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Objective: To study the impacts of the new medical reform on the utilization equity of gynecological examination services for women in economically underdeveloped regions of western China. Methods: Based on the data of the 4th and 5th National Health Service Survey in Shaanxi Province, we used concentration index and decomposition of concentration index to explore the inequality of women's gynecological examination service utilization and its sources; we also used horizontal inequity index to analyze the horizontal equity of the women's gynecological examination service utilization. Results: The concentration index of gynecological examination rate of the women surveyed in 2008 and 2013 was 0.0882 and 0.0640, respectively. The horizontal inequity index was 0.0894 and 0.0463, respectively. The factors that contributed most to the inequality of the women's gynecological examination service utilization were the economic level and contribution which accounted for 54.49% and 61.86%, respectively. Conclusion: The implementation of basic public health and major public health services in the new medical reform policy has increased women's gynecological examinations rate and plays a positive role in improving the equity in utilization of women's gynecological examination services.
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OBJECTIVE： To investigate the current status of pharmacists in public hospitals from Chongqing after the comprehensive reform of public hospitals， to put forward countermeasures and suggestions. METHODS： In questionnaire survey， pharmacists were selected from 33 public hospitals of secondary grade and above in Chongqing as survey objects. The current status of pharmacists in public hospitals of Chongqing from Sept. to Aug. 2018 was collected and surveyed in respects of the basic situation of pharmacists， the impact of medical reform policies， acceptance and professional development requirements of pharmacists. RESULTS： Totally 33 medical institutions included 13 third-grade hospitals and 20 secondary hospitals. A total of 838 questionnaires were distributed and 702 questionnaires were effectively recovered with effective recovery rate of 83.8％. According to the survey results， the majority of pharmacists in public hospitals of Chongqing were 25-35 years old （50.6％）； 8 （1.1％） had doctor’s degree， 86 （12.3％） had master’s degree， and 25.9％ had junior college and technical secondary schools. The number of master’s and doctor’s degrees in third-grade hospitals was higher than that of secondary hospitals， but there were still junior college and technical secondary school degrees in third-grade hospitals. Pharmacists were mainly referred to as middle and junior titles， 217 of which were middle-level titles （30.9％）， and 434 were primary titles（61.8％）； the majors were mainly pharmacy （64％）， followed by traditional Chinese pharmacology （18.7％）. Most of the working years were within 10 years （54.9％）. There were 274 people （39.0％） with an annual income of less than 50 000 yuan， 342 people （48.7％） with an annual income of 50 000- 100 000 yuan and only 86 people （12.3％） with an annual income of more than 100 000 yuan. After the implementation of new medical reform， 430 people （61.3％） thought that the workload had increased significantly or slightly， 99 people （14.1％） thought that the scope of work was significantly expanded， and 433 people thought that the annual income after medical reform was slightly reduced or significantly reduced （61.7％）； 253 people （36.0％） believed that hospital leaders did not pay attention to and did not pay much attention to pharmacists； 294 （41.9％） believed that medical staffs relatively accepted or highly accepted pharmacists. The reasons why pharmaceutical staffs thought that they were not valued mainly included five aspects， including that patients did not understand them； clinical medical staff did not agree with them； leaders did not pay attention to them； corresponding systems and regulations lacked； professional quality lacked. The main work content of pharmacists was mainly based on drug dispensing， and there were fewer people carrying out clinical pharmaceutical care， pharmacy management， pharmaceutical administration and quality control， preparation， pharmaceutical research. The jobs that they hoped to engage in were clinical pharmaceutical care， drug dispensing， pharmaceutical administration and quality monitoring， etc. Pharmacists believed that drug dispensing and delivery， reviewing medical orders， medication education guidance， consultation and medication counseling， drug management were important skills. The pharmaceutical staffs were good at skills， such as medical order review， medication education guidance， drug management. CONCLUSIONS： At present， the pharmacists in public hospitals of Chongqing have some problems， such as low education level， few clinical pharmaceutical professionals， low overall income and not recognized. It is suggested to protect the role and position of pharmacists in the medical treatment process from the perspective of introducing highly educated personnel of clinical pharmacy， improving the professional and educational structure of pharmacists， changing the pharmaceutical care mode， and improving their own ability and treatment.
