Local Medical Institutions Research Articles

Epidemiology of Hypertension in a Typical State-Level Poverty-Stricken County in China and Evaluation of a Whole Population Health Prevention Project Intervention.

Background In China, there were 584 state-level, poverty-stricken counties until January 2019. The central government has invested a large amount of funds and preferential policies to alleviate poverty in these areas. The Whole Population Preventive Healthcare Pilot Project (WPPHCPP) aims to explore the use of limited funds to achieve healthy poverty alleviation through free regular physical examinations and comprehensive health management for the entire population in impoverished regions. Objective By demonstrating the prevalence of hypertension in populations of poverty-stricken counties in Western China and evaluating health management outcomes after implementing the WPPHCPP, we can provide a foundation for the future development and promotion of improved public health. Subjects and Methods Through the WPPHCPP, the entire population in the pilot area was required to undergo free physical examinations. The examinations screened for hypertension revealed the epidemiology of adult hypertension. Based on blood pressure levels and risk factor exposures, risk classifications for hypertensive patients were performed. Corresponding intervention and management strategies for different risk levels were provided by a joint management team consisting of family physicians from three different levels of local medical institutions (village, town, and county). Healthcare management outcomes including awareness, treatment, and hypertension disease rates were compared between the period before and after the intervention and management. Results By the end of 2017, among the 452,200 permanent residents in the region, 285,458 adults had completed the physical examination. The prevalence of hypertension was 18.5%, which was lower than the national average of rural areas (28.8%). The prevalence of hypertension in men (18.7%) was slightly higher than that of women (18.3%). The prevalence of hypertension increases with age; for people aged >65 years, it was 39.2%. There were 15,074 newly discovered hypertensive patients in the WPPHCPP, accounting for 29.6% of the total hypertensive population in the region. Regarding the management outcomes, the rates of management and standardized management of hypertension increased each year between 2015 and 2017. Although the rate of disease control management decreased slightly, the overall level of management remained significant. The awareness and treatment rates of hypertension also increased over the years and peaked at 95.0% and 94.9%, respectively, in 2017. The disease control rate was 45.6% in 2016, which was the highest among the years assessed. All the above parameters were better than the national average of rural areas. From 2015 to 2017, the number of people with high-risk factors for hypertension and percentage of high-risk patients decreased from 33,064 to 26,982 and 27.4% to 24.6%, respectively. The percentage of the population exposed to cigarettes and alcohol decreased from 30.6% to 27.2% and 25.1% to 22.0%, respectively. The number of deaths due to hypertensive cardiovascular or cerebrovascular diseases decreased each year and was 275 (39.55/100,000 people) in 2017, which was the lowest rate measured. The annual growth of cardiovascular or cerebrovascular diseases remained negative. Conclusions The overall prevalence of hypertension in the studied area was lower than the national average of rural areas. The health management model of “government-led joint efforts of three levels of medical institutions (village, town, and county) with active participation of local village communities” improved the management outcomes of hypertensive patients and fulfilled the latest advocacy of the prevention and control of chronic diseases by the United Nations. This model can be considered an effective model for healthcare management practice in similar situations.

Experience of providing early intervention services in the municipal health institution

The Government of Ukraine has approved a plan of measures for the implementation of the pilot project "Creating a system of early intervention services to ensure the development of the child, preserve his health and life" for 2019-2021. The pilot regions implementing the early intervention service include ten regions of Ukraine, including the Odessa region. The main goal of piloting the project is to create and develop an early intervention system for children with disabilities or the risk of disability and their families, to improve the quality of early intervention services, to reduce the level of disability of children in Ukraine and to prevent their institutionalization at an early age. The purpose is to consider, on the example of a municipal non-profit enterprise of urban subordination, a mechanism for implementing early intervention services in Odessa. The materials of the research are the principles of financing of the health care system of the city of Odessa and the work of local medical institutions in the conditions of reforming the medical industry; methods are description, analysis, synthesis, generalization, graphic design. The article provides an example of funding services for the public at the expense of both national and local budgets, as well as mechanisms for coordinating services for children with disabilities or the risk of disability and their families.

