OBJECTIVE:To provide reference for further promoting the implementation ofseparation of prescribing and dis-pensingpolicy which fit China's national conditions. METHODS:Based on literature review,informant interview,and filed in-vestigation the development ofseparation of prescribing and dispensingwere compared between typical eastern and western coun-tries. Constraints ofseparation of prescribing and dispensingin China were explored,international successful experiences were summarized to inspire appropriate implementation of this policy in China. RESULTS & CONCLUSIONS:There are four con-straints in the implementation ofseparation of prescribing and dispensingin China. Firstly,the legal foundation is yet established for the professional development of pharmacists. Secondly,the medicine pricing and hospital financing systems are unreasonable. Thirdly,patients'ownership of prescriptions and right of dispensing options are monopolized by hospitals. Fourthly,safety of medi-cines use is yet ensured.Separation of prescribing and dispensingshould follow the rules of social and economic development and should be adjusted to adapt local conditions.Separation of prescribing and dispensingpolicy itself may not help to achieve the objectives of cost containment and rational use of medicines. To achieve the intended objectives,legislation of Pharmacist Law should also be accelerated to clearly define the role of pharmacist and guide the behavior of prescribers with economic levers.

Objective　To study the effects of dehydroepiandrosterone (DHEA) and/or estradiol (E2) on apoptosis in peripheral blood mononuclear cells (PBMCs) from patients with systemic lupus erythematosus (SLE). Methods　The percentage of apoptosis of PBMCs from SLE patients and healthy blood donors were examined by means of AO staining 48*!h after culture with DHEA and/or E2 at physiologic or pathologic concentrations. Results　The percentage apoptosis of PBMCs from SLE patients is higher than that of healthy blood donors (P<0.01). E2， whether at physiological or at pathological concentrations, had no effects on apoptosis of PBMCs from both SLE patients and healthy donors (P>0.05). Both DHEA and DHEA plus E2 at physiologic concentrations, had no effect on apoptosis of PBMCs from healthy donors (P>0.05), but significantly inhibited that of SLE patients (P<0.05); at pathologic concentrations,they promoted apoptosis of PBMCs from SLE patients as well as healthy blood donors (P<0.05). There were no significant differences between the effects of DHEA and that of DHEA plus E2 (P>0.05). Conclusion　DHEA plays an important role in the apoptosis of PBMCs from SLE patients; low serum levels of DHEA may cause accelerated apoptosis.

The 2nd round of the third-party evaluation of the National Healthcare Improvement Initiative was made during Dec 2016 and Jan 2017.The methods, organization and implementation of the survey and the technical roadmap were the same as those of the 1st round of evaluation.The total number of respondents was 94 218,including 19 773 doctors,24 315 nurses,29 105 outpatients and 21 025 inpatients. 142 typical cases were collected from sample hospitals.The key findings showed that, the National Healthcare Improvement Initiative has been implemented quite well in the 2nd year, achievements and challenges exist side by side.The overall satisfaction rate of both outpatients and inpatients was good, both were about 90%.Further improvement is expected.Hospital staff have been actively involved in this Initiative,but they are not satisfied with their working environments and compensations.

Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system.Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment(2016-2017),the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred.Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower(P<0.01,95%CI=-0.17, -0.06).The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03,95%CI=-0.11,-0.01).Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction.To further improve the referral system and to raise patient satisfaction,there is a need to take following actions,to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system,to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system.In addition, it is critical to further regulate and optimize the referral procedures,so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy.Finally,it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system.

Objective To understand the current situation of inpatients′perceptions of doctor-patient relationship and its influencing factors, and to make policy recommendations for further targeted healthcare improvement.Methods Based on the survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals,we analyzed the inpatients′perceptions of doctor-patient relationship.SPSS 22.0 software was used to conduct Kruskal-Wallis test and Dunn-Bonferroni test,and SAS 9.4 was used to conduct multivariate logistic regression to analyze the influencing factors of inpatients′perceptions of doctor-patient relationship.Results The mean perception score of the inpatients pertaining to doctor-patient relationship was 4.34 ±0.84,and the median was 5.00.The perception score of the male inpatients pertaining to doctor-patient relationship was significantly higher than that of the female respondents(P<0.05),that of the inpatients who had fixed physicians or general practitioners before visiting was higher than that of the inpatients who did not have(P <0.05).The overall satisfaction of inpatients during hospitalization(P <0.01, OR =2.73)and doctors′satisfaction to have enough communication time with patients(P <0.01, OR =1.84)were the most significant protection factors to inpatients′perceptions of doctor-patient relationship.The process and structure evaluation results of hospitals in harmonization of doctor-patient relationship was a significant risk factor.Inpatients who had fixed physicians or general practitioners before visiting(P<0.01, OR=1.31)was another statistically significant positive influencing factor of inpatients′perceptions of doctor-patient relationship.Conclusions It is imperative to strengthen communications between doctors and patients and to improve healthcare service, in order to raise patients′satisfactions for a harmonized doctor-patient relationship.In addition to establish a working mechanism for medical disputes as a post-incident strategy, hospitals are recommended to take proactive and preventive measures.In addition,measures like integration of family doctor system and medical alliance system,as well as encouraging patients to contract their family doctors will help to harmonize the doctor-patient relationship.

