2007~2013年安徽省不同地域县级中医院运行效率分析

目的 对2007~2013年安徽省县级中医院运行效率进行测量和评价.方法 本研究从安徽省县级中医院财务报表中筛选出投入和产出指标,采用数据包络分析软件对安徽省县级中医院运行效率进行测算. 结果 安徽省县级中医院综合技术效率总体呈上升趋势,皖中高于皖北、皖南;纯技术效率总体呈上升趋势,皖北高于皖中、皖南;规模技术效率总体呈上升趋势,皖中高于皖南、皖北. 结论 县级中医院运行效率不断提高,县级中医院存在地域性差异,县级中医院在深化改革过程中须强化效率意识.     

均等化目标下安徽省城乡居民基本公共卫生服务知晓率及满意度分析

目的 分析安徽省城乡居民对基本公共卫生服务均等化的知晓率和满意度,为基本公共卫生服务发展提供科学依据。方法 在皖南、皖中和皖北各随机抽取1～2个城市,其次在每个城市采用方便抽样的方法选取100个城市居民和100个农村居民,用统一设计的调查问卷进行调查。结果 在733名受访居民中,基本公共卫生服务项目总知晓率为21.86%,总满意率为27.42%。影响居民知晓率和满意度的因素包括城乡分布和居民文化程度。知晓率最高的项目为农村地区的预防接种项目（59.83%）,最低的为城市地区健康教育项目（19.36%）;满意度最高的项目为农村地区的预防接种项目（59.55%）,最低的为农村地区的慢性病患者健康管理（21.63%）。结论 城市和农村居民对基本公共卫生服务项目的总体知晓率和满意度较低,其中多个项目,农村居民的知晓率和满意度均大于城市居民。     

安徽省卫生健康资源配置效率分析——基于3阶段DEA—Malmquist指数法

目的 分析安徽省卫生健康资源配置效率的动态变化,为卫生事业改革的政策制定提供支撑依据。方法 基于安徽省2016~2018年卫生健康资源的面板数据,通过3阶段DEA-Malmqusit指数模型进行投入产出效率评价。结果 安徽省在3年期间的资源配置平均全要素生产率指数为1.010,年平均增长率为1%,平均技术效率指数为1.017,平均技术进步指数为0.993,其中10个地市效率提高,6个地市效率下降。结论 安徽省卫生健康资源配置效率处于低水平增长,技术进步或创新不足,各地市效率差异较大。     

2013～2018年安徽省老年肺结核疫情特征分析

目的 分析2013～2018年安徽省老年肺结核疫情特征,为制定老年肺结核防治策略提供参考依据。方法 采用描述性流行病学研究方法,分析2013～2018年安徽省老年肺结核患者疫情特征。结果 2013～2018年,安徽省活动性肺结核年平均登记率老年人高于全人群（χ²=55.061,P<0.001）;涂阳肺结核年平均登记率老年人高于全人群（χ²=21.840,P<0.001）,老年复治涂阳占全省复治涂阳的42.42%（3 379/7 965）;老年肺结核男女性别比为3.32∶1;安徽省所辖16个市以亳州、铜陵、池州老年肺结核年平均登记率最高。结论 安徽省老年肺结核疫情高于全人群,男性高于女性,亳州、铜陵、池州老年肺结核疫情重,需加强重点人群和重点地区的结核病防治工作。     