Развитие здравоохранения Сибири в XVIII — первой половине XIX в.

Development of health care of Siberia in the 18<sup>th</sup> — first half of the 19<sup>th</sup> century was closely connected with economic and political development of the Russian state. Before the medical personnel emergence in Siberia its population received medication only in the form of folk remedies. Development of its territory, insanitary conditions of life of Siberians, constant contingent of exiled to the indigenous people, and severe climate contributed to the spread of such diseases as smallpox, syphilis, and others.<br> The first medical institutions of Siberia were military hospital and infirmaries. In the days of reign of the Empress Anna Ioannovna, the city medical care started developing, and thanks to an initiative of the industrial enterprises owners — medical care for miners. After the establishment of the Public Charity Orders in Siberia, hospitals under their jurisdiction began to function in Tobolsk, Irkutsk, and Tomsk. A worthy contribution to the development of local medical institutions was made by donators Tolstopyatov, Bednyagin, Chupalov, and others. However, deficiency of financing, hospitals, and the medical personnel couldn’t adequately satisfy the needs of Siberian inhabitants in medical care.<br> The purpose of the article is to analyse the condition of public health, causes of morbidity and mortality of the population, as well as the process of medical care development in Siberia the turn of the 18<sup>th</sup> century by means of a historical and genetic method.

The implementation of tuberculosis examination of potential employment migrants in the country of departure: evaluation of possibilities

The migration situation in Russia is characterized by presence of significant number of foreign citizens, including those who are working without official registration and evidence of examination for tuberculosis and other infections. In connection with that, attention is to be paid to propositions concerning organization of preventive examination for tuberculosis in the departure country i.e. medical examination of potential migrants according Russian standards on the basis of local medical institutions. The article presents review of data of official statistics concerning migration and prevalence of tuberculosis including scientific publications about analysis of international experience of organization and implementation of preventive examinations in the departure countries. The experience of implementation of medical examinations of migrants in number of departure countries demonstrates that these programs permit focusing efforts on diagnostic of tuberculosis in one of risk groups hence achieving comparatively high degree of reliability of results and providing economic significance. In the context of conditions in Russia and accounting international experience two scenarios are proposed of implementing preventive examinations for tuberculosis in departure countries: with and without introduction of requirement of preliminary medical inspection of working migrants.

Pediatric dysphagia: Surgical management and collaboration with local medical institutions

Pediatric dysphagia: Surgical management and collaboration with local medical institutions

Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus in long-term care facilities in eastern Taiwan.

Objective:The prevention of infections is crucial in long-term care programs. Investigations of the occurrence and sources of pathogens in long-term care facilities (LTCFs) are still lacking, especially in eastern Taiwan. In this study, we conducted a surveillance of two common pathogens, Acinetobacter baumannii (AB) and methicillin-resistant Staphylococcus aureus (MRSA), in LTCFs in Hualien.Materials and Methods:Pathogenic assays including isolation, identification, and antimicrobial susceptibility tests were conducted for AB and MRSA at LTCFs in Eastern Taiwan. Staphylococcal cassette chromosome mec typing assays were done to understand the relatedness of clonal strains of MRSA.Results:All AB-positive samples in the LTCFs were mainly from water-rich samples and were drug susceptible. Our data indicated that the AB strains from LTCFs were similar to those from Puzi River watersheds in Taiwan, which were not drug resistant to commonly used antibiotics. On the other hand, the drug resistance analysis of MRSA indicated that the genotypes from the LTCFs were similar to those from nearby hospitals. Eight strains of MRSA were isolated from four LTCFs, of which five were identified as hospital-acquired strains according to SSCmed typing assays.Conclusion:These findings suggest that MRSA in LTCFs might propagate from hospitals and could be transmitted between hospitals and LTCFs. Health authorities should be aware of this risk. The long-term follow-up of MRSA is recommended in local medical institutions as well as in LTCFs for correlative analysis.

Acceptance and Resistance of New Digital Technologies in Medicine: Qualitative Study.

