Effect of healthcare system reforms on job satisfaction among village clinic doctors in China

Background Village clinic doctors (VCDs) are part of the health service force in rural China. VCDs’ job satisfaction (JS) is important to the stability of the three-tiered health service system. Since 2009, the Chinese government launched a new health care system reform (NHCSR) which affected VCDs significantly. This study aimed to analysing the effect of NHCSR on JS among VCDs. Methods All the data came from three surveys in Shandong Province conducted in 2012, 2015 and 2018. In 2012, an originally designed questionnaire was used to conduct a baseline survey of 405 VCDs from 27 townships in nine counties. In 2015 and 2018, 519 and 223 VCDs in the same counties were surveyed with the same questionnaire. Descriptive analysis and ANOVA were used to analyse the level and changes in VCDs’ JS. Results The mean scores of VCDs’ total JS were 2.664 ± 1.069, 3.121 ± 0.931 and 2.676 ± 1.044 in 2012, 2015 and 2018, respectively, with a significant difference (F = 28.732, P < 0.001). The mean scores of the medical practice environment and the job itself showed a continuous downward trend. The trends of the mean scores for job reward, internal work environment and organizational management were consistent with the trend for total JS. Conclusion The NHCSR had a partly negative impact on VCDs’ JS. Policy-makers should pay more attention to VCDs’ job reward and medical practice environment. With the implementation of new reform policies, VCDs’ JS should be the subject of more systematic and detailed research.

Changes in the Job Satisfaction of Village Clinic Doctors Since the New Health Care System Reform: A Comparison Based on Three Surveys in Shandong, China

Background: In 2009, the Chinese government launched a new health care system reform. One of the important aims of the reform was to improve the capacity of primary health institutions. Village clinic doctors are part of the health service force rooted in rural China and the basis of the three-tiered health service system. The job satisfaction of village clinic doctors has an important impact on the stability and sustainable development of the three-tiered health service system. This study aimed to analyse the changes in village clinic doctors' job satisfaction after the implementation of the new health care system reform.Methods:All the data came from three surveys of village clinic doctors in Shandong Province conducted in 2012, 2015 and 2018. In 2012, an originally designed questionnaire was used to conduct a baseline survey of 405 village clinic doctors from 27 townships in 9 counties (the response rate was 92.9%). In 2015 and 2018, 519 and 223 village clinic doctors in the same counties were surveyed with the same questionnaire (the response rates were 94.3% and 92.9%, respectively). Descriptive analysis, χ2 test and ANOVA were used to analyse the level of and changes in village clinic doctors' job satisfaction.Results: The mean scores of village clinic doctors' total job satisfaction were 2.664 ± 1.069, 3.121 ± 0.931 and 2.676 ± 1.044 in 2012, 2015 and 2018, respectively, with a significant difference (F = 28.732, P < 0.001). The mean scores of the medical practice environment and the job itself showed a continuous downward trend. The change trends of the mean scores for job reward, internal work environment and organizational management were consistent with the trend for total job satisfaction.Conclusion: After the implementation of the NHCSR, the job satisfaction of village clinic doctors showed a trend of first rising and then falling. To improve primary health care service capacity, the Chinese government has implemented a series of new reform policies. With their ongoing implementation, village clinic doctors' job satisfaction should be the subject of more systematic and detailed research.

2016. Antibiotic Misuse of Rural Residents and Pilot Project of Antibiotic Take-Back Program

Background Self-medication with antibiotics (SMA) is a major form of antibiotic misuse behaviors contributing to increasing antimicrobial resistance (AMR). The main source of SMA usually comes from in-home leftover antibiotics which usually disposed as household waste without classification. Therefore, an antibiotic take-back program (ATBP) is urgently needed. Methods A pilot ATBP was launched in Liantang Village, Zhejiang Province from January to March, 2019. A total of 50 households were randomly selected for the baseline survey. A questionnaire was used to investigate their knowledge and antibiotic use behaviors. Health education leaflets and posters were distributed to each household. A village Wechat group was set up for health communication. Residents were encouraged to hand over those unused or expired antibiotics at home to the village clinic to redeem a commodity. The pilot ATBP was implemented for 30 days. The type, name, and amount of antibiotics were collected as after intervention data. Results All of 50 households finished the questionnaire. Although 27 (52.9%) agreed that keeping antibiotics at home would potentially increase risk of SMA, there were still 32 (64.0%) residents reported that they kept antibiotics at home and 25 (49%) residents indicated that their leftover antibiotics usually disposed as household waste. After the 30-day intervention, 10 (20.0%) households handed their in-home antibiotics or medicine to the village clinic. In total, 32 boxes of medicine including 17 (53.1%) boxes of antibiotics were recycled. All of 32 boxes of medicine could be classified into 19 specific types, of which there were 8 (42.1%) types of antibiotics, belonging to four broad categories: Cephalosporins, Penicillins, Macrolides, and Nitroimidazoles. In addition, there were also antifungal drug, antiviral agent, anti-inflammatory drug, and paracetamol tablets handed over by the villagers as antibiotics. Conclusion Using leaflets and social media to promote health education can reduce the risk of keeping antibiotics at home. Rural residents could not identify commonly used antibiotics even after health education. To conduct a broader intervention to recycle antibiotics, further study needs to focus on improving the antibiotic identification among the rural residents. Disclosures All authors: No reported disclosures.