The People’s Armed Police Force Grassroots Officers And Soldiers’ Health Services Study

Background:As Chinese military conscription reforming, conscripts service period shortened, recruiting time and training time turned to summer fall while it was in winter before, sergeants’ number and percentage have changed, special enrollees from university graduates increasing, the officers and soldiers’ cultural level has generally improved, health education for recruits is more popular than before. All the changes above have direct influence on health services demand and utilization of grassroots officers and soldiers.Purpose:Squadron is our respondents’ unit of living, it is always inconvenient for some of the grassroots officers and soldiers to visit military health organization, grass-roots health services accessibility is not ideal. With the help of “officers and soldiers health questionnaire”, this study investigated the grassroots officers and soldiers’ current health status, health services need and utilization, the preferred organization to seek treatment and satisfaction, also including opinions and suggestions to the grassroots health work. Through the datum we can know if current health services can generally meet the needs of the grassroots officers and soldiers, then analyze the existing problems and possible influencing factors further, finally all these datum will help the superior leadership be more reasonable and efficient to allocation health resource, to build compatible health services system which can meet officers and soldiers’ growing demand, to provide reference in relevant policies formulation.Methods:Referring to the national health services survey content, combining the realities of the People’s Armed Police Force(PAPF), we designed "officers and soldiers’ health questionnaire", with which we carried on pilot survey on 8 training teams in a university of PAPF and 2 grassroots squadrons firstly. Then the questionnaire was completed after analyzing feedback opinion and suggestion carefully. At the same time, we calculated the survey sample size according to the results of the preliminary investigation. In the end, we extracted one contingent’s three detachments as sample applying the method of multistage stratified cluster random sampling. Then formal investigation was conducted with military doctors’ help.Investigation process, called for the squadron as the unit, with squadron leader’s support researchers explain the research purpose and requirements, ask the officers and soldiers to fill in the questionnaire truthfully. Questionnaire’s main content includes: basic information, sick or injury, sick in hospital and other health condition, etc. Main indicators involves: two weeks prevalence, two-week medical consultation rate, two weeks patients medical consultation rate, two weeks patients not medical consultation rate, severity of illness, two weeks sick days, prevalence of chronic diseases, hospitalization rate, average hospitalization days, should but failed to be hospitalized rates, etc. Diseases listed based on the fourth national health services survey disease classification.Results:1 A total of 37 grassroots squadrons or 1881 people were investigated according to this survey, 26 squadrons stations in downtown, 11 squadron quarters in the suburbs. 16 guard squadrons, 3 escort guard squadrons, 13 motor squadrons, 5 patrol squadrons. All sponsors are male, unmarried(95.2%), 15-24 year-olds 94.9%, 25-34 age group 5.1%, the age structure of the population surveyed presents skewed distribution, M(R)=20(3). Cultural degree, the junior middle school and the following accounted for 18.5% of 339 people, 737 people accounted for 40.3% of high school, vocational school, technical secondary school and or 405 people accounted for 22.2%, specialized subject and undergraduate course at the university of 348 people accounted for 19%. 1 year of 776 people(42.4%), 2 years of 600 people(32.8%), 1 noncommissioned officers, 323(17.7%), 2 and noncommissioned officers above 102 people accounted for 5.5%, cadres 72 people accounted for 4.0%. Officers and men of origin from high to low in turn to Hubei, Hebei, Heilongjiang, Tianjin, Jiangsu, Inner Mongolia, Liaoning, Jilin, Henan, Shandong, etc., accounted for 95%, other in Anhui, Zhejiang, etc.2 two-week prevalence rate among this survey is 26.2%, which is higher than 15 to 34 years old group’s 6.2%(χ2=729.184,P<0.05) in the fourth national health services survey. The result above shows that the health services needs of PAPF grassroots officers and soldiers is high. The most common diseases are dislocation, sprain and strain, other motor system disease(such as tendonitis, synovitis, plantar fasciitis, etc.), acute nasopharyngitis(cold) and other skin and subcutaneous tissue disease, exposed blood vessel damage, etc. The cumulative incidence accounted for 60.0% of the common diseases; The top five disease system from high to low are musculoskeletal connective tissue disease, injury, respiratory disease, digestive disease, and the skin and subcutaneous tissue disease. Not serious and common accounted for 90% who evaluate the disease. The severity of illness in respondents was not serious overall.Soft tissue injuries(75.4%) and joint injury(20.2%) constitute majority of training polytrauma, which reminded us that grassroots training should pay more attention to the protection of soft tissue and joint, it is particularly important to warm-up before training activities, it is better to sweat slightly and last to 30 minutes as far as possible. More light Less terrible to evaluate injury, many officers and soldiers still training ignore injury, 84.3% of the officers and soldiers have not absent training while injury.3 The prevalence of chronic diseases among the survey