| BackgroundThe COVID-19 has exposed the shortcomings of China’s emergency prevention and control strategies and emergency response capabilities in response to public health emergencies.In particular,for the Close County Medical Community(CCMC)in the context of the new healthcare reform,both primary health care(PHC)institutions and the leading hospital of the County Medical Community,as well as the entire regional healthcare service system,need to be further considered and improved,by continuously improving the County Medical Community development,improving operational mechanisms,promoting refined management,accelerating the construction of YGT information integration,and establishing a "prevention-oriented,collaborative The County Medical Community emergency response system,which is "preventionoriented,coordinated and integrated with medical prevention",needs to be further considered and improved.ObjectiveThrough literature and policy analysis,grasp the situation of the CCMC in Shandong Province,health emergency management system,input mechanism and operation mechanism,and understand the current situation of the construction of the CCMC in Shandong Province,emergency response system for public health emergencies.The main factors that restrict the construction of the health emergency response system for the CCMC are identified,and in response to the relevant problems,countermeasures,and mechanism innovations to strengthen the construction of the CCMC in Shandong Province,emergency public health incident management system is explored,drawing on advanced practices from home and abroad.The results of the study are used to provide reference suggestions for the construction of the health emergency response system for the CCMC in Shandong Province.MethodsIn this study,10 Close County Medical Communities in Shandong Province,a total of 10 leading hospitals and 20 PHC institutions,selected by multi-stage stratified sampling,were used to investigate the construction of the emergency management system of the CCMC in Shandong Province in response to public health emergencies,based on literature research and the actual development of the CCMC in Shandong Province,using a questionnaire survey.A chi-square test was used to compare the differences in the effectiveness of the emergency response system for public health emergencies among the CCMC with different characteristics of health care institutions.Binary logistic regression analysis was used to explore the factors influencing the effectiveness of the emergency response system in CCMC.All the data analysis were completed with SPSS 26.0 and the statistical significance was set at p≤0.05.A semistructured in-depth interview was also used to understand the problems of the health emergency management of the CCMC in Shandong Province in response to public health emergencies.Results(1)The emergency institutional system of the CCMC needs to be improved.There are 12(40%)level 2 and above hospitals,13(43.3%)level 1 hospitals and 5(16.7%)unrated hospitals.Only four lead hospitals and five PHC institutions have independently set up health emergency departments/departments with separate office space.The rest had designated one/multiple departments to take up the day-to-day management and coordination of health emergency management on a part-time basis.(2)The CCMC has a significant shortage of health emergency manpower,with low education levels and an unreasonable structure of titles,and a lack of emergency management professionals as well as preventive medicine professionals.The percentage of emergency personnel with bachelor’s degree in the 10 leading hospitals is 63.31%,with 22.21%with specialist degree or less,13.99%with postgraduate degree and only 0.49%with doctoral degree.10 leading hospitals have mainly intermediate and junior titles,accounting for 51.17%and 20.37%respectively,while 16.56%have associate senior titles and only 5.40%have full senior titles.The proportion of emergency personnel in preventive medicine in the 10 leading hospitals was only 1.59%,while the proportion of non-preventive medicine related personnel was 89.82%and the proportion of non-medical professionals was 8.59%.The proportion of emergency personnel in primary health care institutions of the 10 medical communities with specialist or less education was 62.86%,36.79%with bachelor’s degree,only 0.36%with postgraduate degree,26.43%with intermediate title,40.00%with junior title and 27.50%with no title;the proportion of senior title was only 6.07%.The proportion of preventive medicine professionals was only 6.07%,and the proportion of nonpreventive medicine medical-related personnel was 93.93%.(3)The County Medical Community has a reasonable stockpile of health emergency supplies but insufficient funding.Only one leading hospital,has included health emergency funding and health emergency reserves in its annual budget.The other nine leading hospitals do not have a dedicated health emergency-related budget.This means that in the event of a public health emergency,the County Medical Community will face enormous financial pressure and it will be difficult for the County Medical Community to carry out its work on early warning,monitoring,training,drills,and stockpiling emergency supplies.(4)The construction of information technology for health emergencies in county health care communities is still a top priority.The problem of "information" is the low utilization rate of remote treatment during epidemics and the low utilization rate of information technology for reporting epidemics in county-level medical communities.In most areas,the foundation of information technology is still weak;the integration of information in health care communities has not yet been established,and the information systems of primary health care institutions,infectious disease hospitals and leading hospitals have different models of hospital information systems,as well as different models of information systems with the Centre for Disease Control and Prevention.(5)The development of health emergency plans at the grassroots level of the County Medical Community needs to be improved.PHC institutions plans for public health emergencies need to be improved and technical solutions need to be sound.The township hospital generally follows the lead hospital at the county level in developing public health emergency plans,but they are often formal and not closely linked to the hospital and CDC,which may make it difficult to respond in the first instance in the event of a major public health emergency.(6)The County Medical Community training drills for public health emergencies need to be optimized.Most the County Medical Communities already conduct relevant emergency training and drills on a monthly or weekly basis as required by their supervisors,and have achieved specialization of staff skills and improved efficiency.However,such training does not allow every medical staff to be upgraded,and there are many shortcomings as well as poor results in the training of some institutions,with problems such as single forms of drills,following scripts and poorly organized drills.In addition,due to the lack of funds for emergency training and drills,the organization of personnel and the actual results are not satisfactory.The number of drills is only organized in accordance with the minimum requirements of the higher authorities,and there is a phenomenon of formality.Conclusions and RecommendationsThis study found that the emergency management of public health emergencies in the 10 Close County Medical Communities in Shandong Province surveyed was generally good.the construction of all types of systems in the leading hospital and PHC institutions was relatively sound.However,there are still problems in the CCMC’s emergency management in Shandong Province such as insufficient manpower and poor quality of personnel,inadequate information construction,shortage of funds,site constraints,inadequate stockpiling of emergency materials,problems with the division of labor,consultation,articulation,and standardization of linkages in the field of emergency management work between departments and lack of collaboration with other hospitals and institutions.Based on the above findings and conclusions,the following recommendations are made:Firstly,strengthen the construction of emergency teams and promote the development of professional talents;Secondly,do a good job of stockpiling materials and funds and equipping emergency equipment to improve logistical support capabilities;Thirdly,continue to strengthen the construction of the CCMC’s integrated information system;Fourthly,pay attention to optimizing emergency training and drills to improve the quality of health emergency Thirdly,continue to strengthen the construction of the government’s integrated information system. |
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