BackgroundThis study discusses the acceptance of new medical technologies in health care settings and resistance to these technologies from hospitals, doctors’ surgical centers, electronic health (eHealth) centers, and related institutions. We suggest a novel method of identifying factors that influence the acceptance of, and resistance to, new technologies by medical staff and patients.ObjectiveThe objective of this study was to determine and evaluate the factors that influence acceptance and resistance to achieve a successful implementation of new technologies.MethodsThe target group was patients residing in Brandenburg and major stakeholders in the local health care structure, for instance, medical institutions and medical professionals. The process relies on 3 models: the technology acceptance model, the unified technology acceptance and use of technology model, and the theory of technical innovation diffusion. Qualitative methodology was employed in this study, and an exploratory design was adopted to gain new insights into a poorly understood phenomenon in the German context. This enabled the researcher to take a flexible approach toward exploring a wide range of secondary data and to choose a different approach when unexpected information emerged. Content analysis was used to identify and interpret the data, and the researcher assured that the meaning associated with the information has concurred with that of the original source.ResultsThis study confirmed that adoption of new technologies in health care depended on individual opinions of the factors relating to them. Some medical professionals believed that technology would interfere with their ability to make independent diagnoses and their relationships with patients. Doctors also feared that technology was a means of management control. In contrast, other medical staff welcomed technology because it provided them with more opportunities to interact with patients and their carers. Generally, patients were more enthusiastic about technology than medical professionals and health care managers because it allowed them to have greater autonomy in selecting health care options. The need for all groups to be involved in the development of the new health care approach was an important outcome, otherwise resistance to it was likely to be greater. In other words, the strategy for change management was the indicator of success or failure. Therefore, following our analysis, a number of practical precepts emerged that could facilitate user acceptance of digital solutions and innovative medical technologies.ConclusionsThe acceptance of digital solutions and innovative medical technology by patients and professionals relies on understanding their anxieties and feelings of insecurity. The process will take time because individuals accept change at different rates. Hence, the development of an extensive user community to fully and successfully implement eHealth is less likely in the short term; however, this should not prevent the push for changes in health care technology.

INTERREGIONAL CENTERS OF HIGH-TECH CHILDREN’S SURGERY – MORTGAGE OF ACCESSIBILITY AND QUALITY OF MEDICAL CARE FOR RUSSIAN CHILDREN

The article starts with a summary of the international experience in making medical care both accessible and high quality for children with surgical conditions and trauma by concentrating patients in specialized trans-regional centers. The authors give results of the retrospective analysis of the reasons for failure when implementing the concept of trans-regional specialized medical care in the Russian healthcare system. The paper lists problems with legislative control over these aspects: supplying the centers with resources, medical evacuation processes, distribution of responsibility by areas, and the information exchange with local medical institutions (hospitals, clinics, etc). The article also illustrates similarities and differences on how the trans-regional centers for pediatric surgical care function inRussiaand in other countries. The authors outline high priority measures for creating trans-regional centers for specialized medical assistance for children inRussia. The systematic review includes 16 domestic and 28 foreign literature sources, 8 references to Russian laws and regulations.

Future directions in tissue repair using biomaterials

Complex soft tissue defects are often challenging to approach using conventional surgical reconstructive techniques. Although autologous tissue repair is still the gold standard in reconstructive surgery, there are particular situations when autografts are not available. Human allografts remains an alternative solution, but with considerable drawbacks regarding availability, immunologic reactions and risk of infectious diseases transmission. Synthetic products used in surgical reconstructions are associated with poor long-term outcomes. Tissue engineering developed based on these reconstructive limitations. Recently, biological scaffolds have been introduced as important players in surgical strategies of tissue reconstruction. A large panel of extracellular matrices cultured with different cell populations has been used, and promising results were reported in complex tissue loss repair including bone, muscles, nerves, blood vessels and skin defects. Future research is mandatory to standardize the bioengineered structures, in order to get the best outcome regarding volume restoration, function regaining, vascular integration and long term stability of the reconstruction. We desire to identify the research area which can be successfully applied in our country, based on an interdisciplinary collaboration between medical institutions, molecular biology laboratories and technical research institutes. We consider very useful to promote a strategy for soft tissue repair and immunomodulation using mesenchymal progenitors from different sources (bone marrow, adipose tissue, umbilical cord blood) seeded on solid scaffolds. This approach will increase the multi-institutional partnership, permitting the development of new reconstructive strategies for patients with tissue defects, more accessible for local medical institutions, with an affordable cost and in appropriate timing for regain the quality of life

Medical service as a part of everyday life of workers of the ferrous metallurgy enterprises in the first half of 1950s.