2011~2015年安徽省妇幼保健院剖宫产率及指征变迁分析

目的 分析安徽省妇幼保健院剖宫产率及剖宫产指征构成的变化,为进一步制定降低剖宫产率的具体措施提供依据。方法 对2011~2015年在安徽省妇幼保健院住院分娩的62 506例孕妇的临床资料进行回顾性分析,统计分析5年间产妇剖宫产指征的构成、剖宫产率的变化、社会因素剖宫产的构成以及围产儿情况。结果 ①2011年安徽省妇幼保健院妇产科剖宫产率为59.30%,2015年为43.90%,2011~2015年剖宫产率呈下降趋势（P<0.01）;5年间我院分娩的新生儿NICU入住率无显著变化。②在剖宫产指征的构成方面,2015年剖宫产产妇主要以瘢痕子宫（13.06%）为主,高于2011年（7.01%）,差异有统计学意义（P<0.01）。2011年剖宫产产妇中主要以社会因素为主（15.47%）,2015年为（4.51%）,呈现显著下降趋势（P<0.01）。③社会因素剖宫产患者中,2015年以认为剖宫产安全方便（30.83%）为主,2011年以不能忍受分娩痛疼（40.02%）为主。结论 2011~2015年安徽省妇幼保健院的总体剖宫产率呈下降趋势,但并没有围生儿发病率及病死率升高;剖宫产指征构成已由原来的社会因素为主,转变为现在的以瘢痕子宫为主。     

安徽省结核病防治核心信息知晓率抽样调查分析

目的 评估安徽省居民结核病防治核心信息知晓率现状,为进一步加强安徽省结核病防治健康教育与健康促进工作提供科学依据。方法 采用分层整群随机抽样方法,2015年在安徽省抽取6个调查点,使用统一调查问卷对15岁以上常住居民进行面对面调查。结果 研究共完成调查对象900人,5条结核病核心信息总知晓率为75.8%。农村居民（87.0%）高于城区居民总知晓率（70.2%）,差异有统计学意义（P<0.05）;接受过宣传教育的居民核心信息总知晓率（80.4%）高于未接受过宣传教育的居民（68.4%）,差异有统计学意义（P<0.05）。5条核心信息中知晓率较低的2条是第四条“我国对肺结核患者实施部分免费政策”（48.0%）和第五条“肺结核大部分能治好”（62.3%）。结论 安徽省结核病防治知识知晓率未达到国家指导要求,有必要进一步加强结核病健康教育工作。     

医院药剂科生产效率描述性指标评价方法的建立

目的 探讨建立能够客观、简便地评价药剂科生产效率的方法。 方法 分析25家军队医疗机构药学部门的投入产出数据,构建药剂科生产效率描述性评价指标。 结果 建立以年人均药品收入、每张床位年均药品收入、人均日调配处方量作为经济产出效率指标,以临床药师服务时数作为改善型效率指标和人均用药差错防范评分作为防范型效率指标的描述性评价方法。 结论 经济产出效率指标具有局限性,质量产出效率指标量化方法需要进一步规范和完善。     

安徽省县级公立医院住院患者满意度分析与评价

目的 了解县级公立医院住院患者的满意度,分析其满意度影响因素。方法 2016年6月至8月依据地区经济水平和地域的差异,采用随机分层抽样的方法,在皖南、皖中、皖北各随机抽取4家县级公立医院,利用自制满意度调查问卷对共12家县级公立医院总计696例住院患者满意度情况进行调查。结果 住院患者总体满意度为（4.39±0.74）分,医护人员形象、医疗质量、医疗服务、医疗流程、医疗环境设施和医疗费用维度的满意度分别为（4.54±0.65）分、（4.45±0.68）分、（4.43±0.71）分、（4.42±0.70）分、（4.13±0.85）分和（4.12±0.85）分。医疗服务态度、医疗流程、医疗人员形象、医疗质量、医疗费用、科室、家庭月收入是住院患者满意度的影响因素。结论 住院患者总体满意度水平较高,但医疗费用和医疗环境设施维度满意度水平较低;医院应从医疗服务态度、医疗流程、医疗人员形象等方面来制定相应措施,为患者提供更加优质的医疗服务,提高患者满意度。     

