded, and labeled. Subsequently, three five-classification models based on Vision Outlooker for Visual Recognition (VOLO), EfficientNetV2, and ResNet50 for detecting myopic maculopathy were trained with data-augmented images, and the diagnostic results of the different trained models were compared and analyzed. The main evaluation metrics were sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), area under the curve (AUC), kappa and accuracy, and receiver operating characteristic curve (ROC). The diagnostic accuracy of the VOLO-D2 model was 96.60% with a kappa value of 95.60%. All indicators used for the diagnosis of myopia-free macular degeneration were 100%. The sensitivity, NPV, specificity, and PPV for diagnosis of leopard fundus were 96.43, 98.33, 100, and 100%, respectively. The sensitivity, specificity, PPV, and NPV for the diagnosis of diffuse chorioretinal atrophy were 96.88, 98.59, 93.94, and 99.29%, respectively. The sensitivity, specificity, PPV, and NPV for the diagnosis of patchy chorioretinal atrophy were 92.31, 99.26, 97.30, and 97.81%, respectively. The sensitivity, specificity, PPV, and NPV for the diagnosis of macular atrophy were 100, 98.10, 84.21, and 100%, respectively. The VOLO-D2 model accurately identified myopia-free macular lesions and four pathological myopia-related macular lesions with high sensitivity and specificity. It can be used in screening pathological myopic macular lesions and can help ophthalmologists and primary medical institution providers complete the initial screening diagnosis of patients.

Analysis of laboratory re-examination results in Sichuan Provincial Malaria Diagnostic Reference Laboratory from 2014 to 2020

To re-examine the diagnosis results of reported malaria cases in Sichuan Province from 2014 to 2020, so as to assess the malaria diagnostic capability of Sichuan Provincial Malaria Diagnostic Reference Laboratory. The blood and blood smear samples from reported malaria cases were collected by Sichuan Provincial Malaria Diagnostic Reference Laboratory from 2014 to 2020, and subjected to re-examinations using microscopy and nested PCR assay. The re-examination results were compared. A total of 1 710 samples from reported malaria cases were re-examined by Sichuan Provincial Malaria Diagnostic Reference Laboratory from 2014 to 2020, and 1 634 samples were identified positive, with a positive coincidence rate of 95.56% (1 634/1 710) and a 92.29% (1 508/1 634) total coincidence rate of the Plasmodium species. The coincidence rates with P. falciparum, P. vivax, P. malariae and P. ovale were 99.48% (961/966), 97.07% (430/443), 83.05% (98/118) and 67.86% (19/28), respectively, and the coincidence rate was 91.81% (1 513/1 648) between microscopic and nested-PCR results. The capability of microscopists remains weak at grassroot medical institutions in Sichuan Province. Further training is required among microscopists to improve the malaria surveillance capability in Sichuan Province during the post-elimination stage.

Analysis of Development Status of Primary Medical and Health Institutions in Chongqing, China from 2015-2018

The important manifestation of social civilization proves to meet the demands of patients for medical treatment to the greatest extent through promoting grass-roots medical reform, improving construction of grass-roots medical and health institutions and improving their service capabilities. Chongqing, the youngest municipality in China, has a population of 34.04 million, is also a typical city with a prominent urban-rural dual structure. Construction and development of service system in primary-level medical and health institutions is of great significance for improving health of people in Chongqing. This essay uses observation variables such as “community health service center”, “township health institution” and “village clinic” as it’s basis and puts its research objects on Chongqing Statistical Yearbook 2015-2018, the latest data from the National Bureau of Statistics and from Chongqing Municipal Health Commission Statistics Bulletin 2015-2018. Through statistical methods, collected and sorted data are imported into EXCEL table, and corresponding database is established. While statistical indicators include composition ratio, utilization rate, average and etc. and a descriptive statistical analysis is performed. Research and study are given on changes of observation variables of primary medical institutions in Chongqing from 2015 to 2018. It is found that: the number of primary medical institutions showed a downward trend as a whole; the proportion of patients seeking medical treatment through primary diagnosis and treatment was still relatively high; composition of observation variable in township and village level is unreasonable; and slow growth happens in the number of township first-level medical and health institutions and the number of beds. In view of problems found in the research, the essay puts forward some solutions to improve construction of service system of primary health institutions in Chongqing, namely, to invest more in basic construction of primary medical and health institutions, to guide medical graduates to work in primary medical institutions and to increase training and guidance of primary medical technicians. In this way, we can better promote the development of primary-level medical and health institutions in Chongqing and provide citizens with more and better medical services.