The aim of the study is to analyze medical aid given to the workers of ferrous metallurgy enterprises in the first half of the 1950s. Primary medical unit provided medical aid for workers of the ferrous metallurgical enterprises. Because of the lack of medical unit at the metallurgical plant or because there was no medical institutions in the organizational structure of the medical unit, local medical institutions provided the workers with medical care. During the first half of the 1950s, was the problem of the lack of medical staff in the medical institutions caused by insufficient material and household support. It did not allow implementing the shop principle of medical service of metallurgists. At the enterprises, individual shops did not have a factory’s sectorial doctor, or the number of workers assigned to a factory’s sectorial doctor exceeded the norm. Because the local hospitals, which controlled the health post at the ferrous metallurgy enterprises of the Zaporizhzhya region, were placed at a considerable distance, ‘the shop principle’ was not implemented there at all. The personnel problem also affected the formation of queues, which were a characteristic feature of the medical care provided to the workers. Work overload of physicians led to a quick examination of the patients, resulting in mistakes in the diagnosis. Contrary to accepted laws aimed at improving the quality of diagnosis, the periodic medical examinations of workers were not always carried out qualitatively, and the medical examination was carried out in a number of plants partly. In the first half of the 1950s the enterprises of the ferrous metallurgy of Zaporizhzhya region had a problem that the medical institutions were on a far distance and the percentage of patients needed medical help reduced. Lack of hospital beds had caused the untimely hospitalization of patients that prevented recovery of their. Many of the medical institutions were located in the old or non-specialized buildings with limited space, stove heating and primitive food units, without household premises and sewage. Characteristic of the medical services of metallurgists were depreciation of the material fund of medical institutions, lack of medicines, medical equipment. Not all medical institutions were provided with ambulances. There were cases of refusal to leave for a challenge or untimely provision of emergency care. It was concluded that the level of medical services given to the metallurgists in the first half of the 1950s was insufficient, despite the fact that they were workers of one of the leading branches of the Soviet economy.

A four-stage DEA-based efficiency evaluation of public hospitals in China after the implementation of new medical reforms.

This study applied the non-parametric four-stage data envelopment analysis method (Four-Stage DEA) to measure the relative efficiencies of Chinese public hospitals from 2010 to 2016, and to determine how efficiencies were affected by eight factors. A sample of public hospitals (n = 84) was selected from Chongqing, China, including general hospitals and traditional Chinese medicine hospitals graded level 2 or above. The Four-Stage-DEA method was chosen since it enables the control of the impact of environment factors on efficiency evaluation results. Data on the number of staff, government financial subsidies, the number of beds and fixed assets were used as input whereas the number of out-patients and emergency department patients and visits, the number of discharged patients, medical and health service income and hospital bed utilization rate were chosen as study outputs. As relevant environmental variables, we selected GDP per capita, permanent population, population density, number of hospitals and number of available sickbeds in local medical institutions. The relative efficiencies (i.e. technical, pure technical, scale) of sample hospitals were also calculated to analyze the change between the first stage and fourth stage every year. The study found that Four-Stage-DEA can effectively filter the impact of environmental factors on evaluation results, which sets it apart from other models commonly used in existing studies.