2015年安徽省精神卫生资源状况分析

目的 了解2015年安徽省精神卫生资源状况,为本省精神卫生服务资源合理配置提供理论依据。方法 收集2016年8 ～9月安徽省各地市精神卫生工作项目承担单位资源调查员填写的《2015年全国精神卫生资源调查表》（调查表数据截至2015年12月31日）。对调查表中全省精神卫生机构数、精神科执业医师数、精神科编制床位数等数据进行总结并做描述性分析。结果 截至2015年12月31日批复成立的精神卫生机构全省共有58家,编制床位数7 957张。全省精神科床位密度平均为1.31张/万人,铜陵最高为4.47张/万人,亳州最低仅为0.16张/万人。精神科执业（助理）医师891名,全省精神科医师密度平均为1.46名/10万人,铜陵最高为6.37名/10万人,滁州最低为0.45名/10万人。全省精神科患者平均住院日为（68.48±56.90）d。结论 安徽省精神卫生资源分布不均,精神卫生机构建设不足,精神科执业医师紧缺。     

2013—2017年黑龙江省肿瘤登记地区膀胱癌发病与死亡分析及时间变化趋势

目的 分析2013—2017年黑龙江省肿瘤登记地区膀胱癌发病与死亡情况及时间变化趋势。方法 收集2013—2017年黑龙江省肿瘤登记地区上报的膀胱癌发病与死亡病例资料,计算发病（死亡）率、标化发病（死亡）率、累积率（0～74岁）等,标化率采用2000年全国人口普查标准人口构成和Segi''s世界标准人口构成作为标准。年度变化百分比（APC）使用JoinPoint软件计算。结果 2013—2017年黑龙江省肿瘤登记地区膀胱癌发病率为6.16/10万,中标率为3.48/10万,累计率（0～74岁）为0.39%;其中男性发病率（9.29/10万）高于女性（3.09/10万）,城市地区发病率（7.11/10万）高于农村地区（3.80/10万）。2013—2017年黑龙江省肿瘤登记地区膀胱癌死亡率为2.77/10万,中标率为1.49/10万,累积率（0～74岁）为0.14%;其中男性死亡率（3.91/10万）高于女性（1.64/10万）,城市地区死亡率（3.17/10万）高于农村地区（1.76/10万）。2013—2017年黑龙江省肿瘤登记地区膀胱癌发病中标率呈升高趋势,APC为11.6%,差异有统计学意义（P<0.05）,2013—2017年死亡中标率也呈升高趋势,APC为7.3%,但差异无统计学意义（P>0.05）。结论 膀胱癌是威胁黑龙江省居民身心健康的恶性肿瘤之一,应对高风险人群做好积极防治工作。     

某军队医院2011~2015年临床科室运行效率评价

目的 应用数据包络分析（DEA）评价2011~2015年某军队医院临床科室运行效率。方法 基于DEA的CCR模型和BCC模型对某军队医院临床科室运行效率进行测算。结果 临床科室平均综合技术效率值为0.83,各年度无明显变化,内科系统平均综合技术效率值0.81,低于外科系统的0.87;平均纯技术效率值0.72,有下降趋势,外科系统平均纯技术效率值0.74,高于内科系统的0.68;平均规模效率值0.87,无明显变化,外科系统平均规模效率值0.93,明显高于内科系统的0.77;规模收益状态呈递增趋势科室居多,仅有1个科室规模收益状态呈递减。结论 部分临床科室运行效率仍有上升空间,新形势下军队医院需积极调整跟进。     

合肥市某区社区医生对国家基本药物制度的认知及影响因素分析

目的 通过社区医生对基本药物制度的认知及影响因素的分析,为进一步提高基本药物使用率提供相关对策和建议。方法 对合肥市某区8个社区卫生服务中心和2个乡镇卫生院所有在岗的215名社区医生进行问卷调查。调查内容主要包括社区医生对基本药物制度的认知、基本药物使用情况和实施后效果评价等。结果 不同年龄（F=6.595,P=0.002）、婚姻状况（t=2.40,P=0.040）、工作年限（F=7.12,P=0.009）和受教育程度（F=5.47,P=0.006）的社区医生对国家基本药物制度的认知比较,差异均有统计学意义（P<0.05）;多因素logistic回归分析,社区医生的年龄、个人年收入和专业技术职务均为国家基本药物制度认知的影响因素（P<0.05）。结论 社区医生对国家基本药物制度的认知不足,应加强对社区医生的宣传教育工作,提高国家基本药物制度的运行效果。     

