1
|
Fang Y, Jiang S, Jiang P, Zhou H, Yang M. Are Rural Primary Care Providers Able to Competently Manage Common Illnesses? A Cross-Sectional Study in Rural Sichuan, Western China. Healthcare (Basel) 2022; 10:healthcare10091750. [PMID: 36141362 PMCID: PMC9498850 DOI: 10.3390/healthcare10091750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Strengthening primary care is a key focus of the latest healthcare reforms in China. However, many challenges, including the workforce competence, still exist. This study aimed to evaluate the common disease management competency of rural primary care providers in Sichuan Province, western China. Methods: A cross-sectional study was conducted in 9 township health centers and 86 village clinics in 3 counties. Diarrhea and respiratory infection were selected as the evaluation cases. General partitioners were assessed through their abilities to (1) take history; (2) make diagnoses; (3) propose treatment; and (4) deal with clinical cases. Results: In total, 362 healthcare workers were surveyed, and 130 general practitioners were enrolled into our study. On average, rural primary care providers could only answer 46.4% of questions absolutely correctly, with 29.7% partly correctly and 23.8% incorrectly. Conclusion: We suggest strengthening training to improve rural primary care providers’ competencies, especially their capacities of history taking. Policy action is also needed to address regional disparities.
Collapse
Affiliation(s)
- Yian Fang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- School of Public Health, Peking University, Beijing 100191, China
| | - Shaohua Jiang
- The First Affiliated Hospital, Xinjiang Medical University, Urumqi 833054, China
| | - Pei Jiang
- School of Public Health, North Sichuan Medical College, Nanchong 637100, China
| | - Huan Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Min Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- Faculty of Health, Design and Art, Swinburne University of Technology, Melbourne 3122, Australia
- Correspondence:
| |
Collapse
|
2
|
Wu Y, Ye R, Wang Q, Sun C, Meng S, Sylvia S, Zhou H, Friesen D, Rozelle S. Provider competence in hypertension management and challenges of the rural primary healthcare system in Sichuan province, China: a study based on standardized clinical vignettes. BMC Health Serv Res 2022; 22:849. [PMID: 35778732 PMCID: PMC9248120 DOI: 10.1186/s12913-022-08179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/01/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Improving primary care providers' competence is key to detecting and managing hypertension, but evidence to guide this work has been limited, particularly for rural areas. This study aimed to use standardized clinical vignettes to assess the competence of providers and the ability of the primary healthcare system to detect and manage hypertension in rural China. METHODS A multi-stage random sampling method was administered to select target health facilities, providers, and households. The clinical vignette script was developed to evaluate provider competence in managing first-visit patients with symptoms of hypertension. Logistic regression was used to explore the factors correlated with provider competence. Provider referral and management rates were combined with patients' facility sorting behaviors to assess the ability of the rural healthcare system to manage hypertension in three policy scenarios. RESULTS A total of 306 providers and 153 facilities were enrolled in our study. In the 306 clinical vignette interactions, 25.9% of providers followed the national guidelines for hypertension consultation. The correct diagnosis was achieved by only 10.1% of providers, and 30.4% of providers were able to prescribe the correct treatment. Multi-variable regression results showed that younger providers (OR = 0.85, 95%CI: 0.73, 0.98) and those who work in township health centers (OR = 4.47, 95%: 1.07, 18.67) were more likely to provide a correct diagnosis. In a free-selection scenario, 29.8% of patients with hypertension were managed correctly throughout the rural system. When all patients first visit village clinics, system-level correct management is reduced to 20.5% but increases to 45.0% when all patients first visit township health centers. CONCLUSIONS Rural primary care providers do not have enough competence to detect and treat hypertension cases in China to an acceptable degree. Policy constraints may limit the competence of the rural healthcare system. Research to improve detection and treatment competence in hypertension and optimize health policy is needed.