Nested case-control study on associated factors for anemia during pregnancy

Objective: To explore the related factors of anemia during pregnancy and provide scientific evidence for the primary prevention of anemia during pregnancy. Methods: The pregnant women (≤12 pregnant weeks) who received the first pregnancy care in a local medical institution in Hunan province from June 2013 to November 2014 were included in this cohort study, and for them anemia had been excluded by physical examination. Baseline survey and follow up till childbirth were conducted for them. A queue-based nested case-control study (1 ∶ 2) was conducted (380 pregnant women with anemia detected in this study as case group, 760 pregnant women without anemia randomly selected and matched by age, habitual residence during pregnancy as control group. And t test, χ(2) test and logistic regression analysis were conducted to identify related factors of anemia during pregnancy. Results: Multivariate logistic regression analysis indicated that low family annual income level (net income) (OR=2.08, 95%CI: 1.22-3.59), low educational level (OR=2.09, 95%CI: 1.22-3.59), pre-pregnancy perm/hair dye (OR=2.23, 95%CI: 1.63-3.05), early pregnancy vomiting (OR=2.51, 95%CI: 1.56-4.03) were the risk factors for anemia during pregnancy. Intake of vitamin and trace element supplements (OR=0.69, 95%CI: 0.50-0.94), frequent meat, fish, shrimp, egg intakes (OR=0.68, 95%CI: 0.49-0.92), frequent soy milk, milk intakes (OR=0.51, 95%CI: 0.27-0.95) were the protective factors for anemia during pregnancy. Conclusion: A number of factors, such as family annual income level, education level, poisonous and harmful material contact, pregnancy reaction, nutrition, are related to the incidence of anemia during pregnancy, it is necessary to take preventive measures to reduce the incidence of anemia during pregnancy.

Relocating Pastorian Medicine: Accommodation and Acclimatization of Pastorian Practices against Smallpox at the Pasteur Institute of Chengdu, China, 1908-1927.

Argument Revising the diffusionist view of current scholarship on the Pasteur Institutes in China, this paper demonstrates the ways in which local networks and circumstances informed the circulation and construction of knowledge and practices relating to smallpox prophylaxis in the Southwest of China during the early twentieth century. I argue that the Pasteur Institute of Chengdu did not operate in a natural continuity with the preceding local French medical institutions, but rather presented an intentional break from them. This Institute, as the first established by the French in China, strove for political and administrative independence both from the Chinese authority and from the Catholic Church. Yet, its operation realized political independence only partially. The founding of this Institute was also an attempt to satisfy the medical demand for local vaccine production. However, even though the Institute succeeded at producing the Jennerian vaccine locally, its production needed to accommodate local conditions pertaining to the climate, vaccine strains, and animals. Furthermore, vaccination had to conform to Chinese variolation, including its social and medical practices, in order to achieve the collaboration of local Chinese traditional practitioners with French colonial physicians, who were Pastorian-trained and worked at the Pasteur Institute of Chengdu. Thus the nature of the Pastorian work in Chengdu was not an imposition of foreign standards and practices, but rather a mutual compromise and collaboration between the French and the Chinese.

The Japan Environment and Children’s Study (JECS) in Fukushima Prefecture-A progress report on the enrollment stage

The Japan Environment and Children's Study is an ongoing nationwide birth cohort study that is being conducted at 15 regional centers throughout Japan. The recruitment of subjects in the study area within Fukushima Prefecture, which includes Fukushima City, Minami Soma City and Futaba County, was begun on January 31, 2011 with the cooperation of the obstetrics and gynecology departments of local medical institutions. On March 11, soon after the start of recruitment, the Tohoku region was hit by an unprecedented disaster in the shape of the Great East Japan Earthquake, which was closely followed by the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant accident. As a result of the disaster, the study area in Fukushima Prefecture was expanded on October 1, 2012 to include 59 municipalities across Fukushima Prefecture. Three points are seen as particularly important: 1) Radiation risk communication, 2) The motto is "Be attentive. Be supportive.", and 3) Establishing cooperating partnerships. With the cooperation of all concerned, the recruitment period ended on March 31, 2014. The tentative total number of the participants enrolled at the Fukushima Regional Center was 34,666 (13,134 pregnant mothers, 8,695 fathers and 12,837 children born before November 30, 2014 as of June 2016).

Application of Telemedicine in Gansu Province of China.