Evaluation of the association between health insurance status and healthcare utilization and expenditures among adult cancer survivors in the United States

BackgroundHealth care expenditures for cancer care has increased significantly over the past decade and is further projected to rise. This study examined the associations between health insurance status and total direct health care expenditures and health care utilization among cancer survivors living in the United States.MethodsA cross-sectional study of cancer survivors aged ≥18 years, identified from the Medical Expenditures Panel Survey (MEPS) during 2017 using International Classification of Diseases, Tenth Revision codes specific for cancer. Health insurance was categorized into Private, Medicare, Medicaid, and uninsured. Multivariable ordinary least squares regression was used to examine the association between log expenditures and health insurance. Negative binomial regression with log link was used to obtain adjusted incident rate ratios (AIRR) for health care utilization. Survey weights were used to produce nationally representative estimates of the US population.ResultsA total of 1140 (weighted = 13.9 million) cancer survivors were identified. Compared to the adjusted mean annual health care expenditures for the private group ($14,265; 95% confidence interval (CI): $12,645 to $16,092), the adjusted mean annual health care expenditures for the Medicare group were higher ($15,112; 95%CI: $13,361 to $17,092). As compared to the private group, the average annual expenditures for uninsured cancer survivors ($2315; 95%CI:1038 to $3501) was significantly lower and so was their health care utilization. Adjusted rates of ER visits for Medicaid were twice (AIRR:2.04; SE:0.28; p = 0.001) as compared to privately insured.ConclusionsA difference in the average total direct expenditures between uninsured and privately insured patients was found. Uninsured had the lowest health care utilization while Medicaid reported significantly higher number of ER visits. Despite differences in program structures, health care expenditures across insurance types were similar. Lower utilization of health care services among uninsured suggests cost maybe a barrier to accessing care.     

Transitioning from interferon-based to direct antiviral treatment options: A potential shift in barriers and facilitators of treatment initiation among people who use drugs?

BackgroundMultiple barriers for accessing hepatitis C virus (HCV) treatment were identified during the interferon-based (IFN) treatment era for people who inject drugs (PWID). Whether these barriers persist since the introduction of IFN-free direct-acting antiviral (DAA) agents in Canada remains to be documented. This study examined temporal trends in HCV treatment initiation and associated factors during the transition from INF-based to all-oral DAA regimens.MethodsThe study population was drawn from a prospective cohort of PWID in Montreal, Canada. At three-month/one-year intervals between 2011 and 2017, participants with chronic HCV infection completed an interviewer-administered questionnaire on socio-demographic characteristics, drug use and health service utilisation, including HCV treatment. Time-updated Cox multivariate regression models, stratified by DAA + INF (2011-2013) and all-oral DAA (2014–2017) availability periods, were conducted to examine associations between time to HCV treatment initiation and associated barriers and facilitators.ResultsOf 308 participants (85% male, median age 42 [IQR: 33, 50]), 80 (26%) initiated HCV treatment during 915 person-years (PY). Incidence rates increased from 1.6 /100 PY (95%CI:0.9–2.6) in 2011 to 12.7 (10.6–15.1) in 2017 (p-trend = 0.0012). In multivariate analyses, visiting a primary care physician (2011–2013: aHR = 3.63[1.21–10.9]; 2014–2017: 2.52[1.10–5.77]) and frequent injection (0.23[0.05–0.99] and 0.49[0.24–0.99]) were consistently associated with treatment initiation. Participants aged >40 (2.27[1.24–4.13]), receiving opioid agonist therapy (OAT) (2.17[1.19–3.94]), and reporting prior HCV treatment (3.00[1.75–5.15]) were more likely to initiate treatment in the all-oral DAA period.ConclusionTreatment initiation increased between 2011 and 2017, but still remains low among PWID. Primary care visiting was a key facilitator regardless of the period, while engagement in OAT and health services, indicated by prior HCV treatment, increased the likelihood of treatment initiation in the DAA era. These findings suggest that access to health services is essential but not enough to scale up treatment in this population.     

