| ESRD needs lifelong treatment and causes serious economic burden, which can be treated by renal transplantation and dialysis. Although renal transplantation is quite proficient now, this treatment still is not an optimal option because of the limitation of social ethics, medical insurance system, available kidneys, patient's economic conditions and other factors. At present, the conventional treatment is kidney dialysis, including hemodialysis (HD) and peritoneal dialysis (PD).It has been proved by clinical practice that PD and HD have basically the same effect, but PD is better in cost-effectiveness, quality of life and protecting the residual renal function. However, according to statistics, the conduct of peritoneal dialysis is not ideal, most regions tend to carry out dialysis.The clinical diagnosis and treatment of PD requires strict specifications and technical conditions, clinicians and nurses should provide patients with continuous technical education and guidance before and during treatment. In China, most PD patients are in poor economic conditions, whose compliance is not high and prone to take non-standard operation, which can lead to complications easily. With the time of dialysis and the decline of residual renal function, patients'health condition deteriorates, and quality of life reduces, which results in a high dropout rate. The following up and management training are particularly important in PD patients. Many scholars have been working at the impact of community care on home PD patients, and come to a conclusion that community care is an important part of PD patients. However, the process of PD is long and systematic, it needs the follow-up and training service of community services, and surgery, complications treatment as well as the adjustment of treating program from superior hospitals. How to ensure the treatment process under the premise that all levels hospitals'function can be made full use of and provide patients with continuous, convenient, accessible and standardized services, is worth pondering. In addition, with the increase of ESRD patients, the HD abililty is close to saturation, and most hospitals have to improve its ability by equipping more HD machines. How to develop dialysis ability sustainably in order to meet the growing demand, is a pressing problem.In order to solve the above problems, this study mainly uses on-site surveys and key person interviews to construct the PD service network, determine the function of medical institutions at all levels, and allocate health resources rationaly so as to enhance the accessibility and convenience of PD services.This study carried out an investigation on the status of the two dialysis treatments in 19 medical institutions in Zhejiang Province. Although there is no obvious difference in cost between these two treatments, their rate of carrying out varys greatly, all samples carried out HD, only 10 have PD, the ratio is 52%. What's more, the rate in secondary hospital is even lower, only 22%. Comparing these two kinds of hospitals from the perspective of human and equipment resources, we found that the personnel and equipment of PD-conducted hospitals are in line with the relevant regulations of the Ministry of Health; while the main problem with PD-conducted-not hospital is the lack of related staff training. There is no problem in device as the equipment needed for PD is relatively small and simple.This study also conducted in-depth interviews with dialysis related departments directors, doctors and nurses and analyded factors which could be categorized into four kinds, that are hospital, patient, policy and market, including:lack of PD priority policies, imperfect of patient territorial management model, loss of PD operational processes, irrationality of fee regulations and inadequate of PD compensation policy; short of leadership emphasis, lack of training, site constraints and low activity; the impact of patients'economy, education, ideas and distance as well as transport; high dialysate price and single sizes.In order to make full use of PD and improve its conduction in Zhejiang province, this study combined in-depth interviews with related policy analysis and built a PD medical service network and determined the function of hospitals at all levels on the basis of PD norms.Specifically, based on a complete PD management information system, this network includes hospitals at all levels and there must be at least of one secondary hospital conduct PD. At the same time, the lowest level should be equipped with one nurse or doctor who has already received PD training. Medical institutions of all levels could share patients'information and referral. Two and three-level hospitals should provide one-level hospitals with guidance and training, and one-level hospitals should feedback patients'information to two and three-level hospitals. The upper level hospitals should make timely adjustment or accessment of the treatment.According to PD norms, the whole process is divided into three stages:before hospitalization, surgery and follow-up. Two-level and three-level health institutions should undertake all the work, and mainly provide the service of surgical stage. Besides, three-level hospitals should also focus on research and treatment of complications of PD as well as provide trainting for one or(and) two-level hospitals. One-level institutions are mainly responsible for the work of follow-up phase, complete the follow-up phase service based on their ability, and also give consideration to provide relevant health information, education and guidance before first stage.According to the function and responsibility of all the hospitals, this study aslo determines the health resources needed from the perspective of personnel, material and financial resources.Personnel, one-level hospitals should carry out the work according to their actual situation, and equip with 1-2 doctors or(and) nurses, whose qualification have no specific requirements. The number medical staff in two and three-level hospitals are decided by the number of PD patients. When there are 50 to 75 PD patients, it needs to equip 3 doctors and 2 full-time nurses; and when more than 75, increase related staff according to an appropriate proportion. There is no requirements of their qualification.Materially, one-level hospital can set the training area combined with health education, and equip TV, computer or VCR and treating brochure and other facilities. While two and three-level hospitals should set all the areas and equip all the facilities according to relevant requirements of Health Ministry.Financially, Government should play a leading role and give enough financial support in the building of PD network so as to ensure an smooth construction and operation.In order to better construct the medical network in Zhejiang province, this study suggests the following policy recommendations:develop PD priority policy; enhance the building of PD medical service network, and establish unified training curriculum and materials; construct patient information management system, and execute local management of PD patients; treat the property of PD and HD's charge equally, and define PD charges; improve PD compensation system; support domestic dialysate, and reduce its price to a reasonable level; enhance the prevention and intervention on ESRD in public.
|
PDF Full Text Request