Evaluating Patient Satisfaction in Township Hospitals in the Cold Regions of China.

This study focused on township hospitals in the cold regions of China and aimed to evaluate patient satisfaction during the medical care process. This study also discusses the correlation between patient needs and satisfaction. Hospitals seek to improve patient satisfaction to provide better service. However, there is a lack of existing literature on grassroots medical institutions in towns and townships, especially in cold regions. Therefore, this study aimed to examine the correlation between patient needs and the satisfaction of township hospitals in the cold regions of China. First, a hierarchical task analysis method was used to build the hierarchy for patient satisfaction demands. Patients from 15 township hospitals in cold areas were subjected to semistructured interviews, and a theoretical model was proposed using the grounded theory method. Finally, each open code index was evaluated, and 270 questionnaires were issued to evaluate patient satisfaction. The framework for patient satisfaction demands included five dimensions: tangibles, reliability, responsiveness, assurance, and empathy. A theoretical model for patient satisfaction demands was built, and four selective codes, including "Characteristic", "Perceived Quality", "Loyalty Intention", and "Environment Expectation", were extracted. The weights of these satisfaction-influencing factors were subsequently evaluated. This study summarizes the existing problems in a basic health service provision capacity, climate adaptability, lack of environmental design, and so on; proposes four influencing factors; establishes a patient satisfaction evaluation model; and obtains the weight of influence of each factor. These results will help provide accurate and effective suggestions for hospital management.

A qualitative research of the status-quo of service in primary health care for dementia who stay in home in the supply-side perspective

Objective To understand the status quo of primary medical and health services for home aged dementia patients in Weifang from the perspective of medical service providers. And to provide suggestions for improving the primary medical services and community care for home aged dementia patients. Methods A semi-structured in-depth interview was conducted with 26 primary medical and health care workers in the primary medical and health services of home patients with senile dementia, and the interview data were summarized and extracted by content analysis method. Results Four themes were extracted according to the primary medical and health services for home aged dementia patients. Theme 1: less chance to contact with dementia patients, and the understanding of the disease is biased. Theme 2: limited medical services and no targeted services. Theme 3: receive less relevant training and need professional technical support. Theme 4: there is no system of medical support, and an effective model needs to be established. Conclusion There are few primary medical and health services for home patients with senile dementia, and there are regional differences. It is necessary to increase the understanding of home patients with senile dementia by various means and increase the primary medical services for home patients. Key words: Dementia; Grass root medical institutions; Community health services; Qualitative research

The Clinical Pharmacist-Led Consultation for Infectious Diseases in Guizhou Province, China: A Survey Among Hospital Pharmacies.

