| There is a large population in rural areas of China, and rural health is a key point of the government's responsibility. The rural health service delivery system and medical insurance system have been improved dramatically during past decades, however, comparing with the social economic development and residents' increasing health demands, rural health resources can hardly satisfy rural residents' health needs. The burden of disease is heavy and the phenomenon of "disease-causing poverty" is widespread in a relative large area. Therefore, how to improve the medical skills and medical environments in rural areas so as to make the economical and efficient health technologies accessible to rural residents is the linchpin of solving the current rural health problems.Therefore, the whole society pays more and more attentions to health appropriate technologies provided in rural areas which are local-demand-conforming, safe, effective, affordable, economical, and social moral conforming. In2008, the Ministry of Health issued a document which stated that as a linchpin of developing rural health system, health appropriate technologies should be studied and spread so as to improve the primary care system. In2009, the new health reform plan emphasized that the township health centers, village clinics, community health centers and stations should provide health appropriate technologies.In recent years, many health technologies are created which are added into the list of "one hundred health appropriate technologies for rural areas program". The first step of this program is to select appropriate health technologies for different areas.Demand is a main characteristic of health appropriate technology, and the main standard of selecting and evaluating health appropriate technology, which is also the main factor to affect the spreading. Therefore, if we want to evaluate and select health appropriate technologies for rural areas, the first step is to know the demand in pilot areas, which is the main procedure to control the quality of evaluation. Hence, in our study, first we investigate the rural health demand to provide evidence for evaluation, then we select appropriate evaluating method which is the key to guarantee the correctness of the result.About the evaluation method, first we select the international recognized "Golden Standard"-evidence-based systematic review. Considering the rural medical environment and the characteristics of health appropriate technology in China, it is not applicable to use systematic reviews to evaluate all health appropriate technologies, therefore, we select comprehensive score method, and the index system is based on analytic hierarchy process.The result of further study shows that some of current health appropriate technologies are comprehensive disease prevention and therapy technologies, the main content of which are prevention and therapy network building or health promotion activities, and technical characteristics of them can't be measured, hence, we use qualitative method to evaluate them. In the end, based on consideration of local health demand, we refer to the health technologies evaluation results and make the list of health appropriate technologies which can be spread.The total objective of this study is to find the comprehensive rural health appropriate technologies evaluation method, and make the list of health appropriate technologies which can be spread in each pilot area.The specific objectives are as follows:find the comprehensive rural health appropriate technologies evaluation method; make the list of health appropriate technologies which can be spread in each pilot area; know rural health appropriate technologies evaluation direction and target; form the policy recommendation about rural health appropriate technology related programs. Study MethodsFirst we investigate the rural health appropriate technology demand, then we adopt health technology assessment method to evaluate and select rural health appropriate technologies in China. The field survey sites are Henan province, Ningxia autonomous region, and Shandong province. The study objects are the fifth, sixth and seventh health appropriate technologies in the "one hundred health appropriate technologies for rural areas program" funded by Ministry of Health.[1] Rural health demand surveyConsidering GDP per capita of each province, we select Henan province and Ningxia autonomous region from the17program provinces, and two counties are selected from each province. The baseline materials are provided by our team, and we adopt stratified sampling method to select rural doctors randomly. The survey tools are baseline table and health appropriate technology demand survey table. First we inform hospitals to convene the doctors, then our interviewers interview the doctors at the same sites. The database is constructed using Microsoft Access2003, and descriptive analysis and single factor analysis are conducted with SPSS17.0.To achieve our study objective, we classify the complex diseases according to ICD-10.[2] Evidenced-based systematic reviews of rural health appropriate technologiesIn total,20health appropriate technologies are fit for systematic review. First we confirm the inclusion criteria and exclusion criteria through expert consultation method and paper analysis, then we make the search strategy and evidence quality evaluation standard. We adopt descriptive analysis and Meta analysis to analyze the data. We select indexes, such as sensitivity, specificity, positive and negative predicted value, sROC curve to analyze diagnosed trials by Meta-disc software; and we select weighted means difference, relative risk degree, and OR to analyze intervention trials by RevMan4.2software.[3] Comprehensive Score of rural health appropriate technologiesHenan province, Ningxia autonomous region, and Shandong province are selected by stratified sample method, and two or three counties are selected from each province. Experienced doctors who have worked as a doctor more than five years are chosen and the tools are expert basic information table and health appropriate technology table. The comprehensive evaluation system based on analytic hierarchy process is selected and the index weight is conducted by experts. The health appropriate technologies are classified into six categories:internal medicine, surgery, gynecology and obstetrics, pediatrics, Ophthalmology and otolaryngology, and public health technologies. Each index score of each health appropriate technology is converted from Epidata data form into Visual FoxPro form. We construct the health technology evaluation score dataset and write relevant Visual FoxPro procedures. After each expert did the evaluation of each health appropriate technology, first we conduct consistency test, then calculate comprehensive average score, and make the order in each category in the end.