Telemedicine has become an increasingly popular option for long-distance health care and continuing education. As information and communication technology is underdeveloped in China, telemedicine develops slowly. At present, telemedicine consultation centers are situated mainly in developed cities, such as Beijing, Shanghai, and Guangzhou. In many less developed regions, such as northwest China, the conditions or related facilities are not available for the application of a better medical service. Accordingly, the aim of this paper was to introduce the construction and application of a telemedicine consultation center in Gansu Province in the northwest of China. In addition, the function of Gansu Provincial Telemedicine Consultation Center on emergency public events was introduced. As a whole, there was a great demand for telemedicine service in the local medical institutions. In the telemedicine consultation center, the telemedicine equipments and regulations were needed to be improved. The function of telemedicine service was not fully used, there was a large space to be applied and the publicity of telemedicine service was important. What is important was that telemedicine played a significance role in promoting the medical policy reform, improving the medical environment and launching the remote rescue in the emergency public events. This paper emphasizes the health care challenges of poor regions, and indicates how to share the high-quality medical service of provincial hospitals effectively and how to help residents in resource-poor environments.

Medical Relief Response by Miyako Public Health Center after the Great East Japan Earthquake and Tsunami, 2011

To improve disaster preparedness, we investigated the response of medical relief activities managed by Iwate Prefectural Miyako Public Health Center during the post-acute phase of the Great East Japan Earthquake and Tsunami on March 11, 2011. The study divided the post-disaster period into three approximate time segments: Period I (time of disaster through late March), Period II (mid-April), and Period III (end of May in Miyako City, early July in Yamada Town). We reviewed records on medical relief activities conducted by medical assistance teams (MATs) in Miyako City and Yamada Town. Miyako Public Health Center had organized a meeting to coordinate medical relief activities from Period I to Period III. According to demand for medical services and recovery from the local medical institutions (LMIs) in the affected area, MATs were deployed and active on evacuation centers in each area assigned. The number of patients examined by MATs in Miyako rose to approximately 250 people per day in Period I and decreased to 100 in Period III. However, in Yamada, the number surged to 700 in Period I, fell to 100 in Period II, and decreased to 50 in Period III. This difference could be partly explained as follows. In Miyako, most evacuees had consulted LMIs which restarted medical services after disaster, and the number of LMIs restarted had already reached 29 (94% of the whole) in Period I. In Yamada, most evacuees who had consulted MATs in Period I had almost moved to LMIs restarted in Period II. During the same time, a division of roles and coordination on medical services provision was conducted, such as MATs mainly in charge of primary emergency triage, in response to the number of LMIs restarted which reached 1 (20%) in Period I and 3 (60%) in Period II. Following Period III, more than 80% of patients in Miyako had been a slight illness, such as need for health guidance, and the number of people who underwent emergency medical transport reached pre-disaster levels in both locations. These results suggest that demand for medical services of evacuees declined to a stable level in an early stage of Period III. Using the above findings, one might justify supporting local medical institutions' recovery earlier. Then, medical relief activities might be finished properly. This study shows useful perspectives in the response of medical relief activities during post-acute phase after disaster and the importance of establishing systems for information management that apply these perspectives.

Clinical conferences for physicians: Who sets the agenda?

Clinical conferences for physicians: Who sets the agenda?

Some Results Of The Project On The Prevention Of Brucellosis In Uranium Biogeochemical Areas Of The Town Of Mayluusuu

Background: The reported incidence rate (IR) of human brucellosis in uranium biogeochemical area of the town of Mayluusuu was markedly higher than that in the neighboring town Tash-Kumyr. In 2009, the IR of human brucellosis reported in Mayluusuu was 265.0 versus 92.2 recorded in Tash-Kumyr; in 2010 - 192.0 and 111.1. In 2011, the figures were 356.6 and 131.3, respectively. Objective: To prevent the spread of brucellosis and zoonotic-infectious diseases in uranium biogeochemical area of the town of Mayluusuu. Materials and methods: Animals and human populations (brucellosis patients, people who had a contact with sick animals and people who recovered from the disease) were subjected to analysis. Results: In the town of Mayluusuu, the incidence of brucellosis among sheep and goats was reported in 29.1% of farms. Brucellosis was found in 8 (0.29%) of the 2726 cattle screened. To raise public awareness on the prevention of brucellosis among animals and human populations, we have developed and published calendars containing complete information on brucellosis. The calendars have been circulated among the local residents, organizations, schools, kindergartens, medical institutions and NGOs. A number of workshops and training courses on brucellosis and typhoid fever diagnostic techniques were conducted for the local medical staff and veterinarians. Five (12.2%) of the 41 brucellosis patients and 13 (10.9%) of the 120 people who had a contact with sick animals were found seropositive. In 2011, the reported IR of brucellosis was 356.6 per 100,000 population; in 2012 - 167.1. A marked decrease (42.7 per 100,000 population) in the incidence rate was observed in 2014. Thus, the researches conducted and comprehensive preventive measures taken during the implementation of the project have reduced the incidence of brucellosis among the population living in uranium biogeochemical area. The IR of human brucellosis was reduced from 356.6 to 42.7 per 100,000 population.

