卫生政策与基层医疗卫生质量

     健康作为重要的人力资本,是经济增长的重要促进因素。初级医疗保健(primary care)是促进人类身心健康和社会福祉最有效的方法。根据世界卫生组织于1978年发布的《阿拉木图宣言》,政府和卫生组织应为社会提供人人均可获得的基本且必要的健康护理,即初级医疗保健。

      近年来我国农村医疗卫生支出快速增长,但是没有证据表明农村居民的健康水平因此得到显著改善。其中一个原因可能在于农村地区医生提供的医疗服务质量不高。村卫生室作为我国农村医疗服务体系的最底层,是守护农民健康的第一道防线。其医疗服务质量如何?投入大量资金的村医培训能否取得预期效果?新医改等一系列医疗改革政策对村级医疗机构的服务提供、农村居民的就医和健康状况有何影响?一系列问题均有待回答。

      课题组先后在陕西、安徽、四川、云南等省份开展调研,调查600余所村卫生室的基本情况及经营状况和村卫生室内村医的基本信息。并通过情景知识测试、标准化病人访问等方法测量了村医的医疗知识水平和医疗服务提供质量。在部分省份课题组还对样本村的住户开展了抽样调查,了解其家庭基本情况、家庭成员健康状况以及就医信息。以下为课题组及合作者的部分研究成果:

1.Liu H, Li H, Teuwen DE, Sylvia S, Shi H, Rozelle S, Yi H. Irrational use of medicine in the treatment of presumptive asthma among rural primary care providers in southwestern China. Frontiers in Pharmacology. 2022;13.

2.Rao Sihang, Xue Hao, Dirk E. Teuwen, Shi Haonan, Yi Hongmei *, 2021. Measurements of quality of village-level care and patients’ healthcare-seeking behaviors in rural China, BMC Public Health, 2021, 21(1): 1-13.

3. Yi, Hongmei, Huidi Liu, Zhiping Wang, Hao Xue, Sean Sylvia, Haonan Shi, Dirk E. Teuwen, Ying Han, Jiong Qin, 2020. The competence of village clinicians in the diagnosis and management of childhood epilepsy in Southwestern China and its determinants: A cross-sectional study, The Lancet Regional Health-Western Pacific, 3 (2020) 100031.

4. Guo Wilson, Sean Sylvia, Karl Umble, Yunwei Chen, Xiaoyuan Zhang, Hongmei Yi*, 2020. The competence of village clinicians in the diagnosis and treatment of heart disease in rural China: A nationally representative assessment, The Lancet Regional Health-Western Pacific, 2 (2020) 100026.

5. Gao, Qiufeng, Lanxi Peng, Wenbin Min, Jingchun Nie, Aiqin Wang*, Yaojiang Shi, Haonan Shi, Dirk E. Teuwen and Hongmei Yi, 2020. Regularity of Clinical Visits and Medication Adherence of Patients with Hypertension or Diabetes in Rural Yunnan Province of China, Int. J. Environ. Res. Public Health, 2020, 17, 9297; doi:10.3390/ijerph17249297

6. Yi, Hongmei, Paiou Wu, Xiaoyuan Zhang, Dirk E. Teuwen, Sean Sylvia, 2020. Market competition and demand for skills in a credence goods market: Evidence from face-to-face and web-based non-physician clinician training in rural China, PLOS ONE, doi.org/10.1371/journal.pone.0233955.

7. Wu, Yuju, Huan Zhou*, Xiao Ma, Yaojiang Shi, Hao Xue, Chengchao Zhou, Hongmei Yi, Alexis Medina, Jason Li, Sean Sylvia, 2020. Using standardized patients to assess the quality of medical records: an application and evidence from rural China, BMJ quality & safety , 2020; 29:491-498.

8. Xue, Hao, Yaojiang Shi, Lei Huang, Hongmei Yi, Huan Zhou*, Chengchao Zhou, Sarah Kotb, Joseph D. Tucker and Sean Y. Sylvia, 2019. Diagnostic ability and inappropriate antibiotic prescriptions: a quasi-experimental study of primary care providers in rural China, Journal of Antimicrobial Chemotherapy, 2019; 74: 256–263.

9. Sean Sylvia, Hao Xue, Chengchao Zhou*, Yaojiang Shi, Hongmei Yi, Huan Zhou, Scott Rozelle, Madhukar Pai, Jishnu Das. Tuberculosis Detection and the Challenges of Integrated Care in Rural China: A Cross-sectional Standardized Patient Study. PLoS Medicine, 2017, 14(10), e1002405