BackgroundAs antimicrobial resistance became an increasing threat to global public health, Clinical Pharmacist-led Consultation (CPC) for Infectious Diseases (ID) was developed in China. We conducted a survey among hospital pharmacies to investigate the present situation and potential determinants of CPC for ID in China's Guizhou Province.MethodsThe study was conducted by sending the questionnaire to the directors of hospital pharmacy who were members of Guizhou Province Pharmaceutical Administration Collaboration Network (GPPACN) from April to May 2019. We implemented the Firth's logistic regression model to analyze the factors that influence the implementation of CPC. The acceptance rate of consultation suggestions (ARCS) and effective response rate after acceptance of pharmacists' suggestions (ERRAPS) were pooled by meta-analysis using a random effect model, respectively. A pairwise meta-analysis was performed to compare the effective response rate between patients whose treatment followed the pharmacists' suggestions and those whose treatment did not.ResultsA total of 83 hospitals covering 9 regions in Guizhou Province were included in this survey. The results showed that 50 hospitals (60.24%) developed the CPC for ID. Staffing ID, respiratory, or general clinical pharmacist had a significantly positive effect on the implementation of CPC [adjusted odds ratios = 7.298, 95% CI (confidence interval): 2.232 to 23.858]. The pooled ARCS and ERRAPS for secondary hospitals were 97.59% (95% CI: 94.27 to 100.00%) and 88.36% (95% CI: 84.71 to 92.17%), respectively. Importantly, CPC improved the prognosis of ID patients [risk ratio (RR) = 6.49, 95% CI: 2.84 to 14.82] in these hospitals.ConclusionCPC adoption is gradually increasing among hospitals and will be a promising intervention for ID treatment at grassroots medical institutions in Guizhou Province. Training more clinical pharmacists to specialize in ID, respiratory, or general diseases might be the most practical measure to promote the development of CPC for ID.

A Survey on the Continuing Education Status and Demand of Nurses in Chongqing Grass-Root Medical Institutions

Background: With the increased aging of population, the continuous increase in the morbidity of chronic diseases, and the issuance of universal two-child policy, the grass-root medical teams become more and more important. Objective: To investigate the continuing education status and demand of nurses in the grass-root medical institutions and thus provide a reference for optimizing the continuing education plan. Methods: From October 2018 to May 2019, a survey of 270 nurses from 28 grass-root medical institutions in Tongliang District of Chongqing was performed using a self-designed questionnaire. Results: In the grass-root medical institutions, the major continuing education pattern of nurses was hospital training and distance education; the continuing education focused on new basic theoretical knowledge and new nursing techniques, and its satisfaction was 67.8%. About 20.6% questionnaire answerers never had received continuing nursing education. As shown by one-way analysis of variance (ANOVA) and binary logistic regression analysis, the following factors were associated with the continuing education participation in the past three years: work unit, organizational affiliation, age, professional title and hospital policies. There were 93.0% questionnaire answerers reflecting that it was necessary to participate in the continuing education and wishing the conformance between the pattern and contents of continuing nursing education and the actual implementation status. Conclusion: The continuing education demand of nurses in the grass-root medical institutions is basic but diverse, and the organizations shall provide effective policy support for continuing education and make the diversified training plan by combining Internet technology, so as to realize the maximization of continuing education participation and keep improving the overall service quality of gross-root nurses.

Are People Enrolled in NCMS and CURBMI Susceptible in Catastrophic Health Expenditure? Evidence From China.

This study investigated associations between different types of medical insurance and the incidence of catastrophic health expenditure among middle-aged and the aged in China. The data came from the China Health and Retirement Longitudinal Survey implemented in 2013, with 9782 individuals analyzed. Probit regression models and multiple linear regressions were employed to explore the relationship mentioned above and potential mechanisms behind it. It was found that compared with participants in Urban Resident Basic Medical Insurance, individuals participating in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance was less likely to undergo catastrophic health expenditure (P < .001, P = .008), especially for low-income and middle-income group. Participants in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance were more likely to utilize inpatient medical service (P < .001, P = .020) and choose low-level medical institutions for treatment (P = .003, P = .006). And individuals participating in New Cooperative Medical Scheme had lower out-of-pocket expenditure (P = .034). The study showed the significant difference in the incidence of catastrophic health expenditure among participants in different medical insurances. Efforts should be made to improve the service quality of grassroots medical institutions except for the increase of reimbursement ratio, so that rural residents can enjoy high-quality medical services.

