Study On The Necessity Of Specialty Outpatient Service For Hepatitis In The Community Health Service Center In Zhabei District

BackgroundVirus hepatitis is a global infectious disease which brings serious effects not only on individuals,but also families and society.Prevention and control of the virus hepatitis is part of the task of public health services nowadays in China.The specialty outpatient service for hepatitis in the community health service center(CHSC) was set up to provide basic services for virus hepatitis patients by treating and controlling in the earlier stage,but the service in Zhabei district can no longer complement the requirement of its function.ObjectivesThe objective is to investigate the present situation of the specialty outpatient service for hepatitis in the community health service center of Zhabei district,including the utilization of its service,the test capability of the lab,the structure of the medical staff,the virus hepatitis typing condition and the viewpoint of related personnel,to analyze the exist problems and provide elementary information for decision making for hepatitis prevention and control policy and the development strategy of the specialty outpatient service for hepatitis in order to prevent residents from virus hepatitis infection and treat it more effectively.MethodsBoth qualitative analyses and quantitative analyses were used in the survey.Qualitative analyses included routine report data,supplementary investigation and questionnaire survey,analyzed and statistically described by using software Excel2003 and EpiData3.0.Quantitative analyses included focus group discussion and in-depth interview,field interview notes and recording material collection,analyzed by SWOT methods.Main results1.The basic situation in the specialty outpatient service for hepatitis in Zhabei district.1.1 The clinics are not set up in isolated district but the same building with the other clinics and share the same counter of register and charge,medicine distributor and lab test,its observation room and the aisle for medical staff are shared with colon and rectal clinic.1.2 6 of the community health service center have set up hepatitis clinics and provided only one concurrent physician each and one concurrent nurse in 2 of the clinics.Only 2 of the medical staff have middle professional titles.1.3 Only outpatient service can be provided and systematical diagnosis and treatment for hepatitis suspects are unavailable;no inpatient wards for hepatitis suspects so they have to be transported to other hospital;medicine for treatment include only 1 or 2 liver protection medicines.Limitation of health center's condition and functional orientation has restricted its service range and content, limited its development.1.4 Only hepatitis B virus can be tested and needs as long as 10 work days to make out the report.The rate of classify averaged 30%a year in 2004～2007,averaged 32.73%in four years,the left were unclassified.1.5 The total amount of outpatients of the 6 hepatitis clinics in 2004～2007 were 2137 person-time,takes 3.81%of the total amount of hepatitis outpatients of Zhabei district.2.There are problems in the specialty outpatient service for hepatitis in Zhabei district.2.1 The installation of the outpatient service for hepatitis can't achieve the basic sanitary inquiries ordered by The Basic Sanitary Demands for Establishing Clinic of Infectious Diseases by Shanghai Medical Organization.The medical team is lack of qualified personnel. The capability of diagnosis and treatment is weak so it is unavailable to provide systematical diagnosis and treatment for hepatitis suspects. The capability of classified hepatitis etiological assay is weak. Outpatients are few,less than I patient per working day in average.2.2 Lack of policy support and concern.2.3 Low awareness and utilization of the outpatient service.3.There are two different views about the development trend of the specialty outpatient service for hepatitis,of which cancellation is dominant.Conclusions1.Policy support is the foundation and guarantee for the establishment and development of specialty outpatient service for hepatitis in the community health service center.2.The work function and the condition of CHSC are the key factor that decides the hepatitis service's importance and developing state.3.There is a distance between current situation of the hepatitis service and the standardized clinic which can fit patients' needs.4.Medical level of the virus hepatitis treatment is the main element that affects people's choice of medical institutions.5.Most of the concerned people hold the view that the outpatient service for hepatitis in the health center should be cancelled.6.The development of outpatient service for hepatitis in the community health service center will face a lot of challenges.ProposalsOn the basis of steps to improve the understanding,tighten up the management,strengthen the medical system,focus more attention on popularizing the hazard and prevention and controlling knowledge of virus hepatitis,get prepared for the emergency and control of safety measurement and intensify the inoculation work,according to the current situation,problems that existed and the available condition,I propose to cancel the outpatient service for hepatitis in Zhabei district CHSC, redistribute the medical resources and accomplish the connecting and coordinating work.1.Rationally distribute the outpatient service for hepatitis according to geographical regions,take advantages of centralized resources and improve medical procedures after the reshuffle.2.Adjust the focal point of health center's work on hepatitis protection and controlling,cancel diagnosis and treatment items,set up and improve easy transferring regulations and disease tracing records system for hepatitis patients.3.Publish hepatitis relevant information promptly so the patients can be acknowledged and get medical services without delay.