Our primary health care institution began to implement national essential medicine system in 2009. In past fi ve years, the goal of national essential medicine system has been initially achieved. For examples, medicine price is steadily reducing, the quality of medical services is improving and residents' satisfaction is substantial increasing every year. However, at the same time, we also found some urgent problems needed to be solved. For examples, the range of national essential medicine is limited, which is difficult to guarantee the quality of essential medication. In addition, how to compensate the primary health care institution is still a question.
China ; Health Services Needs and Demand ; Primary Health Care ; organization & administration

Aged ; Delivery of Health Care ; organization & administration ; Delivery of Health Care, Integrated ; organization & administration ; Humans ; Primary Health Care ; organization & administration ; trends ; Program Development ; Singapore

Child ; Child Health Services ; organization & administration ; China ; Health Care Sector ; standards ; trends ; Humans ; Patient Care Team ; standards ; trends ; Primary Health Care ; organization & administration

In the 1960s, a shortage of primary care medical doctors in rural and urban areas of the United States. Coinciding with the above problem, returning military servicemen who had delivered medical care in Vietnam but were unqualified to do so in the U.S. became a social problem of medical systems. One solution was to train these men quickly and allow them to work under the supervision of a doctor. This was the basic reason for the U.S. physician assistant (PA) system. For underserved communities, PAs are necessary 1) as the principal care provider in rural area or inner-city urban clinics with a supervising physician and other medical professionals and 2) to reduce the pressure, working hours and intensity of work of junior doctors or to replace junior doctors with a qualified and trained healthcare provider. In Korea, Pas would not help reduce the pressure and intensity of work for primary care providers, but could do so for residents. Therefore, the well-established PA system, including its education and training system, may be appropriate for Korea. To establish the appropriate PA system in Korea, several factors must be considered. The first is the qualifications for PAs. In Korea, medical doctors and nurses are considered medical personnel but medical technicians and nurse aids are not. To be certified to work as clinical assistants, certification as medical personnel is mandatory. The second is education and certification. Independent schools for PA training would require longer training time and an additional education system. The society of medical association authorized by the Ministry of Health and Welfare may be more suitable for education and training of PAs in Korea than an additional independent education system. Finally, for successful PA system in Korea, the thorough inspection and control of the system by hospitals and also by society of medical association is critical.
Certification ; Health Personnel ; Humans ; Korea ; Male ; Military Personnel ; Organization and Administration ; Physician Assistants ; Primary Health Care ; Social Problems ; United States ; Vietnam

The community health practitioners (CHP) play an important role in primary health care services to the underserved population in rural area. Time and motion study of 26 CHPs in Kyungpook Province was conducted through work diary method for 6 consecutive days from the time they arrived until they left the primary health post (PHP) during the past 3 weeks from November 16 to December 5, 1987. The allocation of activity time by working category, service category, location of activity and CHP's function was analyzed according to the characteristics of CHPs i. e., age, marital status and experience as CHP. The major findings are as follows: The mean activity time per CHP in a week was 2,918 minutes. The length of their working hours as longer for older, married and more experienced CHPs than other. About 80% of the CHP's activities took place within the PHP and only about 20% occurred outside of the PHP. Working hours for the outdoor activities were longer for younger, single and less experienced CHPs than others. The allocation of activity time by working category showed 46.3% in the technical work and 18.7% in the administrative work. Working hours for the technical activities were longer for younger, single and less experienced CHPs than others. The percentage of activity time revealed greatest as much as 63.1% for direct patient care in technical word and 61.6% for record keeping in administrative work. Of the total working hours in a week, direct patient care and public health activities accounted for 29.2.% and 16.2%, respectively. Of the indoor activities, working hours for direct patient care were longer than those for public health activities. However, of the outdoor activities, working hours for public health activities were longer than those for direct patient care. The allocation of activity time by CHP's function showed 49.7% in management of common disease, 31.8% in management of PHP and technical supervision of village health workers, 9.5% in MCH and family planning, 6.6% in community health management and 2.4% in community approach. Based on these findings, it was found that CHPs were mainly working in the PHP with a majority of their time being spent of direct patient care rather than preventive and promotive health cares. To enhance the preventive and promotive health services of the CHPs and to involve the activities for community development, refresher course for CHPs should be reinforced and supervision mechanism of the CHPs should be established and operated in Gun- and province- level.
Community Health Workers ; Family Planning Services ; Gyeongsangbuk-do ; Health Services ; Humans ; Marital Status ; Methods ; Organization and Administration ; Patient Care ; Primary Health Care ; Public Health ; Social Change ; Vulnerable Populations