Collapse
Affiliation(s)
- Yuju Wu
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ruixue Ye
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qingzhi Wang
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Chang Sun
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Sha Meng
- Department of Operation Management, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Dimitris Friesen
- Freeman Spogli Institute for International Studies, Stanford University, California, Stanford, USA
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, California, Stanford, USA
| |
Collapse
|
3
|
Jiang S, Lv M, Wu T, Chen W, Zhang J. A smartphone application for remote adjustment of warfarin dose: Development and usability study. Appl Nurs Res 2022; 63:151521. [PMID: 35034699 DOI: 10.1016/j.apnr.2021.151521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/17/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
AIM The aim of this article is (a) to design and develop a smartphone app called Alfalfa that can provide remote dose adjustment (b) to evaluate its usability. BACKGROUND Patients taking warfarin need to spend substantial time, money, and energy frequently visiting the hospital in order to adjust its dose. Internet technology may be able to provide convenient dose adjustment services for these patients. METHODS We thought and discussed repeatedly about how to ensure the safety and effectiveness of remote administration of warfarin, and finally designed and developed the Alfalfa app. In addition, patients and medical practitioners were invited to participate in a system usability scale (SUS) to assess the usability of Alfalfa. RESULTS As of July 5, 2021, the number of Alfalfa accounts was 1736, including 1624 patients and 112 medical staff, and it provided a total of 12,968 remote dose adjustments. A total of 26 people participated in the questionnaire, including 15 patients and 11 medical staff. The results of SUS show that the usability score of patient terminal and medical terminal is 61.8 and 82.7, respectively. And age does not affect the usability of patient terminal. The usability of the Alfalfa app was rated similarly by younger and older adults (63.5 vs. 58.5, P = .535). CONCLUSIONS This study proves that the Alfalfa app can be used for remote management of warfarin. The usability of medical terminal is acceptable to medical practitioners, while the usability of patient terminal needs further improvement. TRIAL REGISTRATION ChiCTR1900021920.
Collapse
Affiliation(s)
- Shaojun Jiang
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China
| | - Meina Lv
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China
| | - Tingting Wu
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China
| | - Wenjun Chen
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China
| | - Jinhua Zhang
- Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou 350001, Fujian, China.
| |
Collapse
|
4
|
Rao S, Xue H, Teuwen DE, Shi H, Yi H. Measurements of quality of village-level care and patients' healthcare-seeking behaviors in rural China. BMC Public Health 2021; 21:1873. [PMID: 34657604 PMCID: PMC8520638 DOI: 10.1186/s12889-021-11946-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Although the progress in global health initiatives has improved the availability of primary health care (PHC), unqualified healthcare remains a serious challenge in low- and middle-income countries, where PHC is often underutilized. This study examines factors associated with patients’ healthcare-seeking behaviors in rural Chin—seeking healthcare at village-level PHC providers, at higher-level health facilities, self-medicating, and refraining from seeking medical help. We focus on provider-side factors, including (1) the unobservable quality indicator, (2) the observable quality indicator, and (3) the observable signal indicator. Methods We analyzed 1578 episodes of healthcare-seeking behaviors of patients with diarrhea or cough/runny nose symptom from surveys conducted in July 2017 and January 2018 in 114 villages of the Yunnan province. We investigated the correlation between quality-related factors with patients’ healthcare-seeking behaviors by multinomial logit regression. Results We found that rural patients were insensitive to the unobservable quality of healthcare providers, as measured by standardized clinical vignettes, which might be attributable to the credence nature of PHC. The observable quality indicator, whether the clinician has received full-time junior college formal medical education, was associated with patients’ healthcare choices. Patients, however, were more likely to select healthcare based on the observable signal indicator, which was measured by the availability of medicines. Additionally, the observable signal indicator had no significant association with two quality indicators. Notably, socioeconomically-disadvantaged patients relied more on the village-level PHC, which emphasized the role of PHC in promoting the welfare of rural populations. Conclusions Our study found an inconsistency between objective quality of healthcare provided by providers and subjective quality perceived by patients. Patients could not identify the actual quality of PHC precisely, while they were more likely to make decisions based on the observable signal indicator. Therefore, the quality of PHC should be more observable to patients. This study not only supplements the literature on healthcare-seeking choices by examining four types of behaviors simultaneously but also clarifies rural patients’ perceptions of the quality of PHC for policy decision-making on increasing the utilization of PHC and improving the medical welfare of the vulnerable. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11946-8.
