Analysis of the Influencing Factors for Tiered Medical Service in Dog-bite Clinic of Dujiangyan City_West China Medical Journal

Authors：

 YangDingjun ^1,2 ,  CaoYu ¹ , FuLezhang ² , YangXiaoyan ²

1. West China School of Medicine/Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Emergency Department, Dujiangyan People's Hospital, Dujiangyan, Sichuan 611830, P. R. China;

Corresponding?author：

CaoYu, Email: yuyuer@126.com

Keywords：

Dog-bite clinic; Tiered medical service; Comprehensive hospital

DOI：

10.7507/1002-0179.201600551

Video：

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Objective To explore the possible factors which can influence the tiered medication situation in dog-bite clinic in comprehensive hospitals and village (community) health service centers, in order to provide references for the standardization of the diagnosis and treatment for dog-bite exposed patients. Methods We conducted a retrospective observational study, searched the database of Dujiangyan Center for Disease Control and Prevention, and collected all the information of dog-bite patients administrated by village (community) health service center or hospital from January 2012 to December 2015.Then we investigated the patients' satisfaction and clinical workers' familiarity of dog-bite injury treatment protocols by questionnaires in March 2016.The data were analyzed with statistical description and chi-square test, to explore the possible factors which might influence the tiered medication situation for patients exposed to dog bite in Dujiangyan city. Results There was one comprehensive hospital and 27 township (community) health centers included in this study.During the study period, the total number and proportion of dog-bite injury patients admitted in the comprehensive hospital decreased year by year, especially for the number of grade-two dog-bite exposure patients.One the contrary, the total number and proportion of patients administrated by township (community) health service centers increased year by year, especially for the number (proportion) of grade-two and grade-three dog-bite exposure patients, which increased to 1 944(44.10%) and 1 248(28.31%), respectively.The results also showed that there were significant differences between the comprehensive hospital and township health centers in the satisfaction and familiarity investigation (P < 0.05). Conclusions Township and village (community) health service centers are treating many more patients than the comprehensive hospital, but with a lower satisfaction rate.The distribution of dog-bite exposure patients visiting different degrees of hospitals are generally consistent with tiered medication policy.However, township and village (community) health service centers are recommended to strengthen the staff training about how to deal with dog-bite injuries standardly in order to improve patients' satisfaction.

Citation： YangDingjun, CaoYu, FuLezhang, YangXiaoyan. Analysis of the Influencing Factors for Tiered Medical Service in Dog-bite Clinic of Dujiangyan City. West China Medical Journal, 2016, 31(12): 2013-2016. doi: 10.7507/1002-0179.201600551 Copy

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1. WHO. WHO expert consultation on rabies[J]. World Health Organ Tech Rep Ser, 2005, 931:1-88, back cover.
2. 楊紹基, 任紅.傳染病學[M]. 7版.北京:人民衛生出版社, 2008:109.
3. Jibat T, Hogeveen H, Mourits MC. Review on dog rabies vaccination coverage in Africa:a question of dog accessibility or cost recovery?[J]. PLoS Negl Trop Dis, 2015, 9(2):e0003447.
4. Lewis KT, Stiles M. Management of cat and dog bites[J]. Am Fam Physician, 1995, 52(2):479-485, 489-490.
5. 楊鼎君, 付樂章, 代蓉.我國犬傷門診的設置和運行情況[J].健康必讀:中旬刊, 2013, 12(8):29-30.
6. 夏咸柱, 俞永新, 侯云德, 等.加強我國狂犬病防控[J].中國病毒病雜志, 2011, 1(3):161-162.
7. World Health Organization. WHO hosts milestone international conference to target global elimination of dog-mediated human rabies[EB/OL].[2016-06-06]. http://www.who.int/rabies/international_conference_dog_mediated_human_rabies/en/.
8. 王軍.狂犬病暴露預防處置工作規范[J].中國工作犬業, 2010(2):60-61.
9. 岳勇, 奚川, 張亞蘭, 等. 2010年成都市居民犬傷規范處置情況調查[J].寄生蟲病與感染性疾病, 2013, 11(3):133-137.
10. 李師耿, 羅培培, 涂旭升. 2015年廣州地區部分犬傷暴露病例的回顧性分析[J].中國現代藥物應用, 2016, 10(9):290-291.
11. 徐濤, 李彥, 宋瑛, 等. 2009年四川省疾病預防控制中心犬傷門診病例流行病學調查[J].預防醫學情報雜志, 2010, 26(6):474-476.
12. Giesen A, Gniel D, Malerczyk C. 30 Years of rabies vaccination with Rabipur:a summary of clinical data and global experience[J]. Expert Rev Vaccines, 2015, 14(3):351-367.
13. 尹和平, 霍建國.狂犬病暴露者狂犬病疫苗免疫失敗的原因分析[J].瀘州醫學院學報, 1996, 19(6):411-413.
14. Ellis R, Ellis C. Dog and cat bites[J]. Am Fam Physician, 2014, 90(4):239-243.
15. 李靖, 羊海濤, 孟繁岳, 等.強化狂犬病暴露處置門診健康教育的必要性與可行性[J].職業與健康, 2012, 28(19):2312-2315.
16. Crowcroft NS, Thampi N. The prevention and management of rabies[J]. BMJ, 2015, 350(14):g7827.
17. Millien MF, Pierre-Louis JB, Wallace R. Control of dog mediated human rabies in Haiti:no time to spare[J]. PLoS Negl Trop Dis, 2015, 9(6):e0003806.
18. 李騰輝, 石應康.提高醫院門診服務魅力質量的對策研究[J].華西醫學, 2015, 30(7):1334-1336.
19. 歐志梅, 楊梅, 李志春, 等.成都市主城區犬傷門診977名服務對象滿意度調查[J].現代預防醫學, 2013, 40(1):82-85.
20. 鄭志方, 朱乃庚, 張青黃, 等.蚌埠市某三級醫院患者滿意度影響因素調查分析及對策研究[J].中華全科醫學, 2012, 10(2):274-275.

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Analysis of the Influencing Factors for Tiered Medical Service in Dog-bite Clinic of Dujiangyan City

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