Mapping and Analyzing Stakeholders in China’s Essential Drug System by Using a Circular Model: Who We Should Deal with Next?

ObjectivesTo predict the prospects of the essential drug system by using the Stakeholder Impact Index (SII) and evaluate the current performance of each main stakeholder and suggested dangerous stakeholders and dormant stakeholders. MethodsA Delphi method was used, involving 36 experts with experience in implementation and evaluation of the essential drug policy, to construct the circular model as well as evaluate the performance of each stakeholder. ResultsThe central government was a dominant stakeholder of the whole essential drug system. The provincial governments were definitive stakeholders, whereas local governments and medical institutions were dependent stakeholders. Furthermore, media and drug stores were dormant stakeholders and pharmaceutical manufacturers and delivery enterprises were dangerous stakeholders. Patients, community residents, and medical insurance programs were discretionary stakeholders. The SII for the essential drug system was positive (SIIproj⁎ = 2.72). ConclusionsThe overall anticipation of the essential drug policy is optimistic. Letting definitive stakeholders (provincial governments) having more autonomy can efficiently accelerate the pace of implementation of the essential drug policy in the current situation. Central government, however, also needs to construct an experience exchange platform with the aim of building versatile methods for running the essential drug system in all provinces. Pharmaceutical manufacturers and delivery enterprises were dangerous stakeholders for the essential drug policy. Because of their potential threat to the implementation of the policy, the central government should motivate them to support the construction of the essential drug system spontaneously. In that case, provincial governments need to construct a fair, balanced, and self-stabilized bidding platform.

병원급 이상 의료기관의 간호등급 상승 요인 분석

Background: The purpose of this study was to analyze the increase in Grade of Nursing Management Fee of medical institutions and establish a reasonable government policy by examining which factors affect the increase of nurse staffing. Methods: Analyzing data collected from the Health Insurance Review & Assessment Service resource management department with targets of 1,104 medical institutions. The study period was 5 years from June 30, 2008 to June 30, 2013. SAS ver. 9.2 (SAS Institute Inc., Cary, NC, USA) was used for statistical analysis. The data was analyzed by a chi-square test and also conducted muiltivariate logistic regression analyses for variables of basic characteristics, human resource characteristics, and material resources. Results: Adjusted odds ratio (AOR) of the rise in Grade of Nursing Management Fee among other hospitals compared to hospitals owned by government or universities was 0.264. The AOR in hospitals established after November 2006 compared to those before June 1995 was 2.383. The AOR in Gangwon, Chungcheng South, and Jeolla South Provinces compared to Seoul was 0.084, 0.036, and 0.194, respectively. The AOR in hospitals with more than 6.75 specialists per 100 beds compared to those with less than 6.75 specialists per 100 beds was 7.514. The AOR in hospitals with more than 17.48 nurse per 100 beds compared to those with less than 17.48 nurse per 100 beds was 3.300. The AOR in hospitals with 50% to 75% bed utilization, 75% to 90% bed utilization and more than 90% bed utilization compared to those with less than 50% bed utilization was 5.428, 9.884, and 10.699, respectively. The AOR in hospitals with one magnetic resonance imaging (MRI) and more than two MRI compared to those with no MRI was 2.018 and 2.942, respectively. Conclusion: This result has showed policies to induce the rise in Grade of Nursing Management Fee among old hospitals and the incentive system for local medical institutions are needed. Also we need to develop a governmental policy for medium-small hospitals with low operation rate of beds and insufficient medical personnel and number of equipment in hospitals.