Collapse
Affiliation(s)
- Sihang Rao
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Room 408B, Wangkezhen Building, No. 5, Yiheyuan Road, Haidian, Beijing, 100871, China
| | - Hao Xue
- Stanford Center on China's Economy and Institutions, Stanford University, California, USA
| | - Dirk E Teuwen
- Medical Sustainability, UCB, Brussels, Belgium.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Haonan Shi
- Business Development Center, Red Cross Society of China, Beijing, China
| | - Hongmei Yi
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Room 408B, Wangkezhen Building, No. 5, Yiheyuan Road, Haidian, Beijing, 100871, China.
| |
Collapse
|
5
|
Fang Y, Zhang F, Zhou C, Chen M. Governance Capability of the Public Health System: A Comparative Analysis of the Control of COVID-19 in the Different Provinces of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4210. [PMID: 33921152 PMCID: PMC8071522 DOI: 10.3390/ijerph18084210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
At the beginning of 2020, the global outbreak of the novel coronavirus COVID-19 posed a huge challenge to the governance capabilities of public health in various countries. In this paper, the SEIR model is used to fit the number of confirmed cases in each province in China, and the reduction rate of the basic reproduction number is used to measure the actual score of the control effect of COVID-19. The potential capacity of prevention and control of epidemics, in theory, is constructed, and we use the difference between theoretical ability and actual score to measure the ability of governance of public health. We found that there were significant differences between actual effect and theoretical ability in various regions, and governance capabilities were an important reason leading to this difference, which was not consistent with the level of economic development. The balance of multiple objectives, the guiding ideology of emphasizing medical treatment over prevention, the fragmentation of the public health system, and the insufficiency of prevention and control ability in primary public health systems seriously affected the government's ability to respond to public health emergencies.
Collapse
Affiliation(s)
- Yingfeng Fang
- School of Economics and Management, Wuhan University, Wuhan 430072, China; (F.Z.); (C.Z.); (M.C.)
| | | | | | | |
Collapse
|
6
|
Jing X, Xu L, Qin W, Zhang J, Lu L, Wang Y, Xia Y, Jiao A, Li Y. The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010369. [PMID: 31935834 PMCID: PMC6981471 DOI: 10.3390/ijerph17010369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022]
Abstract
Objectives: The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. Methods: The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. Results: Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor’s advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines’ reimbursement policy significantly correlated with older adults’ willingness for downward referral. Conclusions: The proportion of older adults who self-initiated downward referral was less than one-third. Doctors’ advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors’ advice.
Collapse
Affiliation(s)
- Xiang Jing
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
- Correspondence: ; Tel.: +86-0531-8838-2648
| | - Wenzhe Qin
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Jiao Zhang
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Lu Lu
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yali Wang
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yu Xia
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - An’an Jiao
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| | - Yaozu Li
- School of Public Health, Shandong University, Jinan 250012, China; (X.J.); (W.Q.); (J.Z.); (L.L.); (Y.W.); (Y.X.); (A.J.); (Y.L.)
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan 250012, China
- Shandong University Center for Health Economics Experiment and Public Policy Research, Jinan 250012, China
| |
Collapse
|
7
|
Bitton A, Fifield J, Ratcliffe H, Karlage A, Wang H, Veillard JH, Schwarz D, Hirschhorn LR. Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017. BMJ Glob Health 2019; 4:e001551. [PMID: 31478028 PMCID: PMC6703296 DOI: 10.1136/bmjgh-2019-001551] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/25/2019] [Accepted: 06/15/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The 2018 Astana Declaration reaffirmed global commitment to primary healthcare (PHC) as a core strategy to achieve universal health coverage. To meet this potential, PHC in low-income and middle-income countries (LMIC) needs to be strengthened, but research is lacking and fragmented. We conducted a scoping review of the recent literature to assess the state of research on PHC in LMIC and understand where future research is most needed. METHODS Guided by the Primary Healthcare Performance Initiative (PHCPI) conceptual framework, we conducted searches of the peer-reviewed literature on PHC in LMIC published between 2010 (the publication year of the last major review of PHC in LMIC) and 2017. We also conducted country-specific searches to understand performance trajectories in 14 high-performing countries identified in the previous review. Evidence highlights and gaps for each topic area of the PHCPI framework were extracted and summarised. RESULTS We retrieved 5219 articles, 207 of which met final inclusion criteria. Many PHC system inputs such as payment and workforce are well-studied. A number of emerging service delivery innovations have early evidence of success but lack evidence for how to scale more broadly. Community-based PHC systems with supportive governmental policies and financing structures (public and private) consistently promote better outcomes and equity. Among the 14 highlighted countries, most maintained or improved progress in the scope of services, quality, access and financial coverage of PHC during the review time period. CONCLUSION Our findings revealed a heterogeneous focus of recent literature, with ample evidence for effective PHC policies, payment and other system inputs. More variability was seen in key areas of service delivery, underscoring a need for greater emphasis on implementation science and intervention testing. Future evaluations are needed on PHC system capacities and orientation toward social accountability, innovation, management and population health in order to achieve the promise of PHC.