Objective To learn the current situation and influencing factors of outpatients′perceptions of doctor-patient relationship,and to generate evidence for effective improvement of outpatients′perceptions of doctor-patient relationship.Methods Based on the results of the third party evaluation of the National Healthcare Improvement Initiative(2016-2017)in 136 hospitals, we analyzed the outpatients′perceptions of doctor-patient relationship and its influencing factors.Univariate analysis of the outpatients′perceptions of doctor-patient relationship(Chi-square test and Wilcoxon rank sum test),and binary logistic regression were conducted to analyze the influencing factors of the outpatients′perceptions of doctor-patient relationship.Results A total of 29 105 out-patients were included in this study.The average outpatient perception score of doctor-patient relationship was 3.88 ±0.99, and the median was 4.00.The perception score of outpatients pertaining to doctor-patient relationship was the highest in the eastern regions and lowest in the western regions.That of outpatients from general hospitals was highest than that of those in maternal and child hospitals and traditional Chinese medicine hospitals.Patients′waiting time for consultation,having a fixed physician or general practitioner before visiting, contracting with a community doctor or not, the overall satisfaction,and the household income and insurance coverage were all the influencing factors of the outpatients′perceptions of doctor-patient relationship(P<0.05).Conclusions There is still a long way to go before the patients can agree with the perception of a better doctor-patient relationship.The critical points for improvement include reducing waiting time for consultation, allocation of more medical resources to the western regions,improving humane care to patients and raising outpatients′overall satisfactions, especially in the departments of obstetrics and gynecology,and pediatrics.

Objective To explore the influencing factors of outpatients′satisfaction in different types of hospitals,and to generate evidence for further healthcare improvement in different types of hospitals. Methods Based on the inpatient satisfaction survey results of the third party evaluation of the National Healthcare Improvement Initiative in 136 public tertiary hospitals,we divided the outpatients in four groups according to the hospital types as general, traditional Chinese medicine, maternal and child and specialty hospitals.SPSS 22.0 and SAS 9.4 were used to conduct the Pearson Chi-square test, variance analysis, Bonferroni test for univariate analysis, and multiple stepwise logistic regression analysis of the influencing factors of outpatients′satisfaction in different types of hospitals.Results A total of 29 105 complete questionnaires were collected from the outpatients.There were statistically significant differences between the overall outpatient satisfactions of different types of hospitals(P <0.01).Hospital experience was the common most significant positive factors affecting the overall satisfaction of outpatients in all types of hospitals(P<0.01,OR=4.10,4.39,3.83,4.36).Waiting time for consultation was the common most significant negative influencing factor of the overall outpatient satisfaction of all types of hospitals(P<0.01, OR=0.99).Conclusions In the next round of healthcare improvements, all types of hospitals should focus on shortening outpatient waiting time.In a short run, hospitals can address this issue through more appropriate allocation of resources within hospitals.In a longer run, there is a need to rationalize the allocation of multiple resources within the overall health service delivery system.It is necessary to strengthen patient centered humane care,and to meet diverse healthcare needs.Western areas are called for enhanced investment and strengthened healthcare improvements.

Objective To learn the satisfaction influencing factors of outpatients with different registration approaches, in order to improve outpatient registration and appointment services at hospitals. Methods The composition of outpatients with different registration approaches was analyzed based on the outpatient survey results of the third party evaluation of the National Healthcare Improvement Initiative(2016-2017).Binary multivariate logistic regression analysis was conducted for outpatients with appointment and service counter registration approaches respectively, to analyze the influencing factors of outpatient satisfaction.Results Among the validated respondents, 16 588 cases(56.99%)were registered at the service counter, only 12 517 cases(43.01%)had prior appointment.Outpatients in eastern region hospitals had a higher rate of appointment registration than in western regions.Except in maternal and child hospitals,the outpatients in general hospitals,traditional Chinese medicine hospitals and specialty hospitals still tend to register at the service counter.The satisfaction of outpatients registered at service counters was significantly lower than those with appointment(P<0.05).With control of the social and demographic characteristics of outpatients, medical experiences were the common statistically significant positive influencing factor of the overall satisfaction for outpatients registered via both service counters and appointment(P <0.001), while waiting time ranked their common statistically significant negative satisfaction influencing factor(P<0.001).Conclusions The overall satisfaction of the outpatients with appointment was higher than that of the outpatients registered at service counters.Appointment registration is to be further promoted at large tertiary hospitals in China.

Hyaluronic acid is widely used in biomaterials, cosmetics, clinical medicine and other fields due to its good biocompatibility, degradability, hydrophilicity, tumor targeting, viscosity and other characteristics. Pharmacodynamic activities of natural small molecular products which derived from traditional Chinese medicine (TCM) are significant, but their low solubility and poor targeting limit the clinical application. Based on supramolecular properties of hyaluronic acid, in this review, numerous studies were reviewed on the improvement of solubility, bioavailability, targeting and suitable dosage forms of small molecular compounds in TCM by domestic and foreign scholars using hyaluronic acid as carrier. It provides new ideas and inspirations for exploring the potential application value of small molecule compounds in TCM and even for the research and development of new drugs.