[4] Qualitative interview of rural health appropriate technologyWhen select the experts, we adopt purposive sampling and snowball sampling method. Interview pattern is face-to-face personal deep interview model. The interview content and outline are discussed and confirmed by expert consultation or group discussion in advance. The definite content of interview is analyzed into volume and coded uniformly.Main Study Results:[1] Through the rural health demand survey we grasp the demands of health appropriate technologies in rural.The main health problems in rural are cleared. The technologies evaluated in the study are satisfied with the health demand in rural. They also recommended that the amount and type of public health technologies should be increased, as well as technologies aiming at occupational diseases.[2] Based on rural health demand, considering the economic and actual situations fully in different regions and according to the results of the evaluation, we preliminarily protocol the rural health appropriate technologies to be spread for the17provinces and regions including Henan, Shandong and Ningxia.[3] The comprehensive method for assessment of the appropriate health technologies in rural in China is established. [4] The main results in different methods of assessment of the appropriate health technologiesâ‘ The overall systematic review of the twenty health appropriate technologies involved in the study is not very good. Three technologies can be analyzed by Meta-analysis ultimately. Five technologies can enter the implementing procedure of Meta-analysis and draw conclusions about effectiveness, but they cannot complete all the procedures. Seven technologies can draw partial conclusions, though they cannot enter analyzing procedure of Meta-analysis because of literature searching and literature quality scoring. Five technologies cannot be analyzed for lack of literature support. For the characters of rural health appropriate technologies and the specific requirements of Meta-analysis, we cannot evaluate all the programs merely through Meta-analysis. Therefore we have to seek other evaluation methods to complement and refer.â‘¡From the comprehensive scoring results of different technologies, we can see that there is little difference. between them. Among these six scoring results, internal medicine technologies and surgery technologies are almost the same. Selected health technologies with high scoring will be appropriate for rural basic institutions when they are coherent with the technologies for common diseases in the health demand survey.â‘¢We find from the expert interviews that health technologies aiming at basic common diseases and frequently-occurring diseases can be approved and expected to spread by experts. Those having some problems itself cannot be accepted. Besides, the specific content of technologies need to pay attention to the availability of basic medicines and technologies. In a word, we can learn the relative information about rural health appropriate technologies from many aspects through qualitative interviews. We can also evaluate and select technologies about comprehensive curing strategy and provide reference for the following spread.Conclusions1. Comprehensive health appropriate technologies evaluating and selecting method is appropriate for rural China This study built comprehensive health appropriate technologies evaluating and selecting method based on health demand. This method can adopt different methods to evaluate technologies with different characters and types. It mainly includes evidence-based systematic review, comprehensive scoring method and qualitative interview and these methods complement each other. Proved by practice, the comprehensive evaluating and selecting method is scientific and systematic. It can select really appropriate technologies for rural China.2. Health appropriate technologies in rural China can satisfy the diagnosing and curing of basic common diseases and frequently-occurring diseases substantiallyAs the study results show, the diagnosing and curing technologies of basic common diseases and frequently-occurring diseases in rural China all can be found in the list of technologies to be evaluated. Meanwhile, technologies selected to be spread cover the scope of basic common diseases and frequently-occurring diseases. These indicate that health appropriate technologies in rural China can satisfy the diagnosing and curing of basic common diseases and frequently-occurring diseases substantially at present.3. Weaknesses of health appropriate technologies programs in rural ChinaAccording to rural health demand survey and the systematic review, comprehensive scoring and interview of37health appropriate technologies of western medicine which are included in the second round from group5to7of "one hundred health appropriate technologies for rural areas program" which is used by Ministry of Health to spread health appropriate technologies in rural China, we find that there are some weaknesses in the selecting and spreading processes which are as follows:(1) Some health appropriate technologies have weaknesses themselves(2) Existing technology applying scope need to be clarified(3) Health appropriate technologies cannot satisfy the basic health demand of rural China(4) A portion of health appropriate technologies are not so appropriate to basic medical institutions(5) The government input is relatively insufficientSuggest i ons[1] Emphasize and increase theoretical researches of health appropriate technologies, and improve the quality of literatures on rural health appropriate technologiesEncourage basic medical workers especially the ones at county level to carry out theoretical researches of health appropriate technologies, to conduct clinical observation focusing on specific indicators such as the safety and validity of technologies and write high quality articles. Thus, improve the quality of literatures on health appropriate technologies and provide strong scientific evidences for the evaluation, spread and termination of health technologies.[2] Establish and perfect the formulating standard of rural health appropriate technologiesEstablish the formulating standard of health appropriate technologies and formulate health appropriate technologies applying to rural China. Pay attention to using equipments and medicines available for rural regions as far as possible.[3] Improve the regulation of technology application, add more technologies based on health demandBased on differences of health technology demand and characteristic in different health facilities, we should make lists for county-level hospitals, township health centers and village clinics respectively, which not only can improve the selection system, but also can improve the spread efficiency.At the same time, to satisfy the health demand in rural areas, we should add more technologies in the field of occupational disease, mental disease, and chronic lung infection disease.[4] Government input should be increasedThe governments in each level should provide more resources, such as money, personnel and coordination, to facilitate the spread and application of health appropriate technologies, which can guarantee the effect and efficiency of health appropriate technology application in rural areas in the future.
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