Collapse
Affiliation(s)
- Asaf Bitton
- Ariadne Labs, Boston, Massachusetts, USA
- Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | | | - Hong Wang
- The Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Jeremy H Veillard
- World Bank Group, Washington, District of Columbia, USA
- Institute of Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Dan Schwarz
- Ariadne Labs, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Ariadne Labs, Boston, Massachusetts, USA
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
8
|
Kujawski SA, Leslie HH, Prabhakaran D, Singh K, Kruk ME. Reasons for low utilisation of public facilities among households with hypertension: analysis of a population-based survey in India. BMJ Glob Health 2018; 3:e001002. [PMID: 30622745 PMCID: PMC6307571 DOI: 10.1136/bmjgh-2018-001002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 11/04/2022] Open
Abstract
Introduction In India, for most patients, primary healthcare remains the intended entry point for the management of non-communicable disease risk factors. The extent and determinants of non-utilisation of public primary care among households with hypertension are not well examined. We explored health facility utilisation patterns and reasons for non-utilisation of public facilities in 21 states and union territories in India, with a focus on hypertension. Methods We used data from the 2012-2013 District Level Household and Facility Survey. We examined the self-reported usual source of care for all households, households with hypertension and─to understand multimorbidity for those with hypertension─households with hypertension and diabetes. Hypertension was defined by self-reported diagnosis or measurement of systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg. Diabetes was defined by self-reported diagnosis or fasting blood glucose level ≥ 7.0 mmol/L or non-fasting blood glucose level ≥ 11.1 mmol/L. We assessed facility utilisation choice and reasons for non-utilisation of public facilities by household with the presence of hypertension alone and hypertension with diabetes. Results In 336 305 households, 37.6% (N=126 597) had at least one household member with hypertension, while 15.9% (N=53 385) had members with hypertension and diabetes. 20.0% of households sought care at public primary clinics, 29.9% at public hospitals and 48.3% at private facilities. Choice of private facilities increased with the burden of disease. Households with hypertension only and hypertension and diabetes cited quality reasons for non-utilisation of public facilities more than households without hypertension. Conclusion Households, particularly those with hypertension, chose private over public primary facilities for usual care. Quality of care was an important determinant of facility choice in households with hypertension and diabetes. With the increase in hypertension and cardiovascular disease in India, quality of public primary healthcare must be addressed for current policy to become reality.
Collapse
Affiliation(s)
- Stephanie A Kujawski
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India.,London School of Hygiene and Tropical Medicine, London, UK
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, Adeyi O, Barker P, Daelmans B, Doubova SV, English M, García-Elorrio E, Guanais F, Gureje O, Hirschhorn LR, Jiang L, Kelley E, Lemango ET, Liljestrand J, Malata A, Marchant T, Matsoso MP, Meara JG, Mohanan M, Ndiaye Y, Norheim OF, Reddy KS, Rowe AK, Salomon JA, Thapa G, Twum-Danso NAY, Pate M. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health 2018; 6:e1196-e1252. [PMID: 30196093 PMCID: PMC7734391 DOI: 10.1016/s2214-109x(18)30386-3] [Citation(s) in RCA: 1554] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/16/2018] [Accepted: 08/10/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Anna D Gage
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Keely Jordan
- New York University College of Global Public Health, New York, NY, USA
| | | | | | | | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | | | | | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lixin Jiang
- National Centre for Cardiovascular Disease, Beijing, China
| | | | | | | | - Address Malata
- Malawi University of Science and Technology, Limbe, Malawi
| | - Tanya Marchant
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - John G Meara
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Manoj Mohanan
- Duke University Sanford School of Public Policy, Durham, NC, USA
| | - Youssoupha Ndiaye
- Ministry of Health and Social Action of the Republic of Senegal, Dakar, Senegal
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Gagan Thapa
- Legislature Parliament of Nepal, Kathmandu, Nepal
| | | | | |
Collapse
|