Association between psychological distress and elevated use of electronic devices among U.S. adolescents: Results from the youth risk behavior surveillance 2009-2017

ObjectiveThe purpose of this study was to provide updated information about the prevalence and temporal trends of elevated use of electronic devices (EUED) in leisure time (i.e., 3 h or more on an average school day) in nationally representative samples of U.S. adolescents in recent years and to determine whether there is a significant association between EUED and psychological distress.MethodsWe used the national Youth Risk Behavior Survey (YRBS) data from 2009, 2011, 2013, 2015, and 2017 (N = 75,807). Propensity score matching was used to reduce selection bias due to potential confounding factors with EUED. Ordinal logistic regression analyses were performed for the matched samples to predict the association between EUED and psychological distress.ResultsThe prevalence of EUED in U.S. youth has substantially increased from 24.9% in 2009 to 43.1% in 2017 (p < .001). Boys had higher rates of EUED than girls only in 2009 and 2011 but not in 2013, 2015, and 2017. A significant association between EUED and psychological distress was identified throughout all the five survey years. The odds of having a higher level of psychological distress increased approximately 1.5 times among youth with EUED than those without.ConclusionsThe prevalence of U.S. youth with psychological distress and EUED has increased simultaneously in the past several years. Future longitudinal studies are warranted to examine causal and/or reciprocal relationship between the two.     

Exploring factors associated with scholarly writing among US pharmacy practice faculty

ObjectivesThis study explored intrinsic facilitators (i.e., grit, self-efficacy, and writing motivation) and barriers associated with scholarly output as measured by self-reported publications among US pharmacy practice faculty.MethodsA cross-sectional study design was used to gather information regarding scholarly writing output and intrinsic facilitators and barriers among US pharmacy practice faculty using an online self-reported survey. The survey link was distributed via email between October and November 2017. The Grit-S, New Generalized Self-Efficacy Scale (NGSE), and Scholarly Writing Motivation Scale (SWMS) were used to measure grit, self-efficacy, and writing motivation, respectively. Perceived barriers, self-reported quantity of publications, and demographics were also collected. A structural equation modeling (SEM) approach was used to determine effects of perceived barriers and each intrinsic factor on self-reported total publications.ResultsN = 208 participants were included in the analyses. The average number of self-reported annual publications was 1.88. Participants who reported having higher than average numbers of annual publications (n = 85, 40.9%) more frequently held a PhD degree and were more frequently in the tenure track, compared to those with annual publications less than the average (n = 123, 59.1%). The majority of both groups reported being employed in public institutions. Lack of time for scholarly writing was the highest perceived barrier and lack of knowledge about technical writing/English mastery was the lowest. All three SEM models consistently showed that perceived barriers were negatively associated with numbers of self-reported publications. However, only scholarly writing motivation according to SWMS was positively associated with the numbers of self-reported publications.ConclusionsWriting motivation and barriers to scholarly writing are shown to have a significant impact on scholarly output. These factors can be identified and should be appropriately addressed by colleges/schools of pharmacy to enhance scholarly activities among pharmacy practice faculty.     

安徽省全科医学师资培训效果评价与分析

目的 评价安徽省全科医学师资培训效果,为优化全科医学师资培训提供依据。方法 选择参加2017年安徽省全科医学师资培训的257名学员为研究对象,培训结业成绩为评价指标,对安徽省全科医学师资培训进行统计分析。结果 不同学历、职称学员结业成绩差异有统计学意义（P=0.000）;临床师资与基层实践师资结业成绩差异有统计学意义（P=0.000）;不同地域学员结业成绩差异有统计学意义（P=0.008）;来自综合性医院的学员与基层医院或社区医疗机构的学员结业成绩差异有统计学意义（P=0.003）;省级培训基地培训学员与市级培训基地培训学员结业成绩差异有统计学意义（P=0.000）。结论 全科医学师资培训要更加重视学历、职称较低的学员以及来自基层或社区的学员,对于基层和北方区域的学员要针对性地制订培训计划,使其取得更好的培训效果。同时,要加强市级培训基地的建设。