population is 6.4%, which is higher than the 15 to 34 years old group of men’s 3.5%(χ2=6.810,P<0.05) in the fourth national health services survey. Chronic diseases with the highest prevalence rates are musculoskeletal connective tissue diseases, skin and subcutaneous tissue diseases, injuries and digestive system diseases and circulatory system diseases, other motor system disease, intervertebral disc disease, skin and subcutaneous tissue disease, dislocation, sprain and strain, dental problems, other oral disease are the most important health problems in the officers and soldiers at present.4 The two-week medical consultation rate is 13.9%, higher than the fourth national health services survey’s 5.4%(χ2=244.782,P<0.05) in men’s 15 to 34 years old group. Twice medical consultation rate was 4.1%, repeatedly medical consultation rate was 1.5%, the average medical consultation time is 1.73. The result above shows that the health services demand of PAPF grassroots officers and soldiers is high. Respondents select detachment health team(22.7%), contingent hospital, squadron clinic(18.4%) and local hospital(18.4%) to acquire health services. According to officers and soldiers’ opinions, it is the focus of improving the officers and soldiers medical conditions to strengthen squadron clinic’s capability of diagnosis and treatment, increase drugs and devices of detachment health team, improve contingent hospital’s service quality, and intensify the local medical policy and funding support.5 The hospitalization rate in this survey is 7.4%, which is slightly higher than the fourth national health services survey’s 5.7%(χ2=9.056,P<0.05) in urban areas. The average days of hospitalized patients(M) was 10 days, which is slightly lower than the national survey’s 11.8. The top five hospitalized diseases are pneumonia, fracture, acute nasopharyngitis(cold), appendicitis, acute pharynx and throat, and upper respiratory tract infection. Because of the grassroots units not allow soldiers to stay in bed during day, there will be someone in diseases such as upper respiratory tract infection stay in hospital to get sufficient rest. The top three disease system in hospital are respiratory system diseases, musculoskeletal connective tissue disease and digestive system disease, which accounted for more than 80% of disease system. There are 27.7% of patients(46 person-time) should be hospitalized but failed to. The main reasons for their not being hospitalized: “believe they don’t need to”, “leave off hard” and “big workload lead to have no time”.Conclusions:1Because of free medical care policy, it is convenient to see a doctor for someone who living in detachment(regiment). The health services need of PAPF grass-roots officers and soldiers is high, the severity of diseases is low, the prevention of military training multiple injury or illness is still the current focus of forces health work.2 Because of huge tasks and the large volume training, PAPF grass-roots officers and soldiers show high utilization status on the health services; it is the focus of improving the officers and soldiers medical conditions to strengthen squadron clinic’s capability of diagnosis and treatment, increase drugs and devices of detachment health team, improve contingent hospital’s services quality, and intensify the local medical policy and funding support.Advices:1 Strengthen the construction of detachment health team; reduce its medical scope scientifically.Due to the grassroots health teams take the tasks such as health prevention, health care and medicine supply management, service the grassroots squadrons regularly, maintain and enhance people’s health, it is suggested to strengthen the construction of health teams, especially for areas with poor medical resources, it is advised to improve the doctor’s wages, expand formation and equipment, increase the number of senior titles, retain experienced doctors. In the meantime, contingent hospital should strengthen the technical support to health team, increase health soldiers training; not only service officers and soldiers, but also service resident citizens, so as to improve and maintain medical ability, to realize the purpose of the PAPF serve the people. It is appropriate to reduce the treatment range when health teams are difficult to deal with some illness or injuries, then speed up the medical evacuation, make full use of other local high-quality health resources to maintain men’s health.2 Expanding scope of social medical insurance, explore new medical insurance mode.Due to the squadron is small, scattered, remote, with the help of local developed medical service network, it is to further expand the scope of social medical security, and carry out new security model, such as the PAPF medical insurance. It is advised to adopt Sichuan,Qinghai contingent’s practice of social medical insurance model, which integrated the whole squadrons into the local medical insurance, all or part of medical insurance funds rely on the local government subsidies, as rise as clear. It can even bring in commercial health insurance system as an effective supplementary way to higher health requirement, by the way reduce officers and soldiers’ burden.3 Strengthen health education and propaganda, stimulate rational doctor consultation.Strengthen the propaganda education of rational and scientific doctor consultation, boosting reasonable utilization of health resources, and it is necessary to avoid the phenomenon of health resources abuse meantime, grass-roots officers and soldiers should distinguish disease and injury to get the health service, then the health forces should make sure officers and soldiers can get timely treatment after injury. The ultimate objective is to improve the cure rate, reduce the disability and mortality.