Revisiting current "barefoot doctors" in border areas of China: system of services, financial issue and clinical practice prior to introducing integrated management of childhood illness (IMCI).
Revisiting current "barefoot doctors" in border areas of China: system of services, financial issue and clinical practice prior to introducing integrated management of childhood illness (IMCI).
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DOI：
10.1186/1471-2458-12-620
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发表时间：
2012-08-07
影响因子：
4.5
通讯作者：
Ma K
中科院分区：
文献类型：
--
作者：
Li X;Chongsuvivatwong V;Xia X;Sangsupawanich P;Zheng W;Ma K
在中国农村，5岁以下的儿童死亡率仍然很高。 1998年将儿童疾病综合管理（IMCI）引入了中国，但仅包括少数农村地区。这项研究旨在评估农村卫生保健卫生系统的当前状况，并在偏远边境农村地区实施IMCI计划之前，评估乡村医生在儿童疾病管理中的临床能力。
这项研究是在云南省Puer县边境地区进行的。在这些边境地区，卫生局名单中有182名乡村医生。其中，将154（84.6％）招募到研究中。使用定性方法研究了当地的卫生系统组件，并通过来自不同来源的信息进行了分析。使用描述性统计数据对临床成分进行了客观和定量的评估。
研究发现，新的农村合作医疗计划（NRCMS）通过3层协调了健康保险系统和提供者服务：乡村医生，乡镇和县医院。每人每年30元人民币的保费未支付推荐成本，从而减少了推荐人数。与可用的治疗设施和药物供应相反，乡村医生和乡镇医生的基础医学教育水平很低。乡村医生的不满很常见，尤其是关于服务的低回报率，例外是诸如注射之类的程序，实际上可能会对患者造成道德危害。乡村医生对小儿患者评估和管理的直接观察表明，病史和体格检查不足，无法检测到潜在的严重并发症，注射和抗生素的过度处方，以及口服再水的盐分不足以及咨询质量差。
有必要提高研究区域乡村医生的健康融资和临床能力。
Under-5-years child mortality remains high in rural China. Integrated management of childhood illness (IMCI) was introduced to China in 1998, but only a few rural areas have been included. This study aimed at assessing the current situation of the health system of rural health care and evaluating the clinical competency of village doctors in management of childhood illnesses prior to implementing IMCI programme in remote border rural areas. The study was carried out in the border areas of Puer prefecture of Yunnan province. There were 182 village doctors in the list of the health bureau in these border areas. Of these, 154 (84.6%) were recruited into the study. The local health system components were investigated using a qualitative approach and analyzed with triangulation of information from different sources. The clinical component was assessed objectively and quantitatively presented using descriptive statistics. The study found that the New Rural Cooperative Medical Scheme (NRCMS) coordinated the health insurance system and the provider service through 3 tiers: village doctor, township and county hospitals. The 30 RMB per person per year premium did not cover the referral cost, and thereby decreased the number of referrals. In contrast to available treatment facilities and drug supply, the level of basic medical education of village doctors and township doctors was low. Discontent among village doctors was common, especially concerning low rates of return from the service, exceptions being procedures such as injections, which in fact may create moral hazards to the patients. Direct observation on the assessment and management of paediatric patients by village doctors revealed inadequate history taking and physical examination, inability to detect potentially serious complications, overprescription of injection and antibiotics, and underprescription of oral rehydration salts and poor quality of counseling. There is a need to improve health finance and clinical competency of the village doctors in the study area.
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影响因子：
168.9
作者：
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通讯作者：
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