Research on the Dynamic Mechanism of National Pharmaceutical Industry Chain

This paper relies on the “China Health and Family Planning Statistical Yearbook” published by the National Bureau of Statistics. Analyzing the current development status of ethnic medicine, the driving force of the national medicine industry chain is the national medicine industry, especially the development of grassroots national medical institutions, and the core problem of solving the grassroots development is the construction of national physicians and the accelerated cultivation of national medical talents. Providing sufficient human resources to grassroots medical institutions is an important guarantee for the development of national medicine industry. Finally, on the basis of research, the development model of the national industrial chain of ethnic medicine was established.

Job training and organizational performance: Analyses from medical institutions in China

The benefit of training on economic outcomes has been well-documented in previous literature, as training is generally recognized as one of the important approaches in human capital investment. However, the return of employee training on organizational level performance is not verified sufficiently, especially in the healthcare field. By taking advantage of a dataset with the information on all medical institutions in Sichuan, China over 2012–2016, this paper investigates the effects of employee training on medical institution’s performance through the Propensity Score Matching (PSM) method and the Event Study approach. The results show that training benefits medical institution performance in some indicators, such as total visits, outpatient visits, non-medical-insurance, and local competitiveness. These effects, however, vary across different types of medical institutions. Grassroot medical institutions in the county area that serve as a health gatekeeper (known as primary health care institution, PHCIs) gain most in hospital visits after training. In addition, training results in a 16.5% increase in the average performance wage for county-PHCIs, and a 52.8% increase in the employees’ performance wage for higher-level general hospitals in cities. In general, by participating in training, PHCIs in county region gain more in the overall revenue through the non-medical-insurance income.

Optimization of an efficient solid-phase enrichment medium for Salmonella detection using response surface methodology

Salmonella is a pathogenic bacterium contributing to food poisoning and acute infectious intestinal disease. The traditional standard detection method is based on the principle of liquid phase enrichment and has a low sensitivity on targeted bacteria. We previously developed a visual immunosensor technique for efficient detection and isolation of Salmonella by applying fluorescent nanobioprobes on a specially-designed cellulose-based swab. In this study, a whole-sample solid-phase enrichment assay (WSEA) was established by optimization of the enrichment medium using response surface methodology (RSM), a powerful statistical tool for regression analysis. The optimal formula was determined as: 0.60% polyvalent poly peptone, 0.40% buffered peptone water, 0.09% ferric citrate amine, 0.24% sodium hyposulfite, 0.035% cystine, 0.01 µg mL−1 super absorbing polymer, 0.011% sodium deoxycholate, 15.00 µg mL−1 ethyl green and 30.00 µg mL−1 sodium selenite. Using this formula, Salmonella was visualized with naked eyes by relying on the indication of black spots formed on the swab. The analytic sensitivity of the assay was determined as 101 cells mL−1 with a concentration of interfering bacteria (Escherichia coli) at 105 cells mL−1. This optimized formula was confirmed with 4006 patients’ fecal samples, in which the positive rate was 0.42% by the conventional culture-based method and 2.12% by WSEA. The optimized formulation on solid phase enrichment by RSM allows relatively quick, low-cost, and large-scale detection of Salmonella, and could be used in grassroots medical institutions.

Current status of professional value and influencing factors among health workers in grass-roots medical institutions in Wenzhou city