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OBJECTIVE:To explore new method of prescription comment in medical institutions of Chongqing under the background of"New Medical Reform",and to provide reference for prescription comment innovation and promoting rational drug use in clinic. METHODS:Through analyzing policy background of prescription comment innovation and practice,referring to experience of other regions,the achievements and problems were analyzed by developing centralized prescription comment and prescription comment information construction in municipal and regional (county-level) medical institutions of Chongqing. The countermeasures suggestion was put forward. RESULTS&CONCLUSIONS:The prescriptions of 16 municipal medical institutions were commented centrally,involving more than 300 medical records and 1600 prescriptions or medical orders. The prescriptions of 135 regional (county-level) medical institutions were commented centrally,involving more than 3100 medical records and 12100 prescriptions or medical orders."Chongqing Medical Institution Prescription Comment Key Technology Monitoring System"was established. Above measures innovated centralized prescription comment mode,improved the quality of prescription comment and promoted prescription comment informatization. There were still problems as incomplete coverage of the system,inspection to become a mere formality. It is suggested to strengthen internal quality control of medical institutions by establishing rational drug use scoring management system,developing clinical pharmacist ward round and prescription checking in advance;establish and improve third-party external comment and supervision mechanism;improve the knowledge of prescriptions comment staff in all directions so as to further standardize prescriptions and promote rational drug use in medical institutions.
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Hierarchical diagnosis and treatment is the top priority of health care reform,it will provide a solid institutional foundation and institutional protection for the construction of healthy China and the basic health care system.The paper summarizes the present practice of the hierarchical diagnosis and treatment in China,and analyzes the existing problems,on this basis puts forward corresponding countermeasures and suggestions as the references for the construction of hierarchical diagnosis and treatment and deepening reform.
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OBJECTIVE:To provide reference for the further promotion ofNew Medical Reformand the further implementa-tion and improvement of National Essential Medicine System. METHODS:By systematic sampling,1728 outpatient prescriptions were randomly selected from a community health service center in Foshan during 2012 to 2015,and then analyzed and compared statistically in respects of the amount of drugs,rational drug use indexes,prescription cost,main disease composition,treatment cost. The change rules and characteristics of all the above mentioned information were all studied. RESULTS:The average number of medicines per prescription and the number of essential medicines decreased year by year,Comparied with 2012,the proportion of antimicrobial agents,the proportion of two or more antimicrobial agents,the proportion of injection prescription and the propor-tion of transfusion prescription were significantly reduced,the cost of medical treatment of patients decreased significantly;medi-cine cost and medicare reimbursement amount had increased to different extents,there was statistical significance(P<0.05). Multi-ple linear regression analysis(stepwise)showed that the cost of medical treatment was closely related to rationality of prescriptions. Respiratory diseases,cardiovascular and cerebrovascular diseases,gastrointestinal diseases were the top 3 of the major diseases, the proportion of prescriptions for respiratory diseases,gastrointestinal diseases decreased year by year,while that for cardiovascu-lar and cerebrovascular diseases increased year by year. CONCLUSIONS:The promotion ofNew Medical Reformand the imple-mentation of National Essential Medicine System play a positive role in promoting rational drug use and the quality of medical ser-vice in community health service center. However,there are still many problems in the community health service centers,such as too many medicines each prescription,the lack of diagnosis and treatment ability,the defects of medicine selection and administra-tion.
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Due to the development of economy,the mature of technology,and the improvement of institution,the under-treatment and over-treatment of percutaneous coronary intervention (PCI) gradually tends to be balanced in our country.However,these two phenomena still exist in some regions,even in the same hospital.Under the background of the medical conjoined in the new medical reform,it should play its positive role through strengthening the guidanceof medical ethics and the abiding the principle of optimization,in order to apply PCI scientifically and rationally,benefit patients more,and improve the medical quality.
