Study On Both Training Promotion Effects And Influencing Factors Of Appropriate Techniques Of Traditional Chinese Medicine In Gansu Rural Areas

Objectives Evaluate the training effects and influencing factors of Appropriate Techniques of Traditional Chinese Medicine(ATTCM)in two counties of Gansu province.To study extension effects and model of ATTCM.This research can supply scientific evidences for further extension of ATTCM.Methods(1)Training way:To train the doctors by the way of gathered-trainlng pattern in Lanzhou city;(2)Evaluation on training effects:①objective evaluation:We used the cognition rates and average scores as the evaluation indexes.②subjective evaluation: Investigate subjective cognition and the satisfaction degree of the objects(3)Analysis of influencing factors:①factors of the trainees:analyze trainees' titles,education backgrounds,hospital grades,majors:②factors of the teachers:Analyze Teacher's Tile and source.(4)cost-effectiveness analysis:①cost accounting(C):Calculated Total Cost of training and divided it into direct and indirect cost.②measurement of effects (E):we used the cognitive effect(increase of cognition),average scores(increase of scores)and satisfaction effects(satisfaction degree)as the three evaluation indexes.③cost-effectiveness analysis:Cost-effectiveness ratio(C/E)and incremental cost-effectiveness ratio were analyzed to compare inputs with outputs of training.(5) promotion effects evaluation:Investigate service condition,efficacy of ATTCM,and explore hindering factors in promotion of ATTCM.Results(1)Training effects:①objective effects.Cognition rates:cognition rates of trainees towards 11 Chinese medicine techniques in pre-training,post-lecture and post-interaction are 40.08%,71.71%and 73.83%,respectively,and it has been improved by 33.75%.There was significant difference among them(χ2=5.86,P＜0.05). Average scores:Average scores of trainees at three training periods were 17.33,65.42,and 68.10,respectively,and it has been improved by 2.93 times,There was significant difference among them(F=508.80,P＜0.01).②subjective effects.Demand rate,grasp rate and retaining demand rate among trainees all had statistical significance.Demand rate was 80.43%-100.00%,grasp rate was 84.78%-100.00%, and demand rate of retaining was 23.08%-48.08%.trainees have statistical significance in The cognition of learning difficulty of techniques(Hc=46.15,P＜0.01). 8.05%,57.49%and 34.46%trainees thought it was difficult,medium and easy, respectively.They also have statistical significance in satisfaction degree of interaction reinforcement of each stages(Hc=74.25,P＜0.01).The satisfaction degree of interaction reinforcement was 97.83%-100%.(2)Influencing factors about training effects.①trainees' factors:trainees who have different educational backgrounds had significant difference in scores(F=5.79,P＜0.01),trainees with secondary technical and lower education had lowest scores.There had Correlation between trainees' grade of hospital and demand rates(τ=0.156,P＜0.01),The higher trainees' grade were,the greater the demand rates of appropriate techniques were,and vice versa.Trainees with different grade of hospital had significant difference in cognition of learning difficulty of techniques,The higher trainees' grade were,the lower the difficulty was(P＜0.01). Trainees with different grades of hospital had significant difference in satisfaction degree of teaching(P＜0.05),the satisfaction degree of counties higher than towns'(P＜0.01).Trainees with different titles(τ=-0.085,P＜0.05),education(τ=-0.016,P＜0.01), hospital's grades(τ=-0.020,P＜0.01)and major(Hc=12.512,P＜0.01)had significant difference in demand of retraining,The lower trainees' titles,education and grade were,the greater the demand rates were.Trainees with different major had significant difference in grasp rates(Hc=22.063,P＜0.01).②teachers' factors.Title:there wasn't significant difference in the satisfaction degree among trainees(τ=0.072,P＞0.05). 92.02%or 2.97%trainees satisfied or dissatisfied with teaching.Source:Trainees had higher satisfaction with experts who have hold techniques(87.84%)than local experts (12.16%).(3)cost-effectiveness analysis.Cost accounting:total,direct and indirect cost were 225703.28,169454.48,56248.80 yuans,respectively,total,direct and indirect cost single techniques were 367.47—450.44,260.68—343.75,68.30—115.22 yuans.②measurement of effects:cognitive effects of single techniques were 9.43%—52.00%;average scores of single techniques were 11.43—74.54,satisfactionof single techniques were 80.76%—100%.③cost-effectiveness ratio:cost-effectiveness ratio of cognition of the single techniques were 7.22—38.97,cost-effectiveness ratio of scores of the single techniques were 5.23—32.15,cost-effectiveness ratio of satisfaction of the single techniques were 80.76—100.Cost-effectiveness ratio and incremental cost-effectiveness ratio of scores of the chinese medicine techniques are 35.20 and 54.67,respectively,(4)promotion effects evaluation:The usage rate and the effective rate of single techniques had significant difference.The usage rate and the effective rate of chinese medicine techniques were 11.11%—44.90 and 87.64%—95.97% respectively.Conclusions(1)The training and promotion of Chinese medicine appropriate technology in Gansu had achieved better effect.(2)training effects were influenced by trainees' factors(title,education,level of hospitals and major,)and teacher' title and source.(3)training method was a important influencing factors of cost-effectiveness analysis.We should choose economical and effective training method according to technical characteristic,funds,and so on.(4)No supported product and lack of patients were the major reason of techniques not been used.Shortage of funding and no hardware and software conditions were main hindering factors of promotion of Chinese medicine techniques.(5)background determined model,model dominated mechanism,and mechanism promote extention..Promotion of Chinese medicine techniques in our province were suitable for government-supported model...