Objective To survey the current status of professional value among health workers in grass-roots medical institutions of Wenzhou city and to analyze the influencing factors. Methods A survey on professional value was conducted from October to December 2017 among health workers from 14 primary medical institutions in 4 urban districts of Wenzhou City selected by stratified random sampling method. The self-designed questionnaires were used for the survey. A total of 350 questionnaires were distributed and 331 were returned, of which 302 were valid. The status and influencing factors of professional value were analyzed. Results The overall score of professional value was (96.66±14.94). The univariate analysis showed that the professional value scores were associated with educational level (F=3.851), income(F= 2.660), professional title(F=8.030),position(F=11.658) and specialty (F=4.667) of the health workers(all P< 0.05). The multivariate analysis showed that the gender(male: OR=0.53, 95% CI:-1.077--0.192, P=0.005), educational level (high school and below: OR=3.06, 95% CI: 0.007-2.233, P=0.049), income (2 000-4 000 Yuan: OR=0.07, 95% CI:- 4.783--0.627, P=0.011), professional title (no title: OR=0.27, 95%CI: -2.397--0.232, P=0.017; Junior title: OR=0.31, 95%CI:-2.197--0.153), P=0.024; intermediate title: OR=0.23, 95% CI:-2.533--0.366, P=0.009),position (doctor: OR=0.13, 95% CI:-3.235--0.815, P=0.001; nurse: OR=0.20, 95% CI:-2.883--0.368, P=0.011; technician: OR=0.15, 95% CI:-3.076--0.723, P=0.002) were influencing factors of professional value(all P<0.05). Conclusion The professional values among health workers in Wenzhou grass-roots medical institutions are relatively low. The male gender, low educational level, low income, low professional title or no title and positions are influencing factors of professional value. Key words: Community health services; Medical staff; Social value

VP99 Study On The Responsiveness Of Primary Medical Institution In ZJ &amp; QH

IntroductionThe health system responsiveness, defined as non-medical aspect of treatment relating to the protection of the patients’ legitimate rights, is the intrinsic goal of the WHO strategy for 21st century, and is an important index to measure the service ability of medical institutions.MethodsThe data were collected in 2016-2017 and consists of the first visits for patients of grass-roots medical institutions. SPSS21.0 was used to complete statistical description and tests including multiple linear regression model analysis and structural equation analysis.ResultsThere are differences in perceived responsiveness of primary medical institutions in Qinghai and Zhejiang. Zhejiang residents believe that the primary medical institutions have better medical environment, medical staff have better attitudes to explain problems, treatment plan explanation is more clear, and the attitude toward listening to patient condition is more serious. However, Qinghai residents think that the waiting time of the basic medical institutions is shorter and the degree of trust in the medical staff is higher. There are differences in health system responsiveness among different groups. According to the standard of ɑ=0.05, factors such as ethnicity, household registration type, the medical insurance type, the occupational type, the marital status, the educational level have a significant impact on the perceived responsiveness of primary medical institutions.ConclusionsHealth system responsiveness exists in the region, which may be related to the differences in the economic development level, the state of health service and the management and investment in health services among different regions. On the other hand, residents living in the same area are more similar in terms of living environment, socio-economic status, ideology and culture, and health beliefs than those from different regions. This may be one of the reasons the results of health system responsiveness assessment are closer than for residents in different regions.

Discussion on the Functional Mechanism of the Community Health Service Center in the Existing Medical Service System

The current situation of patients visiting hospitals is that, large hospitals are overcrowded with patients, but there are relatively insufficient patients in community hospitals. The root cause is that the role of existing basic medical and health institutions has not been properly and fully utilized. If this situation cannot be fundamentally changed, then it is impossible to say that the medical reform has embarked on the road to success. Therefore, if the overall medical development strategy can be implemented to provide more preferential support to the grass-roots hospital, in order to lead the general direction of social and medical development further, and facilitate the work of grass-roots hospitals; the work direction of community health service centers, in terms of business philosophy, examination, treatment, technical means, hospital management, and resource mobilization in all directions etc.., has been adjusted accordingly, so as to create internal conditions and driving factors for more patients to return to the grass-roots hospitals; the large hospitals should also provide more corresponding support and help to community health service centers in the focus of work, with the aim of promoting the development of grass-roots medical institutions objectively at the higher medical level, we believe that the number and categories of diseases of patients visiting basic medical and health institutions will change a lot in the near future, even fundamentally.