Singapore is facing an increasing noncommunicable disease burden due to its ageing population. Singapore's primary healthcare services, provided by both polyclinic physicians and private general practitioners, are available to the public at differential fees for service. The resultant disproportionate patient loads lead to dissatisfaction for both healthcare providers and consumers. This article describes the 'PAIR UP' approach as a potential endeavour to facilitate primary care physicians (PCPs) in public and private sectors to collaborate to deliver enhanced primary care in Singapore. PAIR UP is an acronym referring to Policy, Academic development, Integration of healthcare information system, Research in primary care, Utility and safety evaluation, and Practice transformation. The current healthcare landscape is favourable to test out this multipronged approach. PCPs in both sectors can ride on it and work together synergistically to provide quality primary care in Singapore.
Aged ; Aging ; Family Practice ; methods ; Geriatrics ; methods ; organization & administration ; Health Policy ; Humans ; Medical Informatics ; Physicians ; Primary Health Care ; organization & administration ; Singapore ; Treatment Outcome

Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care.
Asia ; Depression ; diagnosis ; Hospitalization ; Humans ; Primary Health Care ; organization & administration ; Risk Assessment ; Risk Factors ; Self-Injurious Behavior ; Suicide ; prevention & control

Obesity is now recognized as a critical target for public health intervention in many parts of the world, affecting virtually all age and socio-economic groups within both developed and developing countries. This study's objective is to provide an overview of the full range of methods and models available for weight loss, including some methods used by overweight and obese people without medical supervision. Many diverse approaches for achieving weight loss and weight maintenance have been evaluated. According to some evidence-based guidelines, in order to achieve the best treatment outcomes, it is recommended that a combination of dietary therapy with low-calorie diet, increased physical activity, and behavioral therapy be incorporated. Advances in treatment and innovative policy initiatives focusing on prevention could reverse the global problem of obesity and overweight. The most effective forms of treatment require collaboration among health care providers in primary care settings, including nurses, dietitians, psychologists, physicians, and psychiatrists. Effective strategies for weight loss require management strategies that combine dietary therapy and physical activity by using behavioral interventions. Thus, in the near future, the Korean government must develop evidence-based (clinical or community) guidelines for obesity management. Also, due to the lack of high quality primary studies on obesity management in Korea, future randomized clinical or community trials are recommended in this area.
Caloric Restriction ; Cooperative Behavior ; Developing Countries ; Evidence-Based Medicine ; Health Personnel ; Humans ; Korea ; Motor Activity ; Obesity ; Organization and Administration ; Overweight ; Primary Health Care ; Psychiatry ; Public Health ; Weight Loss

BACKGROUND: The objectives of the study are to find out the effect of the implementing reform in three Central Asian countries, identify its impact on health status and health care delivery systems. This study address to identify strong and weak points of the health systems and provide a recommendation for further health care organization. METHODS: A comparative analysis was conducted to evaluate the effects of implemented policy on health care system efficiency and equity. Secondary data were collected on selected health indicators using information from the World Health Organization Global Health Expenditure Database, European Health Information Platform, and World Bank Open Data. RESULTS: In terms of population status, countries achieved relatively good results. Infant mortality and under-5 mortality rate decreased in all countries; also, life expectancy increased, and it was more than 70 years. Regulations of the health systems are still highly centralized, and the Ministry of Health is the main organ responsible for national health policy developing and implementation. Among the three countries, only Kyrgyzstan was successful in introducing a national health system. Distribution of health expenditure between public expenditure and out-of-pocket payments was decreased, and out-of-pocket payments were less the 50% of total health expenditure in all countries, in 2014. CONCLUSION: After independent, all three countries implemented a certain number of the policy reform, mostly it was directed to move away from the old the Soviet system. Subsequent reform should be focused on evidence-based decision making and strengthening of primary health care in terms of new public health concepts.
Asian Continental Ancestry Group ; Decision Making ; Delivery of Health Care ; Global Health ; Health Expenditures ; Health Policy ; Humans ; Infant ; Infant Mortality ; Kazakhstan ; Kyrgyzstan ; Life Expectancy ; Mortality ; Primary Health Care ; Public Health ; Social Control, Formal ; United Nations ; Uzbekistan ; World Health Organization

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme ; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization ; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially In continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions. Quality in terms of accessibility and continuity highly varied among institutions. To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.
Accreditation ; Consumer Participation ; Cooperative Behavior ; Delivery of Health Care ; Education ; Financial Management ; Health Resources ; Humans ; Information Systems ; Korea* ; Occupational Health Services* ; Occupational Health* ; Primary Health Care ; Quality Improvement ; Questionnaires ; Social Welfare ; World Health Organization