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OBJECTIVE:To provide reference for further comprehensive evaluation of the improvement of the accessibility of family medicines after the implementation of the new health care reform. METHODS:Sampled as 180 households from 2 urban ar-eas,2 counties and 2 rural areas in Chengdu,a questionnaire survey was adopted based on the WHO’s manual for the Household Survey to Measure Access and Use of Medicines to investigate the situation of drug use,storage and accessibility,and the results were statistically analyzed. RESULTS:Totally 180 questionnaires were sent out,179 were effectively received with effective recov-ery of 99.44%. In the terms of medicines taken for the acute illness,there were more than 60% rural households obtained drugs from the public health care facilities,while more than 60% counties households purchased drugs in public medical and health insti-tutions;in the terms of medicines taken for the chronic illness,the proportion of households reporting a chronic illness who did not take any medicines was low(3.80%);in terms of medicines storage,the proportion of households without reserve drugs was low (13.41%). In terms of drug accessibility,the proportions of respondents who agreed that the location and opening hours of their public healthcare facility were convenient were high;there was no situation for“patients did not take prescribed drugs because med-icines were not available at the healthcare facility and drug store”,while more than 95% respondents who agreed that drugs were available at their public health care facilities and drug stores;the essential medicines in the household use of chronic drugs in Chengdu accounted more than 60%;more than 85% can afford the drug costs,while the proportion of the monthly costs for acute illness and chronic illness in the total month costs was low;the health insurance coverage reached 90% in the survey households, but the proportions of households which could reimburse acute,chronic illness drug cost were lower(14.13% and 12.66%). CON-CLUSIONS:At present,the level of drug accessibility in Chengdu is high;the implementation of National Essential Medicines System has a positive effect on reducing the economic burden of chronic disease family. But there are shortcomings in the Medicare reimbursement levels and antibiotics use,it is suggested to take effective measures to solve it,such as exploring the stable and ef-fective medical insurance fund raising channels,improving the compensation level and the level of insurance reimbursement,formu-late and implement the corresponding antibacterial drugs supervision system and regulate the rational use of antibiotics in residents.
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Through to the new reform under the background of hosting the analysis of the hospital management , put forward according to the construction of talent as the breakthrough point , the two-way referral system , focus on building characteristic specialized platform , stick to the quality construction , carrying out medical core system vig-orously and also carrying out fine management , set up the mechanism of medical quality long -term improvement , constantly improving the quality of connotation construction level , lay a foundation for hosting the hospital sustain-able development .
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OBJECTIVE:To investigate the new management model of the hospital pharmacy established by application of vender managed inventory (VMI) model. METHODS:Concerned about the implementation of VMI model,its effects and prob-lems,new management model of hospital pharmacy were described after the hospital cooperated with two suppliers. The hospital is mainly in charge of the management and application of pharmaceutical staff and equipment,drug capital flow,and the selection and optimization of drug use list;focus on the training of pharmaceutical talents;improve drug quality management,pharmaceuti-cal administration,pharmaceutical care and rational drug use. Two suppliers are mainly in charge of drug logistics,and the alloca-tion of servicer,software and hardware(as automatic medicine dispensing machine);share logistic cost of supply chain. Drug in-formation flow was established by both hospital and supplier. RESULTS:After cooperation,pharmaceutical staff,related equip-ment and inventory cost(floating capital decreased by 10 million yuan each month)were decreased,and the efficiency of distribu-tion improved;the error rate of drug dispensing in outpatient pharmacy were decreased (decreasing from 0.39‰ to 0.12‰) after the establishment of automatic pharmacy. The establishment of early warning system for abnormal patients flowrate in pharmacy window shortened the time of getting medicine,and improved service level and satisfactory degree of patients (increasing from 84.91% to 93.62%). CONCLUSIONS:New management model of hospital pharmacy based on VMI model provides reference for public hospital reform and hospital-enterprise cooperation under New Medical Reform.
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OBJECTIVE: To provide references for adapting to the new medical reform and facilitating development of hospital pharmacy. METHODS: By studying and analyzing the new "medical reform" program, comparing the development of hospital pharmacy at home and abroad, hospital pharmacy development direction and pharmacist working mode in China are put forward. RESULTS: The function of hospital pharmaceutical care lags behind the development of new "medical reform", which thus calls for further improvement. CONCLUSION: Under the new condition of medical reform, it is imperative to perfect the related system and implement pharmacist service fee as soon as possible, to facilitate rapid development of pharmacist team and guarantee the system of essential drugs with rational drug use as focus smooth implementation.
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OBJECTIVE: To implement the policy of New Medical Reform, and to promote pharmaceutical care of our hospital. METHODS: The policy of New Medical Reform was carried out and specific implementation methods for the improvement of pharmaceutical care of our hospital were analyzed. RESULTS & CONCLUSION: Prescription evaluation was applied to provide pharmaceutical care in the clinic indirectly. Clinical pharmacists went into the wards to provide direct pharmaceutical care. They supervised the utilization of antimicrobial drugs, carried out pharmacy propaganda and wrote Clinical Drug News. ADR monitoring was also carried out. The policy of New Medical Reform was implemented through above methods to promote pharmaceutical care of our hospital.